Ever since a new variant of the Covid-19 virus, named B.1.1.7, was reported late last year from UK with a 30-80 percent increased transmissibility and nearly 30 percent increased risk of serious illness, the world has been grappling with the challenge of new variants arising in populations across the world. New variants that evade existing immunity like the South African (B.1.351) and the Brazilian (P.1) variant may be responsible for the new waves even in areas where seroprevalence studies indicated herd immunity levels, as was evident in one province of Brazil. The double mutant variant of concern reported from India that has mutations noted in South Africa and California may have both high transmissibility and immunity evasion and might explain the behavior of the second wave in the country. Since some of the variants may evade immunity induced by current vaccines, it becomes vital to understand the efficacy of the vaccines against the emerging variants.
Genomic surveillance coupled with epidemiological and clinical surveillance is critical to guide the response of the health systems during such times. The Indian SARS-CoV2 Genomic Consortia (INSACOG) consisting ten reputed public research labs has been set up to undertake genomic surveillance. Despite the guidance that 5 percent of all Covidpositive samples should undergo genomic analysis, only 9722 genomes have been analyzed as on 11th February. What could be reasons for not undertaking genomic analysis on the requisite number of samples?
A set of practical issues might be hampering the pace at which the samples are being analyzed. Most research labs have been facing a shortage of funds given the impact on the economy. Added to that, labs are facing a new challenge from the recent policy on limiting imports by various public research undertakings. As part of theAtmaNirbhar Bharat (self reliant India) agenda, there have been attempts to reduce imports by various public sector undertakings including defense establishments and research labs across the country. One of the unintended consequences of the new policy has been the acute shortage of critical reagents to undertake genomic analysis.
There may be another set of reasons for the inadequate genomic surveillance. It becomes critical for the government to ramp up the genomic analysis as it provides the important ongoing insight required in fine-tuning and improving the public health response. The government should rethink the guidelines regarding the import of vital ingredients required to undertake the needed research in disease surveillance, revalidating the current diagnostic tests, and continuously testing the effectiveness of the current vaccines in in-vitro and animal tests. If the clinical behavior changes due to the new variants, it becomes important to relook at the current guidelines on the drug, convalescent plasma, and monoclonal antibody therapies which were studied in the original pandemic strain.