Several international organisations pitched in to supplement domestic effort to combat the second wave of Covid-19. Rajiv Shah, president, The Rockefeller Foundation, and former USAID head who led the American response during the Obama administration to the Ebola outbreak in West Africa, spoke with Rudroneel Ghosh about what India can do now:
India and its health system are now at a critical moment. The extraordinary scale of the second wave in the number of cases, deaths, and economic losses is truly tragic, especially because in India, as it is all around the world, this virus disproportionately afflicts the socio-economically vulnerable. Although vaccinations are underway, inoculations will not be delivered fast enough to stop this latest wave. The Rockefeller Foundation is working closely with several local partners to bolster India’s pandemic response and secure emergency medical relief.
India’s testing rate has fluctuated and labs were overwhelmed during the peak of the current surge. How can testing be increased?
During the first wave, India met its testing benchmark of one million tests per day, which was instrumental in containing the chain of the transmission. Alongside vaccinations, testing and contact tracing will continue to be critical components of responding to Covid-19 outbreaks in the short term and managing the pandemic in the long term. The Rockefeller Foundation convened and engaged with an expert advisory panel over the last seven months to create this insight-based report, ‘The Road Ahead for Smart Testing and Tracing in India’. The report provides a series of actionable recommendations to strengthen India’s pandemic response, overall, in a resource-constrained environment. This includes taking a ‘cafeteria approach’ to scaling up access to testing by developing a diverse portfolio of tests, such as RT-PCRs, rapid antigen, saliva tests, lateral flow tests and others, with clear decision processes for use and follow ups. Target cost-effectiveness through a centralised pooled procurement of kits and components while integrating testing into existing government social protection schemes.
Is contact tracing even possible given the scale of the spread of Covid in India?
Right from the start of the pandemic, several countries have demonstrated the merits of undertaking comprehensive contact tracing to track the patterns of viral transmission. For a country as geographically and demographically diverse as India, while contact tracing is undoubtedly an enormous and complicated task, it continues to be an essential tool in containing infections. It is possible through robust digital tools integrated with manual contact tracing efforts. Further, to combat community transmission, a well-tailored contact tracing exercise that targets high-risk exposure contacts, along with super-spreading events or clusters can save more lives and is crucial to securing equitable health outcomes.
How significant is the threat of the B.1.617 variant of the virus?
The more we learn about the B.1.617 variant, the more concerning it becomes. WHO recently reclassified it as a ‘variant of concern’ which is why testing and genomic surveillance efforts are so critical to identifying new and circulating variants. Without it, we are essentially flying blind. When combined with clinical and epidemiological data, it can offer real-time guidance on new strains and their potential impact on the effectiveness of vaccines, inform clinical decisions, development of therapeutics, and ensure that the testing technologies are continuously calibrated to maintain high levels of accuracy. The testing systems may also need recalibration through upgraded primers and proactive communication with test developers to launch variant-detecting point-of-care tests in the market.
Since the virus is mutating fast, what should be our primary tool to flatten the current surge and prepare for the next wave?
Vaccinations are the key to stopping the virus, so until we reach herd immunity, access to widespread testing is the bedrock of pandemic containment. I saw first-hand how testing can bend the curve in West Africa during the Ebola outbreak, where I led the US response as the head of the US Agency for International Development (USAID). Working with governments and local community health workers, we were able to get the time it takes to get a test result for someone who was a suspected Ebola carrier from eight or nine days to under four hours. It was essential then and is now when highly contagious coronavirus variants increase complexity of the situation.
What lessons can India learn from its current surge and other nations that managed their second waves better?
To overcome the current wave, India must sustain the momentum of its vaccination programme supplemented by proven public health mitigation measures. Data has always been a key enabler when it comes to prioritising and accelerating health outcomes. It helps us understand where the need is greatest, predict potential hotspots and target interventions with a focus on equity. Covid-19 has also demonstrated that early warning and speed are the most critical components of any outbreak response.
Views expressed above are the author’s own.
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