Insights into Editorial: Whatever it takes: On govt. powers to combat vaccine hesitancy

Context:

India started its massive vaccination campaign aiming to inoculate 3 crore health and other frontline workers to start with.

With the highest number of coronavirus infections after the US, India plans to vaccinate around 30 crore people with two doses in the first six to eight months of this year.

Frontline workers will be followed by about 27 crore people older than 50 or deemed high-risk because of pre-existing medical conditions.

So far, Indian drug regulators have given the go-ahead to the Oxford-AstraZeneca developed and Serum Institute of India manufactured Covishield and Bharat Biotech International Ltd’s Covaxin for domestic inoculation.

A second lot of vaccines including Zydus Cadila’s ZyCoV-D, Russia’s Sputnik V, Biological E’s protein subunit shots, and Gennova Biopharmaceutical’s mRNA jabs, are likely to be ready between March and August.

Besides these, the Pune-based Serum Institute is also likely to make doses of a vaccine developed by US-based Novax company.

Marked favouring for Vaccination:

1. Faith in entities is often an act of personal commitment not amenable to falsification, but trust in a scientific process can be established with confidence-building measures and full disclosure of all relevant data.
2. Any mass campaign that involves voluntary effort on the part of the public can succeed only when transparency and open communication channels are the tools of choice.
3. If the poor rate of uptake of the COVID-19 vaccine in most of the States in the country is any indication, the government has not taken the people of the country along, in what is a purely voluntary exercise, but one vested with great power to retard the pace of the epidemic.
4. For instance, Tamil Nadu, a State perceived to be largely health literate, and relatively well-equipped with health infrastructure, achieved only over 16% of its targeted coverage on the launch day.
5. On the second day of vaccination, the compliance further dropped; in some States, vaccination was suspended.
6. A marked favouring of the Covishield vaccine over Covaxin was also noticed in multiple States.

India announces supply of coronavirus vaccines to six countries under grant assistance:

1. India announced that it will supply COVID-19 vaccines under grant assistance to Bhutan, Maldives, Bangladesh, Nepal, Myanmar and Seychelles.
2. The Ministry of External Affairs said India will supply COVID-19 vaccines to partner countries over the coming weeks and months in a phased manner keeping in view the domestic requirements.
3. It said India is awaiting confirmation of necessary regulatory clearances from Sri Lanka, Afghanistan and Mauritius for supply of the vaccines.
4. India has received several requests for the supply of Indian-manufactured vaccines from neighbouring and key partner countries.
5. India has already rolled out a massive coronavirus vaccination drive under which two vaccines, Covishield and Covaxin, are being administered to frontline health workers across the country.
6. While Oxford-AstraZeneca’s Covishield is being manufactured by the Serum Institute, and the Covaxin is being produced by Bharat Biotech.

What are co-morbidities and why do they make COVID-19 severe and life-threatening?

1. COVID-19 is an infectious disease and especially affects the lungs. The immune system responds as best as it can.
2. Within 2-3 weeks of infection, when immunity is at its peak, the immune system may clear the virus from the organs, but the damages to the organs take time to repair.
3. In the absence of co-morbidities, the body physiology can bounce back to normalcy quickly, but in those with co-morbidities, the ailing organs may not recover in time to avert death due to damage to the lungs, heart, kidney or brain.
4. The borders between infectious pathology and metabolic/vascular pathology are blurred or breached.
5. Chronic nutritional/metabolic diseases start as diabetes, hypertension, metabolic syndrome or obesity.
6. They in turn lead to chronic heart, brain and kidney diseases because of damage to the lining cells of the blood vessels, the ‘endothelium’.
7. For someone with an acute disease, a pre-existing chronic disease is now a co-morbidity.
8. The immune system is highly conserved even in undernourished people; the impact of co-morbidities on the immune system is mild.
9. Exceptions occur: TB is more common in undernourished adults and uncontrolled diabetes; metabolic syndrome, however, is associated with over-nutrition.
10. If someone with a co-morbidity gets COVID-19, the disease severity is increased out of proportion to any subtle or mild effect of the co-morbidity on the immune system.

However, don’t doubt Indian vaccines:

1. Several people have questioned the emergency approval given to the indigenously developed COVID-19 vaccine.
2. They have demanded efficacy data and cast aspersions on the regulatory machinery. Such views will only increase vaccine hesitancy.
3. It is not the case that the vaccine developed indigenously is being pushed by vested interests, while the international vaccines are great.
4. Questions have been raised about the Moderna and Pfizer vaccines too, which have reported more than 90% efficacy.
5. A vaccine, unequivocally, is public good, but the lack of transparency surrounding the roll-out of the COVID vaccines has done little to enhance trust in this experiential principle.
6. This uncommon haste in trying to lunge towards the tape while still some distance from the finish line might have been justified if the state had taken the people along.
7. Vaccinating the nation, however, is less a race than a slow and steady process. Building confidence in the process is crucial to achieving the task at hand.
8. Prime Minister Modi’s oft-repeated mantra, ‘Sabka Saath, Sabka Vikas’, is very relevant here. And the Health Ministry must do whatever it takes to make a success of the vaccination drive.

Moving Ahead:

Given the context of the pandemic, it would be prudent for India to go by safety studies (Phase I and II) and assessment of virus neutralisation assays with the serum.

It is also not appropriate to doubt the integrity of the expert committee advising the Drugs Controller General of India (DCGI).

The DCGI is not just an individual to be pressured; it follows due process for making an informed decision regarding emergency use, or, as is called in India, approval for restricted use.

It is understandable that limited approval has been given in clinical trial mode, where individuals vaccinated will be monitored regularly.

Though no particular vaccine candidate should be favoured, candidates with proven safety studies and efficacy, as assessed based on the virus neutralisation potency of the sera, should be allowed to go ahead.

Eventually, affordability could become an issue. Selective criticism of indigenous efforts will only jeopardise such efforts. India has a huge population to be vaccinated and we need to move ahead.