Over the last several days, India’s overall dip in reported Covid-19 cases and deaths has seen many States relax restrictions and open their doors to business (almost nearly) as usual.

But in the neighbourhood, Hong Kong and Japan are grappling with a spike in cases. Hong Kong is even mulling a lockdown. Could that be a red flag from the region, as India navigates the tricky terrain mapped by the SARS-CoV-2 virus and its variants?

Other regions present mixed messages too, with the United Kingdom completely abandoning the mask mandate and experts in the US suggesting a fourth booster –something Israel did months ago. And this, even as a humanitarian situation unfolds from Russia’s attack on Ukraine, displacing over a million people in a week.

Looking at the evolving scenario in different regions, health experts point out that countries come with their own ground realities. Nevertheless, India would need to define a formal pathway ahead on booster doses, besides strengthening its genomic surveillance and healthcare delivery systems to “live with Covid”, and beyond, they say.

The Omicron variant of the virus, for instance, hit different countries at different times, as seen in South Africa and later in India. Japan is seeing its cycle of Omicorn playing out, says Siddhartha Kar, epidemiologist and UK Research and Innovation Future Leaders Fellow, University of Bristol.

Hong Kong presents a unique situation that comes from a combination of factors, including their early “zero Covid approach” (stringent restrictions that left a large number of people uninfected, hence susceptible now); they have a large population over 65 years and a sizeable number over 80 years, and only about half this number is vaccinated, he says.

Pointing out that India was in a very different position with extensive vaccination and exposures to the Delta and Omicron variants, Kar says, the country needs a clear policy on boosters. The evidence is that vaccines have worked well in preventing severe disease, he says. With multiple vaccines getting approval (including Covovax and Corbevax), and with newer vaccines in the pipeline (from Sanofi-GSK), a clear policy is needed, he says, specially since the situation tends to get worse in the second half of the year.

“Past the worst”

Dr Swapneil Parikh also believes that Hong Kong’s Covid-19 scenario is very different from that in India. Hong Kong has “dismal” vaccine coverage in the elderly and, the low exposure to the virus presents an “immunologically naive” population, says Dr Parikh, physician and co-author, `The Coronavirus : What you need to know about the global pandemic’.

While it is difficult to forecast virus behaviour, he says, India is possibly “past the worst”. The tricky part is the transition period between pandemic to endemic scenarios, to understand what would trigger the next, possibly seasonal, spike in Covid-19 cases. There is concern on the emergence of the next variant from inter-species shifts, underserved populations and immuno-compromised populations. Stressing the need for better surveillance, Dr Parikh urged researchers and vaccine-makers to work on variant-specific boosters.

Be prepared

Looking ahead, Kar suggests the Government could consider making vaccines available through the private sector, for those who may want to pay for it, and continue making it available through Government centres for the rest. While this would continue under the Government’s watch, it could bring about flexibility for those choosing to take a booster. Vaccines and masks are the centre-pieces of the prevention strategy, Kar outlines for the future.

Against the backdrop of war and with new virus variants being a worry, Kar says, India should continue to push internationally for a waiver on Intellectual Property (IP) on the newer Covid-19 tools, like the anti-viral Paxlovid from Pfizer, he said. It is better to be prepared for another wave, he says, as countries begin to approve and procure these pills.

The pandemic has overwhelmed an already over-burdened system, stretched healthcare workers, delayed public health programmes and essential treatments. Parikh says, the key issue is – ‘how Covid-19 has impacted our health infrastructure and how that will impact our health’. A worrisome thought that health administrators will now need to confront.