A third wave in India is an unlikely scenario with these high levels of antibodies, and vaccination levels continuing to rise.

It’s now recognised those who become naturally infected with COVID and recover before vaccination develop better immunity than those who only have antibodies from vaccination. This is referred to as “hybrid immunity” – those with previous SARS-CoV-2 infection mount unusually potent immune responses to the COVID vaccines.

The Centers for Disease Control in the US notes that both the fully vaccinated individuals and previously infected groups have a low risk of subsequent infection for at least 6 months.

Results of the most recent national serosurvey in India reflect the seroprevalence during the third week of June 2021; the Delta-led second wave had bottomed out at that time. Though about 30% of the population remained susceptible, subsequent serosurveys and an absence of any post-festival surge confirm continuing high levels of protection.

“Patchwork vaccination” areas, where there are pockets of low coverage of vaccination among areas with high levels of coverage, run the risk of small outbreaks, but are unlikely to be large enough to be of any major epidemiological concern.

With high seropositivity among adults, many of the new cases can now be expected among children, particularly with the reopening of educational institutions. But high levels of immunisation among teachers (upwards of 90%) and the emerging evidence that reopening schools has not been associated with significant increases in community transmission, are reassuring.

The WHO’s chief scientist said in late August that India seems to be “entering some stage of endemicity”. Endemic refers to the constant presence or usual prevalence of a disease in a population within a geographic area, where disease spread and rates are predictable.

Could a new variant, such as the Delta Plus subvariant first detected in India in April 2021 threaten the current relative stability? While it has been said it might be about 10–15% more transmissible than the Delta variant, the evidence from Europe suggests it has not yet been able to establish any dominance over Delta.

Of India’s 1.4 billion people, 26.9% are fully vaccinated and 54.9% have received at least one dose so far. But 35 million fewer women have been vaccinated compared to men and independent analyses show tribal and rural districts continue to lag.

There are two current targets: achieving 90% coverage of the first dose by the end of November and timely administration of the second dose. While the first is likely to be achieved, there are widespread reports of complacency regarding the second dose. A campaign is underway to encourage people to complete the schedule.

Delivering the billion plus doses has convincingly demonstrated vaccine confidence. But convincing people to take a vaccine when for many it seems like the risk has passed is a difficult task. Prior infection-induced immunity protects against reinfection but this acquired immunity wanes over time. Hence the recommendation for COVID vaccination for all eligible persons, including those who have been previously infected.

Districts with relatively low vaccine coverage require greater outreach efforts to reduce prevailing inequities. India’s immunisation program has demonstrated its strengths in polio eradication and measles-rubella elimination campaigns. We need to borrow some of those techniques to ensure all Indians are protected against COVID.

Rajib Dasgupta, Chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.