Interview: Dr Poonam Khetrapal Singh

Poonam Khetrapal Singh: The pandemic is far from over

Print edition : September 25, 2020

Dr Poonam Khetrapal Singh. Photo: Violaine Martin/ WHO

Interview with Dr Poonam Khetrapal Singh, Regional Director, World Health Organisation, South-East Asia.

The rising graph, and resurgence, of COVID-19 cases globally presents a new set of challenges to governments. With no cure in sight, health experts and governments are increasingly of the view that physical distancing and hygiene are the only options available until a vaccine is developed. Many governments have also given directions for the resumption of all economic activity which, in turn, seems to have contributed to the rising numbers. Dr Poonam Khetrapal Singh, Regional Director of the World Health Organisation’s office for South-East Asia, spoke to Frontline on the reasons for the resurgence, disruption of essential health services, vaccine development and the importance of collaborations between countries in the search for a cure and vaccine. Excerpts from the interview:

Countries in Europe that earlier showed signs of tapering, such as Spain, now show a rising graph of infections. In France, too, infections seem to have gone up in all age groups. What does this indicate?

The pandemic is far from over. Whenever responses slow down, including complacency on the part of the public with regard to safe behaviour, the virus bounces back. It is important to keep suppressing the virus. We are seeing instances where countries that had managed to curb the infections are now seeing a re-emergence. It is important to quickly identify any new case or cluster so that it does not spread in the community. For this, we need to make sure we test, treat and isolate and quarantine contacts so that any resurgence can be identified and stopped.

COVID-19 affects people across all age groups. As individuals, we have to continue to remain vigilant and be responsible for ourselves and the health of others. We know what that takes: keep our hands clean, maintain a distance of at least a metre between ourselves and others, avoid crowded places, practice respiratory hygiene and wear masks wherever recommended. Until such time when there is a medicine or a vaccine to protect us from this virus, this is how we have to protect ourselves.

Are countries testing adequately? In India, a WHO guideline states the adequate level of testing as 140 tests per million. Can this apply to large populations such as India’s?

Testing is an important tool in battling the COVID-19 pandemic. India has significantly ramped up its testing capacity from 100 a day early in the outbreak to more than 8,00,000 a day currently. We are aware that as of August 30 as many as 4,23,07,914 cumulative samples have been tested. On the same day, 8,46,278 samples were tested across the country. The more we test, the better we will know and understand the spread of transmission which will help us further strengthen our response.

The WHO has repeatedly warned that plasma therapy is not a conclusive and proven cure. Why then do countries and hospitals push it as a “cure” and encourage people to donate plasma?

The WHO is doing a living meta-analysis of all published trials that are ongoing for therapeutics, including plasma. The WHO recognises COVID-19 convalescent plasma as an experimental therapy that is appropriate for evaluation in clinical studies. Further clinical evidence is needed before guidance can be provided on its clinical use. The WHO recommends strongly that COVID-19 convalescent plasma should be used in clinical trials as the most effective and efficient strategy to determine the efficacy and safety of this experimental therapy.

Many governments are opening up offices and institutions and even insisting on students giving examinations. We know that health systems have come under immense pressure dealing with the pandemic.Do you feel countries that have reported more than 50,000 cases on an average should focus more on getting the numbers under control rather than conduct work as if it is business as usual?

COVID-19 has affected lives and livelihoods the world over. Easing lockdowns, countries globally are opening up and transitioning to the new normal. Whatever the transmission scenario, continued focus on core public health measures—test, trace, isolate and treat; hand hygiene; cough etiquette and social distancing—are a must. Our focus should continue to be protection of health care workers and the vulnerable population which should inform the adoption of appropriate measures by the government. Along with measures and recommendations of governments, continued community involvement is important. Every individual should contribute, by adopting appropriate hand hygiene and social distancing measures. This is a pandemic. We all need to join forces to combat it.

Vaccine research is in different stages in different countries. There is much anticipation about the discovery of a vaccine by the COVAX vaccine facility that promises to roll out vaccines, but not before the end of next year. Do you think that countries should embark on serious course correction with respect to investing in public health?

Currently, over 169 vaccine candidates are at various stages of development. Of these, about 26 vaccine candidates are under human trial and we know of at least three or four going into phase III. The COVID-19 vaccine pipeline is very robust. The more candidates we have, the more the opportunities for success—depending on their results. The COVAX facility is speeding up the search for an effective vaccine for all countries and at the same time supporting the building of manufacturing capabilities and buying supply ahead of time so that two billion doses can be equitably distributed by the end of 2021.

The pandemic has affected health systems globally, prompting countries to rethink how to have essential health services functional during COVID-19 response. It is true that essential health services were affected. Areas such as immunisation, non-communicable disease care and youth services are just some examples of services that were disrupted while health systems struggled to cope. We are encouraged by the signs we are seeing now of those services resuming in parts of the world and in significant measure in the WHO South-East Asia Region. While the pandemic exposed several weaknesses within health systems, there is a strong focus on building back.

What is the WHO’s opinion on the Russian vaccine?

The WHO welcomes all vaccine development programmes around the world, and we are very encouraged by the fact that there are several candidate vaccines in various stages of clinical trial, including the Russian vaccine Sputnik V. The WHO has started discussions with Russian authorities to learn more about the vaccine candidate. Sputnik V is about to start phase III clinical trials, we understand.

A vaccine should offer a minimum of 50 per cent efficacy in preventing infection with a lower bound of at least 30 per cent protection at the population level and should be safe, among other factors.

With the world in the grip of such a crisis, and its economic ramifications, is it not in everybody’s interest to collaborate towards the common goal of saving humanity rather than compete or blame each other for the crisis? This question is in the context of China and the decision by some countries to economically boycott it.

The rapid global spread of COVID-19 has demonstrated that pathogens do not respect local, national or international boundaries. Hence, the world needs to work together to share knowledge on the virus and its transmission dynamics, suppress the current outbreak by implementing core public health measures, and prevent any future outbreak from adopting pandemic proportions. We are already seeing this, especially in the collaboration on the COVID-19 vaccine and therapeutics.

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