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Insights into Editorial: Weighing the costs: On COVID-19 vaccine

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Context:

Union Health Minister, on multiple occasions has said that an India-made vaccine was likely to be available in “early 2021”. The government already has an expert committee on vaccine distribution.

With over 6 million cases and the death toll from COVID-19 approaching 100,000, India is entering the first winter of the pandemic.

Viral infections, particularly of the influenza variety, are also common at this time of the year and there may be new unknowns in the risks that lie ahead.

However, another potential milestone approaches: the probable availability of a vaccine.

Expert committee on vaccine distribution:

  1. The government had formed the expert committee comprising representatives from all relevant ministries and institutions to oversee all aspects of its Covid-19 vaccine plan.
  2. It has been tasked with the identification of the vaccine to buying to financing the purchase to distribution and administration.
  3. The committee members will take the decision on vaccines that will be effective for Indian citizens. The task force will also chalk out a budget and discuss how capital can be raised for procurement, distribution of the vaccine.
  4. Moreover, the high-level panel will prepare a strategy on inventory management and administration.
  5. Expert committee job is to decide who gets the vaccine first, how many will be eligible for the early doses, what the costs would be, and whether there should be a cost at all for the majority of Indians, who anyway were the hardest hit by the pandemic in the summer.
  6. Storage and supply of vaccines are also problems as daunting as making one and pose complex challenges in India.

Nobody would be denied a vaccine on the grounds of affordability:

The government is yet to make its policy on distribution explicit but the current thinking appears to be that nobody would be denied a vaccine on the grounds of affordability.

There is even discussion that a vaccine may be available via the national immunisation programme.

This initiative currently offers at least nine vaccines for preventable diseases free for children and pregnant women.

The pandemic’s global nature has meant that even the quest for a vaccine is international.

The GAVI Covax alliance has emerged as the largest coordinator of vaccine development as well as distribution of a probable vaccine.

Based on a combination of payments by 78 high-income countries and donations, the GAVI Covax aims to ensure that between 15-20% of every country’s population, or at least their most vulnerable, are able to be inoculated first.

COVAX Facility:

Gavi is coordinating the development and implementation of the COVAX Facility, the global procurement mechanism of COVAX.

The COVAX Facility will make investments across a broad portfolio of promising vaccine candidates (including those being supported by CEPI) to make sure at-risk investment in manufacturing happens now.

This means the COVAX Facility, by pooling purchasing power from all countries that participate, will have rapid access to doses of safe and effective vaccines as soon as they receive regulatory approval.

Gavi is working with Alliance partners UNICEF and WHO to ensure that the infrastructure is in place, and the technical support available, to make sure COVID-19 vaccines can be safely delivered to all those who need them.

Gavi is also part of the health systems work of the ACT-Accelerator effort, focusing on areas where it has expertise and experience, such as cold chain.

Guided by an allocation framework being developed by WHO, the COVAX Facility will then equitably distribute these doses to help protect the most at-risk groups in all participating countries.

Once the vaccine has been rolled out to scale, how long will it take to bring the pandemic to a halt?

  1. The pandemic comes to a halt when there are enough people immune in the population, and the virus can no longer transmit from person to person.
  2. There are two ways we get immunity, the first is by getting the infection, and the other is through vaccination.
  3. For many diseases, we build up our immunity by getting the infection in childhood. That is true of many coronaviruses that exist in the world today.
  4. We have all had them as children, and that has built up our immunity. The difference here is that this is a new virus that no humans have seen before, and so it will take a while for that immunity to build up.
  5. The problem is that if you just have a virus spreading wildly until everyone is immune, there will be lots of people dead in the meantime.
  6. That is where the vaccines may be able to intervene, by generating immunity without facing the consequences of the infection.
  7. We need to have enough doses of the vaccine available, and then we need to be able to vaccinate enough people to stop the virus in its tracks.
  8. But that is quite a big deal. First of all, you have got to manufacture it at an enormous scale, for a country like India, to be able to vaccinate a large proportion of the population.
  9. Then you actually have to get out and deliver the vaccine on a scale that has never been seen before. That is also a big hurdle.
  10. Even if you have a vaccine and you have enough doses, the logistics of preventing infection is everyone is going to be a huge, mass vaccination programme.
  11. Many countries are thinking, initially, about how to protect those at greatest risk, like hospital workers, older individuals, and those with comorbidities. That is probably the right way to start.

Conclusion:

In principle, these are laudable aims and underline principles of equity. A paucity of testing facilities and equipment in March led to stringent restrictions on who could be tested.

Though the tests were ‘free’, they were first available only in government facilities and this contributed to a significant pool of untested carriers and a rapid spread of the virus that was only marginally blunted by the lockdown.

Only after the number of labs expanded to both public and private labs, restrictions on who could get tested were removed and, a greater variety of tests became available that disease management improved even though testing though not expensive was also not free.

It is to be anticipated that vaccine delivery will be a protracted process and it will be a long time before the average citizen has access to it.

There are at least three Indian companies testing their own vaccines, and so a prohibitively expensive vaccine, besides being unacceptable, is also unlikely.