If everything goes well, Vaccine will be ready by early 2021- Chat with Dr. Soumya Swaminathan -WHO

Interview Dr. Soumya Swaminathan (WHO)

Dr. Soumya Swaminathan was most recently WHO's Deputy Director-General for Programmes. A paediatrician from India and a globally recognized researcher on tuberculosis and HIV, she brings with her 30 years of experience in clinical care and research and has worked throughout her career to translate research into impactful programmes. Dr. Swaminathan was Secretary to the Government of India for Health Research and Director General of the Indian Council of Medical Research from 2015 to 2017. In that position, she focused on bringing science and evidence into health policy making, building research capacity in Indian medical schools and forging south-south partnerships in health sciences. From 2009 to 2011, she also served as Coordinator of the UNICEF/ UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases in Geneva.

IF EVERYTHING GOES WELL, VACCINE WILL BE READY BY EARLY 2021 A CHAT WITH DR. SOUMYA SWAMINATHAN

People are anxious to know when will the drug/vaccine arrive. Will it be within next 6 months or another year?

Normally a vaccine takes about 10 years for development. If we look historically, Ebola vaccine was developed in 5 years, the Zika in less than 2 years, but by that time the Zika problem was over. We are hoping to break that record also and try and develop a vaccine in under 12 months. That will be an astounding achievement if that happens. The only way it can happen is to have a global collaboration, rather than competition. There were over 100 candidates which were in various stages of development two months back. Of these, 7 were in Phase 1 human testing, including two each in China, USA and Germany and one in the UK. India also has a number of candidates in progressing development. Now, we have at least a few candidates which are in phase 2/3 trials. As this will be a new vaccine, safety is foremost and efficacy against COVID infection needs to be proved. If everything goes well, we may have a vaccine early in 2021. Right from the outset of the pandemic, WHO had started planning the R&D needed to promote the development of therapeutics, vaccines and diagnostics. As this is a new virus, we need to establish and standardize animal model and assays which will be used for vaccine testing. If everyone set up their own system of testing, they will not be comparable, so it is important to standardize that. We track the development of vaccine candidates and update the knowledge base regularly. We have also set up an expert group that looks at the criteria for prioritizing vaccine. You cannot bring 100 vaccines into phase 3. It can be say 2 to 5 at most – so we have criteria to pick the most promising candidates. We have developed a protocol for a phase 3 vaccine trial which is ongoing now. Similar to the Solidarity trial for drugs, it would be a solidarity trial for vaccines. It would test multiple vaccine candidates against a placebo arm, and enrol in many countries at the same time, thus improving the efficiency and reducing the time needed . We also need to ensure that these vaccines are available to populations everywhere, regardless of their ability to pay. WHO will work with countries and developers to ensure a fair and equitable allocation system. Any prediction based on scientific data about when will the curve flatten globally? There are many hypotheses on why infection rates are low in Africa and India, but there is no clear answer. We see flattening of

the curve in countries where there are robust public health measures like physical distancing etc. As countries lift lockdowns, we have to see how vigorously it rebounds again. That’s the risk, as we don’t know how this virus will behave. It is possible it goes down and stays at a low level, might flair up next winter or its possible that as soon as lock- down measures are lifted, it would increase. But what is clear is that the infection is going to stay with us, as it is already widespread. What the curves will look like, only time will tell. We have to keep a close Ex. Union Minister Sri. Ghulam Nabi Azad presenting the ICMR Kshanika Oration award to watch on that. We Dr. Soumya Swaminathan, at the ICMR awards presentation function, in New Delhi. can see what is happening in those countries which started early. For instance,China, also using digital technology and mobile phones to track people. South Korea and Hong Kong managed to keep new infections at a New infection rates are very low and most of them are travelvery low level. In Singapore, there was a spurt in cases, but it was ers. Those from outside the country are being quarantined for linked to a cluster of migrant workers living in dormitories. What 14 days. i s encouraging is that China, South Korea, Taiwan and Hong Kong could bring the curve down and keep it low. They have lifted lockdowns, but they have expanded testing, and still do isolation There have been talks that the virus is manufactured virus. Is it natural or man-made virus? and quarantining . China used the zoning like India is doing of Available evidence strongly suggests that it had a natural anidividing the areas as red, yellow, green zones. In China, they are mal origin and is not a manipulated or constructed virus. By looking at the genetic sequence, scientists have been able to say this. Most likely it has come from bats as there is similarAvailable evidence strongly suggests ity between bat corona virus and covid 19. We don’t know if it has come through an intermediate host and if so what that that it had a natural animal origin and is not a manipulated or constructed host was. Like for MERS we know it was camel for SARS 1, it was the civet cat. Here it could be a domestic, wild or domesticated wild animal. We continue to collaborate with Chinese virus. By looking at the genetic sequeexperts and have offered all support to work on identifying nce, scientists have been able to say what animal it came from and how it spread to humans and whether it was one spillover incident or multiple. This underthis. Most likely it has come from bats standing will help us for the future in prevention and control. as there is similarity between bat corona Do you feel, India can lead the path in drug and vaccine virus and Covid-1 9. development? Every country can decide how to use these drugs. Our position from the beginning has been that there is isn’t enough Courtesy to Shimona Kanwar, TOI

Interview Dr. Soumya Swaminathan (WHO)

evidence for prevention or treatment. So we advised conducting high quality research to find out. There are two big multicentric trials which will be done for pre and post exposure prophylaxis using HCQ amongst health care workers and high risk contacts. We propose to pool the data and make recommendations based on those results. As far as India is concerned, ICMR can still study the effectiveness of HCQ. Despite the fact that it has an advisory, there are ways of collecting data from healthcare workers which can give useful information about how effective it was. RCTs are ideal, but in a situation when you are already asking people to take it under exAward was presented at the hands of Shri D S Mehta, President Kasturba Health Society at a panded use program, then program organized by the Kasturba Health Society and Mahatma Gandhi Institute of you have to collect data Medical Sciences on 22nd September 2017. from health care workers. And examine if it was actually useful in preventing the infection. is the response of the WHO? India has the capacity. It has academic centres and good pharWe re gret the decision of the US. The US has been a long-standing maceutical and vaccine manufacturers. But what it lacks is the supporter and generous friend to the WHO – not only with financapacity for phase 1 trials. Indian companies go out of the cial resources, but also technical cooperation with agencies like country to do those. So India should build that capacity. Even the NIH and CDC. WHO has to continue its crucial work, as counfor animal models, many developers go outside India. WHO is t ries around the world depend on the organization. We hope the providing all the SOPs for animal model. So it should be posUS will continue to support WHO i n the future. sible for facilities in India to actually be able to do that also. We, Agappe Diagnostics, are a leading Indian Diagnostic What is required is partnership between private and public Company serving mankind with more than 500 diagnostic sector and institutes with different capacities,infrastructure products across globe. We have launched Covid-19 RNA Exand expertise. traction kits in association with Sree Chitra Tirunal Institute How could WHO ensure access to protection equipment a nd overcoming its shortage worldwide? of Medical Science, Trivandrum India which cut shortened the diagnostic cost and many other Covid-19 Diagnostics Products are in pipeline. We appreciate the efforts taken by There was a huge global shortage of many of these prodWHO to eradicate the disease. Here we would like to have a ucts, including diagnostic kits and PPEs. What the WHO was few advices from you to improve our services to the general doing to resolve the shortage as follows: The DG, WHO had public. appealed to the G20 trade ministers to ease the transportation I toast all the healthcare entities highlighting the efforts and of essential commodities including the PPEs and medical their augmented contributions towards eradicating this pandemic. equipment and not to have any trade restrictions. The UN task The heads always need to mind that all we are public servants and force was looking at the supply chain mechanism that involves this is the time to attest our accountability in ensuring public negotiating a price with the manufacturers and procuring large welfare. quantities. This was picked up by different agencies which sent it to those countries that need it. I trust more and more R&D activities are progressing globally to manage this pandemic and I wish all the best to do more better The WHO has been accused of mismanagement and as a assignments in imminent days and make sure that every people fallout the US withdrew its funds to the organization. What will live healthily.

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