Of course, some things are different. Many of the countries on the chart above got hit by a third wave when there weren’t any vaccines. But vaccines work to prevent large-scale outbreaks, and going by current rates in India, it looks like it will be a while before we vaccinate everyone. 

Also, we may just avoid a third wave due to other factors. There’s a lot we don’t know about the virus, and we may just get lucky. But probability swings both ways, so it’s equally likely that we may get incredibly unlucky.

I’ve written before about how India lost the vaccine war, which was one of the contributing factors to the severity and scope of the second wave that’s destroying the country. 

Today, I’m going to write about India’s preparation for the war that lies ahead. 

What happens in the third wave? Who is likely to get impacted? And are we ready and prepared for it? 

Let’s dive in. 

It’s been over a year since the coronavirus hit us. So, before we get to the third wave, it’s time to assess what we’ve done so far, what we’ve learnt, and how our understanding of the virus has evolved. 

At the outset, let me say that a lot of what’s written below is simplistic and stripped of scientific nuance. Science has a very high bar for what constitutes evidence—most of which takes a lot of time, proof, and rigorous testing. A lot of what we know today is indicative and even suggestive, but not necessarily conclusive. 

When Covid-19 hit the world last year, there was little consensus on what exactly needed to be done. It was unclear if masks were needed, or if we needed to go into a lockdown, and for how long. 

In March 2020, a science fiction author named Tomas Pueyo wrote a fairly viral Medium post, where he summarised the pandemic measures that needed to be taken, and the associated costs, benefits, and consequences of that decision. It’s a strategy he called ‘The Hammer and the Dance’. 

The idea of the hammer and the dance is this—move quickly at first and restrict everything decisively. Go into a lockdown. Ramp up healthcare. That’s the hammer. After a certain period of time, when the number of cases go down, go into a dance—start loosening restrictions, monitor people, do contact tracing, etc. The purpose of the hammer and dance strategy is not to eliminate the virus, but to accumulate and buy the most precious resource that you need when you are hit by a global pandemic. 

Time. 

When you have a pandemic, nothing is more valuable than time. Time helps you prepare. Time helps you to ramp up hospital capacity and ICU beds. When you wield the hammer, you essentially slow down the transmission of the coronavirus, and when that happens, you delay the war. This helps you prepare. And more than anything else, time gets you closer to the only thing you need to defeat the virus—a vaccine. And no matter how hard we work, vaccines take time. The world needed time. 

So for most of 2020, the world adopted this approach—in varying degrees of execution and implementation. Lockdown. And then a slight release when cases went down. And then lockdown again when it went back up. Meanwhile, scientists worked furiously, and in what will surely count as one of the greatest scientific accomplishments in the history of the human race, developed multiple vaccines at a speed and efficacy never seen before. 

However, vaccines take time to produce and deploy. Human beings could stay indoors only for so long. Plus, economies started to come under stress. And lockdowns are a tool to control outbreaks in smaller populations—not for several billion. So the world continued to get infected at rapid rates. 

In parallel, another theory was starting to take hold. It was the idea of herd immunity. Some people reasoned that since we were getting infected anyway, the infected folks would develop a natural immunity to the virus. If enough people were infected and immune in a population, it would prevent the virus from spreading among those who weren’t, so it would die a natural death. 

Some others took this even further—if a good part of the population was already infected, and if a big chunk of the uninfected population was vaccinated, then herd immunity would kick in even faster.

Here’s the New York Times estimating how long it would take to reach herd immunity by combining both those numbers.

To be clear, this is very, very preliminary data. And this does not suggest that vaccines are totally ineffective against variants, but that some vaccines may be less effective against some variants. 

That’s more or less what we know so far. 

So what does this mean? 

Well, in short, it’s increasingly likely that the coronavirus may never go away. 

Instead, the virus will probably keep mutating and circulating amongst the population. Alongside this, we will likely continue to create vaccines that fight newer and newer variants, until the virus mutates to (hopefully) become less and less deadly over time, and it gets concentrated in local, smaller populations or even become seasonal, like the flu. 

This has deep implications for all of us, but especially so for India.
 

India’s Third Wave 

A direct consequence of the unending battle between vaccines and variants is that the Covid-19 vaccine isn’t something that needs to be administered once to everyone, but one that needs to be given periodically—maybe once a year. 

Assuming this happens, this completely changes our existing assumptions about the economics, manufacturing, and production of vaccines. 

The CEOs of Pfizer and Johnson & Johnson, both major manufacturers of Covid-19 vaccines, have recently said that people may need to get vaccinated annually against the virus. To be clear, there’s little scientific data at this point to suggest that annual vaccinations are needed, but directionally, it’s looking more likely by the day.

Pharma companies are preparing for this eventuality.

Assuming this pans out, the projections made by countries like India for how long they’ll take to vaccinate their entire population will go completely out of sync. Vaccine manufacturers may scale up production, only to keep producing boosters, while the majority of the country remains unvaccinated. 

That’s the first problem—a large population remains unvaccinated because booster shots corner the demand from vaccine manufacturers. 

Then there’s the second problem, a far worse one, about who gets infected when the third wave hits India. Many scientists believe that there’s a good chance that the third wave will affect children the most. 

If that happens, that’s a terrifying scenario. 

Here’s Dr Devi Shetty, Chairman and Founder of Narayana Health, explaining what happens if this pans out. 

Dr. Shetty goes on to list all the things India needs to do to prepare for this wave. An “army of young nurses and doctors on standby” are needed. Drugs like Crocin need to be manufactured on a war footing. Oxygen. And so on. 

The good news is that there are signs that India is taking this possibility seriously, and appears to be doing some preparation for it. The government of Karnataka has appointed Shetty the chairman of a task force to prepare for the third wave. Uttar Pradesh is setting up paediatric ICUs as well. Other states are following suit. 

Even the vaccine manufacturers are moving on this. Bharat Biotech, which is responsible for manufacturing Covaxin, has started trials for children between the ages of 2 to 18. 

It remains to be seen whether we will be ready when the third wave hits India. 

Because now, we still the one thing we thought we had earlier and largely squandered.

Time.