'Six Indian firms working on Corona vaccine trial with foreign partners'

In an exclusive interview, Union Health Minister Harsh Vardhan tells Dhirendra Kumar that there are eight candidate vaccines in clinical evaluation and another 102 candidate vaccines in preclinical evaluation. Excerpts:

We are entering into the fourth phase of the national lockdown. How it helped in containing the spread of coronavirus?

I will say that the nationwide lockdown has been a great success in containing the spread of the COVID-19. As the number of cases and deaths are concerned, India is in a very good position in comparison to other countries, including western nations. There is evidence that case doubling rate and the outbreak growth rate have significantly improved and are showing good results.

In the absence of availability of specific treatment and vaccine, it becomes very difficult to contain the outbreak but social and physical distancing measures of complete lockdown have proved to be a 'social vaccine', beneficial in slowing the chain of transmission, thus, restricting the spread of disease.

It's well known that these measures have an impact on other social factors in addition to health but we prioritised the lives of our people as topmost at this juncture. Lockdown and social distancing when supported with public health measures like case detection, contact tracing, isolation and management of cases is helping in containing the disease significantly.

How do you see the role of doctors and healthcare workers in the fight against the virus? Please give your views on the poor strength of doctors in the country.

Our doctors and healthcare workers are warriors at the forefront in the fight against COVID-19. Their efforts, spirit, and dedication are unmatched and are being lauded by everyone. The passion to serve humanity beyond self and family among healthcare professionals have kept them in an exclusive position.

Doctors are the real corona warriors who are leading this battle from the front without bothering about self and their family.

We are providing our doctors and healthcare workers all the support they need to do their duty safely and we have brought out an Epidemic Disease (Amendment) Ordinance 2020 for giving adequate protection to doctors and members of healthcare service. Offences under the ordinance have been made cognisable and non-bailable, with the punishment of imprisonment for a term of six months to seven years and with a fine up to Rs 5 lakh.

Our Prime Minister Narendra Modi had himself appealed on March 22 to respect them, admire their work during the time of national crisis. The nation's heartfelt gratitude goes out to each and every member of the medical profession. My message to the community is simple – "the nation shall never forget your sacrifice". We are grateful to not just doctors and healthcare workers, but their families as well.

As regards to the shortage of doctors, there is no dearth of health professions as of now. Doctors of railways department, ESIC, defence and other public sector establishment have joined hands and are actively participating in the COVID-19 control activities. Besides, several professional bodies like Indian Medical Association (IMA) and associations of nurses are also involved in this mammoth task of coronavirus containment.

Ayush practitioners and doctors in other alternate systems are assisting in the control activities regularly. In addition, we are recruiting medical practitioners on a contract basis, weighing in on extending services of retiring and retired doctors. We have also roped in private hospitals and doctors for the purpose.

What initiatives have been taken by the government in the direction of vaccine development?

Physicians, funders and manufacturers have come together as part of an international collaboration, coordinated by the WHO to help speed the availability of a vaccine against COVID-19. The WHO has convened multiple public and private partners for mapping eligible candidate vaccines and is coordinating clinical trials across the world.

A draft landscape of COVID-19 candidate vaccines, developed by WHO, includes eight candidate vaccines in clinical evaluation and another 102 candidate vaccines in preclinical evaluation. At the moment, half a dozen Indian firms are also making efforts to develop vaccines against the virus that causes COVID-19. Seven vaccines are in the process of evaluation at various stages of development.

Some of the pharma companies working in the direction of vaccine development include the Serum Institute of India has started human clinical trials for its vaccine in collaboration with New York-based Codagenix Inc, Hyderabad-based Bharat Biotech had announced a partnership with the University of Wisconsin Madison and US-based firm FluGen to make a nasal vaccine, ZydusCadilla is working on two vaccines, Biological E, Indian Immunologicals and Mynvax are developing a vaccine each.

In addition, another four or five home-grown vaccines are in early stages of development. The CSIR has been involved proactively from the beginning in our efforts for drug discovery, virus genetic sequencing and other activities.

When the cases were increasing in Kerala, Maharashtra, Delhi, Tamil Nadu, etc, the Health Ministry officials were not even able to define the hotspots as the officials were of the view that every district with a single case is a hotspot. Don't you think the government failed a little in understanding the real meaning of hotspots and implementing ruthless containment measures in those areas?

I think it will be inappropriate to say that. If you can recall, we have issued cluster containment plan as back as March 2 which was shared with all concerned for implementation. After that on March 24, a micro plan for containing local transmission of coronavirus disease (COVID-19) was developed and disseminated to all states and UTs for implementation. Further, as the number of expected cases increased, containment plan for large outbreaks of novel Coronavirus Disease 2019 was issued on April 17.

It can be seen that there was no gap in understanding the real meaning of hotspot and well-thought containment measures were planned and implemented. As a strategy, our objective was to stop the entry of COVID-19 cases in India and to restrict the localised spread with public health initiatives like quarantine, isolation, contact tracing and testing to contain the outbreak.

When cases reported from these states, a differential strategy was adopted for these areas depending on the extent of infections being reported. As it's important to protect the districts where no cases have emerged, it's equally essential to limit the spread of infection in districts where cases have been noted.

These states also had the fastest-growing incidence of cases. It was also observed that less number of districts accounted for 80 per cent of the cases that have occurred. We worked in a much-focused way using multiple strategies to contain the further spread of infection in these districts. The Central government works in very close coordination with the states to ensure that the rate of growth of new cases is contained. Testing of eligible populations, contact tracing, quarantine and isolation remains the focus in our strategy

What were the various measures that have taken by you in controlling the virus spread?

Under the able guidance of the Prime Minister, we had conceived a well-thought strategy to stop the COVID-19 spread outbreak in the country right from the beginning. We are following a multi-pronged proactive and pre-emptive graded strategy to handle the situation. It was on January 7 that China informed WHO about COVID-19 and we started our technical consultations with experts on January 8 and by January 17, we had formulated our comprehensive health preparedness response and issued detailed advisories to all states.

Our initial focus was on comprehensive screening at entry points preventing disease entry in India through international travellers and started screening all international passengers coming from COVID-19 affected countries and later universal screening for entry in India. As of now, 15.25 lakh passengers at 30 airports; 20.70 lakh passengers/crew members at 12 major seaports and 65 minor ports and 66,837 persons at land borders integrated check posts in 5 states, 21 districts, making a total of around 36.62 lakh were screened for COVOD-19 by teams of specialist doctors and trained paramedics to ensure effective screening, isolation and quarantine.

World Health Organization (WHO) has also appreciated our efforts. Now we have a very clear cut red, orange and green zones in the country depending upon the number of cases or no cases and are gradually relaxing the lockdown in a differential manner.

In terms of strengthening testing facilities, we have scaled up testing labs to 522 from one single laboratory in the month of January. The testing capacity has climbed up to 1 lakh per day and at present, we are testing above 90,000 samples every day.

Do you think India has reached at the peak, if so what are your estimates of bringing down the graph and till when?

The current outbreak is probably the most significant event of our lifetime with major socio-economic implications. There are so many mathematical models doing the rounds, projecting so many things but they don't match with real ground data. With so much diversity, India has a different social structure and has tackled COVID-19 in a better way than other developed countries. It may be inappropriate to guess about projections of possible COVID-19 scenario in future. COVID-19 is a new virus which was born 4-5 month back. We are trying to study it by isolating and genetic sequencing. Nobody can predict its future behaviour right now.

The social and physical distancing through the lockdown is an important intervention; since it has the potential to delay and slow down the growth of outbreak and flattens the curve of emerging cases of COVID-19 gradually. As of now, we have a steady curve and it has never shown an exponential rise. We are now trying to bend the curve.

Though there is definite evidence of improved case doubling rate and growth rate of cases, but despite the availability of all public health and social and physical distancing measures in place, it is not possible to predict the peak and estimate the time of bringing down the graph of cases. This all is determined by the outcome of collective performance of all measures undertaken to contain the outbreak.

Do you think that the government is ready to provide quality treatment to over 1 lakh COVID-19 patients if cases increase? What about the availability of the PPEs, ventilators and other required equipment in handling the situation?

Yes, India is prepared well to manage a surge in cases and is ready to face the challenge of providing quality treatment to not only one lakh COVID-19 patients but even more. I would like to inform that 80 per cent of the infections of COVID-19 are mild or asymptomatic, 15 per cent are severe infections requiring oxygen and maximum of 5 per cent is critical infections requiring ventilator support. The more important thing is oxygen supply which may be needed for 20 per cent of the cases, 15 per cent through masks or cannula and 5 per cent for patients on a ventilator. As of now the number of beds in dedicated COVID hospitals is 2,50,920 and that in COVID health centres is 1,74,813 making a total of 4,25,733.

In addition several domestic manufacturers for ventilators have been identified and orders for 60,848 ventilators have been placed which will be received in phase manner in this month and June.

As regards PPE, as on date 23.50 lakhs PPE are available with states & UTs. With the help of Ministry of Textile, 109 domestic manufacturers have been identified and orders have been placed for 2.23 crore of which 47.98 lakhs already been supplied. Today we are manufacturing 3 lakh PPEs every day and distributing to states.

Chinese testing kits found faulty. What's the plan to increase testing as it's been reported that India is testing very less in proportion to its population?

You must have been aware of it that the current strategy for COVID-19 testing is customized, based on the transmission typology in India and prioritises testing of individuals who are primarily at risk. Further, we need to ensure the quality of the testing kits and the bio-safety of the testing labs to avoid any issues related to unreliable results or iatrogenic transmission of the infection in health care or laboratory staff.

Before moving forward it is important to know that there are two types of tests done for COVID-19, the first one is called RT-PCR which is a diagnostic test for COVID-19 and the second one is the Rapid Antibody test, which is useful in clusters and large gatherings/evacuees centres. The rapid testing kits are suggestive and not diagnostic of COVID-19, so diagnosis needs to be confirmed with subsequent RT-PCR test. The rapid antibody test is used mainly for surveillance, epidemiological and scientific studies

"Chinese testing kits found faulty" was about rapid antibody test kits. ICMR had immediately recommended the withdrawal of the related batch of test kits. Rapid testing may be restarted once better test kits become available to ICMR.

What are the major challenges that the Centre is facing in coordinating with states?

I have been in regular touch with the state health ministers right from the beginning of the COVID-19 battle. We issued the advisories for health preparedness as early as January 17 and I must commend them for leading from the front containing the spread of this outbreak in the country by contact tracing, enforcing lockdown, providing isolation and quarantine facilities, ensuring smooth flow of supplies of critical equipment and PPEs, boosting the morale of healthcare workers, etc.

What the government need to learn from COVID-19pandemic?

The COVID-19 is a unique disease outbreak and posed a unique set of challenges. However, with India's past experiences we could develop an effective strategy to deal with COVID-19 in India. Basic learning has been the fact that we need to build up community-based approaches, where the interventions are not only accepted by communities but also owned by communities to ensure that they are sustainably scaled up. This also involved the development of the infrastructure to deal with the COVID-19 on a sustainable basis.

In shaping the Indian response, we have to build up on the policy and intervention experiences of other countries. Scaling up testing, moving towards community-owned interventions, dedicated health facilities at the district level for case management, and the current lockdown --- all have been calibrated to the Indian needs based on our past experience and experience about the outbreak of various other countries

Another most important aspect was developing a system to provide informational support through data sharing on an open platform through the ministry site or portals to counter the challenge of misinformation which accompanied the rise of the COVID-19 outbreak. Providing regular correct information to people is an important intervention to ensure that there is no panic or unrest in the population.

What precautions need to be taken by the people once lockdown is lifted?

Once the lockdown is over, all necessary guidelines for social and physical distancing, use of face cover/masks, hand washing, respiratory etiquettes and sanitisations at home and workplace need to be followed regularly. Further crowded places and gatherings for any purpose need to be avoided. I have said it time and again that social and physical distancing is the most potent social vaccine available to us.

Do you have any message for the nation?

During this unprecedented crisis faced by humanity as a whole, I would appeal to the people to follow the policies and advisories which are being issued by the government from time to time. I will appeal to all fellow citizens to take ownership of social and physical distancing and lockdown intervention and strictly follow it. All of us should make it a part of our lifestyle, for all time to come, and contribute to the fight against COVID-19.