A group of Indian public health experts that include doctors from AIIMS and the national task force on covid-19 members have warned against indiscriminate and incomplete vaccination, saying that it could trigger the emergence of mutant strains and advised against inoculating people already sickened by coronavirus.

Health experts from the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists (IAE) have advised that the governments current aim should be to vaccinate the vulnerable and those at risk instead of mass vaccination, including childre, according to an NDTV report.

"The present situation of the pandemic in the country demands that we should be guided by the logistics and epidemiological data to prioritise vaccination rather than opening vaccination for all age groups at this stage.

"Opening all fronts simultaneously will drain human and other resources and would be spreading it too thin to make an impact at the population level," the experts said in the report to Prime Minister Narendra Modi.

Unplanned and incomplete vaccination can promote mutant strains, they said while highlighting that vaccination of children and young adults was not supported by evidence and wasn't cost-effective.

"Mass, indiscriminate, and incomplete vaccination can also trigger emergence of mutant strains. Given the rapid transmission of infection in various parts of the country, it is unlikely that mass vaccination of all adults will catch up with the pace of natural infection among our young population," they said in the report.

Vaccinating people who have ben already infected by coronavirus was not required and such people may be vaccinated after evidence is generated that vaccination would be beneficial to them after natural infection, they noted.

They also asserted on evidence-based flexibility in scheduling vaccine doses pointing out the need to push the vaccination drive in those areas of populations where infection is on the rise due to specific variants.

For example, reducing the gap between two doses of Covishield should be considered in places where there is surge in Covid-19 cases due to the Delta variant.

Vaccinating all adults makes sense but in view of limited resources amid the pandemic the government should focus on inoculating the elderly persons with comorbidities and people with obesity. They said vaccinating young adults would not be cost effective in the current scenario

Experts suggested repeated local level serosurvyys in real time at the end of the second wave to map vulnerability at district level to formulate vaccine strategy and long term follow up of the population recovered from covid-19 to record green section celebrity to understand how long immunity purses after natural infection

So suggested that effectiveness should be studied by following vaccinated and unvaccinated individuals in different age straightener

India should also achieve the target of genome sequencing of at least 3% positive samples if not 5%. They pointed out that less than 1% sequencing of positive samples is unacceptable

The experts lauded the setting up of the Indian SARS-CoV-2 Genomics Consortium (INSACOG) of 10 national laboratories on time and adding 17 more laboratories.

They also pointed out the acute shortage of testing facilities for Covid-19 in rural and peri-urban areas.

"Timely testing of each and every symptomatic patient is not possible and will put a huge burden on the health system and will delay the isolation and treatment. The optimal solution in such a situation is to adopt a syndromic management approach. It should put focus on making a diagnosis based on clinical symptoms and epidemiologically linked suspects," they said.

The vaccination status of all individuals getting tested for Coronavirus should be stated in the sample referral form in the RTPCR app both for individuals tested by RTPCR and RAT.

This should be examined to study the status of vaccinated individuals if they get infected by coronavirus, the severity of infection and mortality.

They also suggested way forward for future.

"If the seroprevalence at district level, is more than 70 per cent (on account of a combination of natural infection and vaccination,) there should not be any lockdown and return to normalcy should be attempted.

"This will also help in prioritizing the districts for vaccination i.e. districts with lower seroprevalence should be given priority for vaccination. A fine balance is needed to be maintained between life and livelihood." (SAM)