Ramanan Laxminarayan: ‘Vaccination the only way out of the pandemic’

Interview with Ramanan Laxminarayan, economist and epidemiologist.

Ramanan Laxminarayanan

RamananLaxminarayan , Director and Senior Fellow at the Center for Disease Dynamics, Economics and Policy, was among the experts who underscored the importance of testing and predicted the scale of devastation of the first wave of COVID-19 as early as in March 2020. The lockdown, he had stated in many interviews last year, had only slowed down the virus, not eliminated it. He feels that while the second wave was not avoidable, the scale was entirely preventable. Laxminarayan, who is an Affiliate Professor at the University of Washington, a Senior Research Scholar and Lecturer at Princeton University and a Consultant with the World Health Organisation, has co-authored an epidemiological study of the transmission pathways and mortality of COVID-19 in Tamil Nadu and Andhra Pradesh. Among other things, the study suggested that primary data were of crucial importance to guide control measures; and that surveillance and contact tracing were critical components. In an interview to Frontline , Laxminarayan, who has been involved in helping people get oxygen through a forum called OxygenforIndia.org, said that preparedness was totally lacking in many parts of the country and added that people dying because of lack of oxygen was unpardonable. Excerpts:

Is the surge experienced in the second wave unique to India?

Multiple waves have been noted in other countries, and second waves have been severe in other countries as well, but none as overwhelming as what we are seeing in India. What we are witnessing is the scale of devastation that I had anticipated in interviews last March when calling for an early lockdown. That lockdown helped temper disease transmission, but this year, with no restrictions on activity, the virus has shown what it is capable of when it is allowed to transmit freely.

Was it possible to anticipate such a surge and have a strategy in terms of a government response in place beforehand?

My own assessment in February was that the low caseload was partly a result of immunity pockets in some urban areas but also that if everyone returned to normal activity, there could be a significant uptick in cases. There are others who believed that COVID was essentially over in India, and that has not been the case. The second wave was not avoidable but the scale, and lack of preparation, was avertable. We were told that there was enough equipment, COVID beds on trains and supply of drugs for any eventuality. Now we see that the preparedness was not just lacking, it seems to have been wholly absent in many parts of the country. Some things, including Intensive Care Units and critical care physician capacity, are hard to establish in a short time. But most people today are dying due to lack of oxygen, an issue that could have been solved for a trivial sum of money. That is simply unpardonable.

Given the high transmissibility of the virus and fast progression of certain Covid variants within the body, do you think we might end up with a much higher morbidity and mortality rate?

The higher mortality in this wave is first and foremost going to be because of people who died needlessly due to lack of oxygen. Other explanatory factors may be present but will likely play a smaller role.

Is it possible to have a reasonable estimate when the current surge will peak?

It is really hard to tell and it will depend entirely on our own behavioural response. If mass gatherings continue and we give the virus additional opportunities to spread, this could go on for a while.

The study you co-authored on disease surveillance and epidemiology in two States seems to suggest that late diagnosis was responsible for early deaths, as compared to the median observed in the United States where deaths occurred on the 13th day after hospital admission. In the second surge, deaths seem to be occurring at an even faster pace. What were the lessons that the first wave taught us and did we as a nation learn anything from that?

In that study, we observed a median time to death of five to six days. That time seems to have dropped even more during this current wave and there does seem to be a combination of differential impact of a variant and people coming into hospital later, likely because of the difficulty in finding beds.

Much hope seems to be pinned on achieving herd immunity by vaccination. Given the present surge and the emergence of new variants, do you think vaccination alone will address it? By the time all age groups are covered, it will be time for the next round for those who have received the first and second doses, as the efficacy of the vaccine is only six months.

Vaccination is our only way out of the pandemic. At the current rate of vaccination, getting to a reasonable level of coverage that will be protective is going to take more than two years. However, India has the capacity to expand manufacturing. A five-fold increase in supply could see us exiting this pandemic in 2021 but that takes political will and good execution.

Most of Asia (excluding West and Central Asia) seems to have been more successful in containing the virus than the West. Why do you think India has been a poor performer even when one accounts for population size?

I don’t think this virus is done with us. It is possible that places that seem to have performed better today may end up worse depending on the way transmission unfolds. We have to see what the impact of variants will be and it is not inconceivable that one of these could cause havoc in places that seem to have avoided the brunt of the pandemic thus far.

What are the dangers to the rest of the world posed by the second surge in India and the possibility of new variants emerging from it? Does the level of genome sequencing need to be ramped up?

India’s size, population density and slow rate of vaccination all put it at risk for being a giant Petri dish for generating new variants, since viruses do mutate. Some of these variants could pose a risk both within and outside the country. The current level of sequencing is wholly inadequate and one of the immediate responses should be to vastly increase that capacity. This is in the interest of not just India, but the whole world.