The Union health ministry reviewed the Covid-19 situation in India on Wednesday in light of a surge in cases in China and other countries such as Japan, South Korea, Brazil and the United States. Since China is the only big country where cases are at an all-time high, it is important to consider if India is protected against the factors driving China’s wave. An news agency analysis of data from China and India suggests that India is likely better protected than China. However, this analysis also shows that this fact will not remain true without dynamic action on the vaccination front. Here are three charts that explain this argument.
India’s vaccines work better than China’s, but India needs faster booster uptake
96% of the Covid-19 vaccines administered in India are either Oxford/AstraZeneca formulated Covishield manufactured by the Serum Institute of India or Bharat Biotech’s Covaxin. Most of the vaccines administered in China are CoronaVac and Sinopharm. The efficacy of Oxford/Astrazeneca vaccine (which accounts for 80% of India’s doses) has been tested against CoronaVac. A study of one million people in Brazil found that both vaccines offered similar protection among young people, but CoronaVac was less effective against severe infection in older people. According to the study, CoronaVac offered up to 60% protection against severe disease for people up to the age of 79 years, as compared to the Oxford/AstraZeneca vaccine’s 76%. But in people over the age of 80, CoronaVac, the most used vaccine in China, was only 30% effective in protecting people against severe disease, and 45% effective against death, as compared to the Oxford vaccine’s 67% and 85% respectively.
This problem is compounded for China by the fact that its age-wise vaccine coverage is opposite to India’s: China has covered a higher proportion of younger rather than older people.
To be sure, Indian vaccines’ efficacy is irrelevant if people don’t take them. For instance, even mRNA vaccines being administered in western countries are more effective than CoronaVac. Yet, the United States and European countries are also seeing a surge, although smaller than China’s and without any stringent lockdowns like China. India is a laggard in terms of booster coverage. Among 14 countries with a population of more than 100 million, India’s booster coverage is ranked 10th: 16 people per hundred population compared to 57 in Brazil and 40 in the United States. This is not just because only adults are eligible for boosters in India. The last time the health ministry published dose and the age-wise breakup of vaccination (on October 31), 719 million of 940 million adults were yet to take a booster (591 million of them despite being eligible by the required six-month gap on the day). This is unlikely to have changed as only 2.5 million boosters have been administered since. In addition, 135 million people (60 million of them are teenagers) have not yet taken a second dose either.
A larger share of people in India have been infected with Covid-19 recently
Despite the lag in boosters, India has reason to not panic because of China’s wave. China’s strict lockdowns have meant that fewer people in the country are likely to have natural immunity from recent infections. There have been just about 2 million cumulative Covid-19 cases in China until December 20 against 45 million in India. This translates to 1,348 infected people per million in China compared to 32,819 in India according to 2021 population projections. Pan-India sero-prevalence studies also showed 62% prevalence in India even in June-July 2021. This figure has likely grown, as 22% of infections in India have happened in India only since mid-December last year, when the third wave led by the Omicron variant broke in the country.
The Omicron sub-variant behind the surge in China has been around in India since July
Another reason why India needs to respond with calm to the China surge is that the country has been acquainted longer with the Omicron sub-variant. The latest data from China (samples found on December 9) showed the BF.7 sub-variant of Omicron present in 14% samples compared to 7% of BQ.1.1 sub-variant. The latter constituted all the samples in the last data from November 3, according to data compiled by outbreak.info. India on the other hand first detected the BF.7 sub-variant in a sample taken in July. The latest sequence in India (from November 30 samples) did not show any presence of BF.7.
This data suggests that India, where a different sub-variant of the Omicron started a wave last December, might be better protected than China against Omicron. However, this conclusion needs to be taken with two caveats. One, both India and China are very frugal in sequencing Covid-19 samples. In total, they have sequenced 223,588 and 3,313 samples respectively compared to 4,255,409 samples sequenced by the US. Two, India’s better protection against new sub-variants so far is no guarantee of lifetime protection. When the Omicron wave first came to India, the country’s vaccination drive was in full swing and people were lining up for boosters. Those shots are now almost a year in the past. They need to be either repeated or updated with ones that protect against new variants — the so-called bivalent vaccines. This is also what experts think too. “The current path we are on is good but in my mind, not good enough. We should be striving for much better and robust vaccines,” Ashish K Jha, the White House Coronavirus Response Coordinator, said at an online session of the Hindustan Times Leadership Summit held in November this year, speaking on the pandemic’s trajectory around the world. “For now, prepare for an annual shot,” he added.