Rise in breakthrough infections may compel us to administer booster dose: AIIMS Trauma Centre Chief

On Friday, India achieved a historic milestone by administering more than 1 crore doses of COVID-19 vaccination in a single day. The total number of coronavirus vaccination doses provided in the country crossed the 63-crore mark as per a provisional report by health ministry on Saturday, marking another milestone for the country.

Yet, there is a huge enigma around the fact that as India charges towards rapid vaccination, how necessary is the booster shot.

To discuss facts on the booster shot and upcoming third wave, Medically Speaking invited Dr Rajesh Malhotra, Chief of AIIMS Trauma Centre. Here are a few snippets from the discussion:

What is the need of the booster shot and how effective is it?

Dr Rajesh Malhotra: when there is a pandemic, the public health aspects need to be kept above the individual health goal. The objectives have to be more broad based and conducive to the overall welfare of the nation and the world as a whole. As far as a booster dose is concerned, it is nor required nor advisable because ideally a booster dose is given when the entire population has been vaccinated with both the doses. Secondly, we do need to concentrate on those who have undergone any transplant or someone who is immunosuppressed. If a virus keeps on multiplying in an immunosuppressed person, it may cause recurring infection while persisting in the body. Therefore, this should be the criteria for considering a booster dose rather than an age-related criterion.

Will we see a booster dose in India as well?

Dr Rajesh Malhotra: We might eventually introduce a booster dose because we know that immunity produced by certain vaccines decreases with time and are not efficient against the delta variant also. We are not aware of how long will the immunity produced by two doses last and we can only study this through a breakthrough infection. Rise in the breakthrough infections may constrain us to administer the booster dose.

You speak about the possibility of everyone getting a booster dose. Will that act against various variants of Covid in the future?

Dr Rajesh Malhotra: For this we need to know about the next variant since currently we can only talk about the variants in existence. It is not necessary that a new variant can be more lethal than the previous one and some of them are not even compatible with survival. But surely, for another surge, a variant has to be more deadly than the Delta variant.

Government of India aimed to vaccinate people by the end of 2021. What is your assessment of that practically happening?

Dr Rajesh Malhotra: For everyone to be vaccinated by December, we need to vaccinate 1 crore people per day and now that it has happened, why the doubt?! If a better strain is to come, rapid vaccination is one big hurdle it has to face because the longer the virus is given time in the community, the better will it mutate. But we are hoping that there is no upgrade to the virus so soon.

Kerala is a state where we can see a huge surge in cases. Festivals, also are on the way. Do you want to give any advise for the same?

Dr Rajesh Malhotra: In any case, if people get together, they are going to abet the spread of infection. All said and done, vaccines have one big inherent disadvantage of not being able to prevent the spread. The vaccines should create a local immunity that prevents the virus from getting a foothold in the body. This will be a better intervention from a spread.

Social distancing, masks and other protocols should be religiously followed because there is no bigger religion than protecting your own country.

We can see many states opening the schools already and a body of over 50 doctors have already written to the government questioning this move. What, in your perspective, should be done?

Dr Rajesh Malhotra: This area should be dealt more sensitively since countries like UK and USA are already witnessing the surge in infections just because they opened schools. Mainly because children don’t comply with anti-Covid norms and rapidly spread infection among themselves. Therefore, a constant watch should be kept on this section. Secondly, we need to ensure that entire school staff is vaccinated. Thirdly, classes can be held outdoors maintaining social distancing and 50% capacity. Also, elderly should be kept away from the children at home for some time. We need to have a constant guarded approach.