New Delhi: Covid-19, the novel coronavirus infections, has killed 3,131 people worldwide till Tuesday. In India, in a span of 24 hours, three new persons tested positive for the virus, nearly a month after the first batch of cases of the infection were reported from Kerala. As the central and state governments step up their vigil to screen and contain the virus, News18.com interviewed one of India’s foremost scientists, Professor Gagandeep Kang, on the challenges in detecting Covid-19 cases, the resources available to fight the virus and the infections emerging from zoonotic diseases.
Kang, 57, is the executive director of the Translational Health Science and Technology Institute, an autonomous body under the Ministry of Science and Technology, Government of India and was the first woman from India to be elected as a Fellow of the Royal Society. More importantly, she currently serves as a member on the board of the Coalition for Epidemic Preparedness Innovations (CEPI), a global alliance financing and coordinating the development of vaccines against emerging infectious diseases. CEPI works with public, private and civil society organisations, as per its website.
Kang said that with CEPI funding, the University of Queensland and US-based biotech company Moderna have developed a vaccine candidate in six weeks, which she termed as “phenomenal”. These vaccines will be tested in clinical trials and animal trials and both sets of teams are trying to shorten the period of the vaccine roll out to a year and year and half. Edited excerpts:
India has undertaken screening of passengers, containment and pushed for self-reporting even as awareness about the disease is still poor, are these steps effective enough?
We are looking at people who are at a potential risk of being infected and screening them. But we know from SARS cases in Canada that despite screening people coming in from Hong Kong and China, the disease spread there. Doing this kind of screening is not the perfect way of preventing spread of infection, though it is helpful. You will find a certain number of cases and you will be able to undertake contact tracing and quarantine them. But because this virus can spread in the pre-symptomatic period as well, you are not going to be able to detect every case and therefore cannot prevent all disease. You will slow it down but won't be able to completely contain it.
We have dealt with infectious diseases in the past that were predictable. For example, in case of H1N1, we expected it to behave like some form of flu whereas in this case we are dealing with a disease that is hugely transmissible through the air. It is more difficult to control them through containment measures.
Three people have tested positive within 24 hours and three who were discharged are healthy. Do you think we may need to adopt measures like China and limit movement of people in the future?
I don't actually think it is doable in India. In order to be able to limit travel and movement to that extent, you need to have sufficient people to monitor and we do not have that. We have dense populations, a population that is used to independence and we don't have the kind of policing and monitoring mechanisms that would allow us to control population movements on a sustained basis. Doing a bandobast for a rally or doing it for a curfew is fine. But how do you do it across a wide region for a long period of time? We won't able to sustain containment in that fashion.
What impact will India's largely tropical climate have on the virus?
Yes, environmental conditions do play a role in how viruses spread and how long they survive in the environment. In enveloped viruses (ones that have an envelope or lipid membrane), drying is one way of getting rid of the virus and of not allowing it to infect cells. Similarly, high temperatures prevent viruses from growing. That is why you tend to see more influenza during winters. In this particular case, with the new virus we can take some lessons from other coronaviruses. But it is not a given. You don't know for sure that this virus is going to behave exactly like SARS (Severe acute respiratory syndrome). A lot of people are predicting that it may not survive high temperatures of Indian summer.
The global community is racing against time to develop a vaccine for Covid-19, is it possible to roll it out soon enough?
For respiratory viruses, given how they spread, prevention is always better than waiting for someone to get sick and then get them treated. The feasibility of a vaccine and the timing of the development of that vaccine are both things we don't know yet with certainty. There are already ongoing efforts. I am part of a group called CEPI (Coalition for Epidemic Preparedness Innovations) and I am on the board of the group. It is an international group that has funded different vaccine projects and one vaccine is already developed as a candidate. This means that we try this out to see if it will become a vaccine. Usually, the process can take four-five years after going through all the trials. We would like to shorten that period to one year so at least we can know if we have a vaccine candidate or not.
Already, we have done something fantastic. In six weeks, we have a candidate vaccine. That is phenomenal and it has never been done before. That's what makes me think that even if it is only a candidate at this stage, we can actually think that we will be able to progress fast enough to make a vaccine. If you look at Ebola the there was no vaccine during the first outbreak in 2014-15 but there was a candidate. But when people got together after Ebola, during the second outbreak the vaccine has been part of the management of that outbreak, despite the fact that it was in a conflict ridden zone where there are all kinds of challenges to contain diseases.
Who is developing the vaccine and where will it be tested?
The first vaccine is made by a company called Moderna, based in the US. The second vaccine has been developed by the University of Queensland, Australia. We will be seeing more vaccines in other countries soon. But when it comes to large scale manufacturing of vaccines, many of these companies are small companies. They are looking to Indian vaccine manufacturers to see whether they can partner with Indian companies to make them at a later stage when they think about their supply on a larger scale.
When CEPI decides to fund a vaccine programme, it is funding it for public good. The access is written into our grant. They can own the intellectual property but not use it to make an expensive product. CEPI gives grants to make sure the access issue is addressed. At every stage of development, it is discussed how the vaccine will reach the people in need.
What will it be tested on?
We will have to do clinical trials on people. Sometimes ferrets are used for testing vaccines for respiratory viruses before clinical trials.
It has been established now that Covid-19 was transmitted from wildlife to humans. But has the global community zeroed down on the particular species?
Right now, we don't know. We are not screening enough bats. Bats and Pangolins are the ones that have been proposed as the most likely sources. As we keep getting more strains and are sequencing more strains of coronaviruses from animals and humans, we will have a better sense of where it came from. To some extent it is not really relevant at this stage. It is good for us to understand. But we also need to understand that this animal-human crossover is going to keep happening. Viruses change, they adapt. When they cross that species barrier and come into humans, it’s more about understanding the ecology of animal-human interaction At this stage, whether it came from a bat or a cat or anything else does not matter quite so much. It could have gone through multiple animal species before making the jump to humans.
Which country, in your assessment, has done the most effective job in tackling the situation?
Right now I don't think any country is doing everything. China probably did the best job of both containment and screening of individuals. The kind of measures they put in to control the disease were drastic and they seem to have controlled it. Italy is doing containment in small towns where the cases have been identified but Italians, who are infected, are travelling to other parts of the world and are transmitting it. So containment in Italy is helping in small towns but it is not eliminating disease transmission completely. I am anticipating that that is what is going to happen with all the places that are doing this type of screening. You will miss some cases. We were doing this for H1N1 too. Ultimately it was found in a girl in Pune who had never travelled anywhere. Obviously local transmission was taking place and we missed it.
Do we need a more vigorous approach vis-a-vis diseases transmitted from wildlife to humans?
I think we need better surveillance. We don't do a good job of surveillance anytime. We don't know our endemic diseases let alone diseases that might potentially result in an epidemic. Improving lab surveillance for infectious diseases I think is essential and we need to make sure that labs get the support to have a systematic surveillance in place. This applies to not just humans, but also in the case of zoonotic diseases. Sometimes, screening animals gives us a signal that there is something that might be important.