More the Infections, More Chances of Variants: Dr Gagandeep Kang

(Producer/Anchor: Devina Buckshee, Video Editor: Rahul Sanpui, Senior Editor: Vaishali Sood)

“In every person that the virus infects, the virus has an opportunity to change.”

Dr Gagandeep Kang

As India struggles to contain its second wave, fresh variants - the double mutant strain classified as a variant of interest in India - B.1.617, a new triple mutant variant, which is being called the Bengal variant and variant in South India - B.1.6.29 - have resulted in fresh panic.

Beyond that, as India rolls out a fresh vaccination policy for everyone above 18, questions of shortages in supply and equitable distribution given the differential pricing still arise.

Dr Gagandeep Kang, often called India's vaccine "God Mother", speaks to FIT to help clear the air on variants, vaccines and more.

Why are the new variants still classified only as ‘VOC or variants of interest’ and not ‘VOC or variants of concern’ given their spread in parts of India amid the rising cases?

“The Indian variant - B.617 - is a variant of interest because it has mutations that predict there may be changes in its biological behaviour. But so far, we don’t have confirmation of that yet and so it cannot yet be classified as a variant of concern.”

Why is it taking so long to confirm? Can we speed up the sequencing of data?

“We got to it being a VOC because we had sequencing data. In terms of sequencing, we should be increasing that for all RNA viruses. We are in a pandemic and this is a virus that is evolving very, very quickly. I don’t think the sequencing we are doing is enough. It’s not geographically or epidemiologically representative. I hope the efforts undertaken by INSACOG and others are addressing this.”

Is the rise in cases linked to the variants?

“It looks likely but there is a lot more that we need to look at. For example, in Punjab and Delhi, the proportion of strains that are B.117 has increased much more. This was the pattern seen in the UK, it was detected in September but rose to become the predominant strain in early December. Same for us, we started seeing this strain a few months ago but it has become more important. Maybe we imported it and then it grew. If we look at the strain that started in Maharashtra, B.1617, what we are seeing there is an increase in the proportion of sequenced strain that are B.1617. So while we don’t have biological data, we have epidemiological data that shows this strain is more. It is likely that it is spreading more and outperforming the other strains but we need to keep tracking it and gather more information on the severity, about the ability to cause reinfections - all this has not been done yet and can be done.”

Can the new variants escape detection in and RT-PCR test?

“It can happen that the variants may be able at some point in the future to be able to escape detection. Right. That’s much more likely with the rapid antigen test than it is with the RT-PCR test. It was the rapid antigen test is dependent on having an antibody that captures the antigen of the virus. Now if the virus antigen changes its shape then the rapid antibody test won’t work anymore. And it’s really one target that has been detected and if the target changes it’s gone. Most of the PCR tests that we do, not all but most of them, look at the three sequenced targets on the virus. So even if one target is of, the others will work.

And in fact the UK variant, that’s how it was picked up. One the test that the UK was using showed what was called an S gene dropout. The target on the S gene was not working when the other two targets were working.

So in fact it became a diagnostic test, for the variant, to say that if only two out of three your targets are working, most likely you will have B117. And that was found to be the case.

Now sequencing then told you that the reason that the S gene dropout was happening was because there was a deletion at the sight that was being used for the S gene.

So it became possible to explain why the this was happened.

So will this happen in the future, I think it is very unlikely that we lose all our targets at the same time.

This story that people tell of false negative tests, false positive tests, now one thing at a time would advice is look at the test that is being used and look at the laboratory that is doing the test. Usually if it is a laboratory that has a accreditation with the nation accreditation board for laboratory standards that and it had it before the SARS CoV 2 testing started, then that lab usually has good standards for doing these kinds of molecular testing .

The second thing to look at is what is the test that is being used. All lot of tests have come into the market, its flooded with tests and there is a price war to that goes on.

You know test for Rs 200, test for Rs 300, test for Rs 500, this lab is charging so much Rs 1000. Well actually when you pay for quality you get a quality result.

Do you think we can vaccinate everyone equitably in a short span of time given the pricing differentials and the new vaccination policy?

“I think vaccination should be for a public health problem should be free for everyone. You know ultimately this country runs on all our taxes. It’s not being income tax payers or not being income tax payers, all of us pay taxes in some shape of form. And I think health is human right. Prevention is part of health and I think all vaccines should be purchased by the government and provide it free.

Having differential pricing for the same product is not appropriate. If there is a situation of abundant supply, where there is absolutely no shortage of vaccines, then if somebody wants to pay to get a vaccine in a five star facility instead of your local clinic, then that’s ok if you have , if you pay for that supplements.

Or if people want a choice of vaccines, I want to get this one instead of that one. But when you can only two vaccines that are being liberal in your system, you have prioritized populations that have not being fully vaccinated yet.

I don’t think this is the time for us to be creating a free for all vaccines. I think the people, who will get left out of the vaccination, will be the ones, who will be worst affected it they get serious.

Can we delay giving the second dose to people to ensure everyone gets the first dose and has basic protection in light of vaccine shortages?

“Lets look at the data. The UK decided early on that it would be for both Covidshield and the Pfizer vaccine, which were the first vaccines that they introduced to their system, that they could delay the second vaccination two to three months. Now, we have real world used data of what does a single dose of the AstraZeneca vaccine or the Pfizer vaccine does, and both of them are showing that there is very good protection against hospitalizations and against death, with a single dose of vaccine.

So clearly single dose is able to protect for at least three months.

So I think there is a rational, if you have a shortage of supply with the AstraZeneca vaccine. You can safely delay vaccination for upto three months.

For Covaxin it’s an inactivated vaccine and for these,most likely you will need two doses. There is data from the Chinese Sinovac Vaccine being used in South America, where it shows that one dose gives you very little protect and two doses gives you better protection. So I think for Covaxin, we should stay with the four wheels. For Covishield, using the single dose and delaying the second dose, is a safe way of delaying with vaccine shortage.