Going Viral - Dr. Balram Bhargava (Details)


INDIA'S JOURNEY IN DEVELOPING COVAXIN

CHALLENGE FACED

CONTEXT

CHALLENGE DEFEATED

Lack of health infrastructure

  • Population of 1.3 billion
  • Public and private sector models in India
  • Public sector caters to financially needy
  •  Private sector catered to those who could afford costs
  • Aim of universal health coverage could not be met through the private sector alone

 

  • Impose a nationwide lockdown on 24th March
  • Restrictive measures to contain the spread of the virus
  • Added time to ramp up resources

Shortage of sufficient samples for ICMR and NIV to isolate and study virus

  • Requirement of high-quality samples
  • samples needed to have a high viral load
  • Someone had to deliver them safely to the NIV lab

12 tourist samples arrived in New Delhi

Genomic sequencing was conducted overnight

Requirement of mass production of testing kits

  •  First seroprevalence survey in April 2020 to assess the extent of virus
  • Testing kits needed
  • BSL-4 team grew the virus, standardized ELISA tests

 

  •  NIV team created testing kits
  • CovidKavach ELISA was launched by Zydus Cadila in May 2020
  • Team effort between GOI and private sector bodies

The key challenge to procuring components to develop kits


  • Serum institute of India gave sealers
  • NIV gave lyophilizers

Testing 1.3 billion people for infection

By May 2020, India was performing 100.000 COVID tests/per day

  • Dedicated teams from research institutes, medical colleges, and ministries worked together
  •  Postal services involved
  • Civil aviation, and railways helped in the transportation of goods to each corner of the country

Logistic issues in conducting RT-PCR tests

  •  Paucity of material
  •  China à seller’s market for testing kits
  • Expensive, had to place prompt orders within 12h to ensure the deal with China

  • India started manufacturing RT-PCR kits
  • Setting up of Government
  • e-Marketplace
  • Licensing of private companies to manufacture kit materials
  • Grants from the Ministry of Textiles to support these companies
  •  24 additional validation centers approved apart from NIV to validate kits before testing
  • Mission “lifeline UDAAN” setup by Ministry of Civil aviation to help transport kits around country

Making testing accessible to all Indians


  • Scale up labs
  • Upgrade BSL-3, BSL-2 labs to BSL-4
  • Participation of private enterprise
  • Set up NABL to ensure qualified labs are made testing centers
  • Training sessions for operationalization of labs
  • Tru-NAT technology – repurposing TB diagnostic equipment for COVID testing

Testing stranded Indian pilgrims in Iran

  • Screening and testing
  • Set-up RT-PCR center to collect swabs in Indian embassy
  • Quarantine center to house >250 Indians

Small team from NIV flew to Tehran to conduct testing. Incredibly patriotic!

Speculation of Plasma therapy as a treatment modality

Patients insisted in desperation as a form of treatment

PLACID trial from April to June 2020 confirmed that convalescent plasma had no effect on treatment.

  • PLACID trial

  • -          Setting up a multidisciplinary team
  • -          Assuring data quality and following protocol

  • -          Capacity building and training
  • -          Virtual meetings

 

Vaccine development

 

1.       Acquiring Rhesus monkeys for testing

2.       Protecting the experimental animals from SARS before starting preclinical trials

3.       Performing large animals experiments in NIVs high security containment facility

-           

  • -          Dedicated team travelled to Maharashtra to identify sites for capture of monkeys
  • -          Strict prevention protocols for animals

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