Along with all the mayhem, Covid-19 also left behind some important lessons for the public and governments. It paved the way for crucial platforms, interconnectedness between institutions, increased manufacturing capacity and a novel approach to handling a future pandemic. Dr Renu Swarup, Former Secretary of the Department of Biotechnology (DBT), Ministry of Science and Technology, Government of India, who led the Covid-19 vaccine, diagnostics and genome sequencing mission for India, sheds some light on the ecosystem that has been created.
Dr Swarup is credited with the establishment of the country’s largest microbial resource centre, the National Centre for Microbial Resources (NCMR).
Q. What role has the COVID vaccine diagnostic and genome sequencing mission played during the pandemic?
When COVID came, the public or the citizens did not know about the significance of a vaccine, diagnostics or genome sequencing. Nobody even knew what genome sequencing was or how it would impact us. But as we moved into COVID, I think the diagnostics were the first ones that caught everyone’s attention because the pandemic touched everyone’s lives. And we realised immediately how important diagnostics were, how important it was to do the testing, which led us to the tracking.
And very early on, the message started coming that we have to have a vaccine immunisation program because vaccines are going to be the only way that will build your immunity and help you fight that virus. It was important that we develop our own indigenous vaccines and diagnostics because we had the capacities and capabilities to do it and we needed them in large numbers. The supply chain was disrupted due to the pandemic.
And for any country, not just India, which obviously has a huge, huge population, but for any country at that point of time to procure such a large number of vaccines and diagnostics was extremely tough.
And the only way that we had to take it forward was to develop it indigenously. The Ministry of Science, my own department, and the Department of Biotechnology were responsible, and we could do it.
But this was clearly a mission that had to be launched because it was a war on humanity and no war can be fought unless it’s fought in a systematic, planned manner.
The genome sequencing came along the way. We realised that, being a virus, there would be mutations and India was so well prepared.
“the pandemic has resulted in the creation of an ecosystem.”
Q. What role did the COVID vaccine, Diagnostic and Genome Sequencing Mission play and what is it doing right now?
A mission is set-up with a very focused objective and goal. Missions don’t continue forever. So, we achieved vaccination. In the diagnostics, on March 26th, 2020, I think we got the first indigenous diagnostic approved by CDSCO (Central Drugs Standard Control Organization). The cases were rising and by mid-June, we were already producing over 10 lakh kits per day.
In terms of vaccination, as you already know, over a billion people have been vaccinated, not just with 2 doses but with a precautionary dose as well. Mission Covid Suraksha was launched to develop indigenous vaccines. We invested in high-risk research to develop vaccine candidates on different platforms. From Covaxin to Covishield to Corbevax, the world’s first DNA vaccine, the mRNA vaccine, the nasal vaccine, and Novovax – we had a number of vaccines ready for human immunisation. Covaxin and Covishield were produced in very large quantities, and they also scaled up their manufacturing capacities. Through the mission, there was also an effort to strengthen the gaps in the ecosystem and build a robust translational ecosystem, which helped foster public private partnerships.
Then comes the genome sequencing. We had taken up sequencing of the virus at different laboratories and locations across the country to understand and study the trend of mutations. However, when the Alpha strain emerged as a variant of concern, it was important that we do extensive genome sequencing and link it with epidemiological surveillance. INSACOG (Indian SARS-CoV-2 Genomics Consortium) didn’t exist then. We, however, had individual laboratories that had strength. We initially had just 10 laboratories. INSACOG was set up in December of 2020. Today, we have over 50 or 60 laboratories. Every state has become a part of it. So, a huge infrastructure has been set up. We have built a capacity, an ecosystem, just in case we need it in the future. The mission was accomplished successfully.
The INSACOG is there. It is still doing the testing but now it’s also looking at getting into other viruses or other infections because it’s a surveillance system. It got connected to the epidemiological surveillance that the NCDC (National Centre for Disease Control) and others do. A good hospital network connection has been established.
(INSACOG is a multi-laboratory, multi-agency, Pan-India network to monitor genomic variations in the SARS-CoV-2)
Q. What were the challenges faced in implementing the mission?
We didn’t have the luxury of time. Moreover, we had lockdowns and supply chain disruptions. We had a lot of people who were infected and fell sick. The workforce would be reduced. When we started our diagnostic preparation, we realised that we had the capacity to develop diagnostics but mostly all of the reagents used to be imported. Due to supply chain disruptions, we had to start building them indigenously. So, we launched NBRIC at cCAMP Bangalore. We made them the Nodal Center. We brought in about 30 initially and then subsequently, it became over 300 manufacturers who were manufacturing these reagents for different purposes. They then provided reagents for our kits; there was an aggregate demand and an assured supply.
We suddenly had to also map the existing landscape. We had a lot of laboratories that were very competent, but they all didn’t have BSL 3 facilities. So, we had to set up BSL 3 facilities all over our institutes. We had set up biorepositories. They were holding COVID clinical samples, moving forward, they will always continue to hold samples. We do keep having these epidemics or these little outbreaks like NIPA and Zika. In the same line, we recently had monkeypox. We had the capacity to handle these but with COVID, we took it to the next level.
We realised that we had excellent animal house facilities, animal challenge facilities, but we needed specific disease models.
Q. In terms of public communication, how is information disseminated to ensure transparency and build public trust in the mission’s activity?
So, one was the informal way of dissemination – through the media, with which, of course, we used to have regular briefing sessions for the Ministry of Health. Those sessions got the message across.
The government kept bringing out these information bulletins. We ramped up a number of our databases and digital health portals. So, the NCDC already had this IDSP (Integrated Disease Surveillance Programme) or surveillance programme. It had integrated health, the information portal and the ITIP, which has a number of diseases already mapped onto it.
We have the primary health care centres, tertiary healthcare centres, state-level district officers, and all that data that is coming.
Through this system, we’ve brought everything together.
We had the ICMR data, the genomic sequencing data, the COVID app data and state-level information all coming together.
So, this information is being disseminated. There is some information that, based on the analysis of the data, has to go back to the states. It’s like a warning system for them; let them know where clusters are and what immediate action needs to be taken.
The other second level of information is information that has to be shared with the public in terms of the measures you need to take, and the COVID appropriate behaviours you need to follow. How important is vaccination? Why is it that people need to be vaccinated?
Or why should you isolate yourself? Why do you really need to be informed in terms of being a tracking thing? So those are again information, advocacy, and that became a system through this whole coordination effort done by the health ministry.
Q. What lessons were learned from the mission that could be applied to pandemic preparedness and response?
Never before in our lifetime have, we faced a pandemic like this. We learned a lot of lessons. Globally and nationally, there are efforts going on now to document these lessons.
Now it’s important that we do not let this whole thing get disintegrated. The lesson is that now we should have early preparedness. We have ramped up our manufacturing capacity. So, how do we continue to sustain them? How do we globally stay connected?
There is a need for equity and access for everyone to have the vaccines, the diagnostics.
I think we need to continue to invest in R&D. We have to look at the priority pathogens, which are important for us.
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