Vaccine Rollout : Conditions Apply

With Pfizer/BioNtech becoming the first company to get its vaccine approved for public use in the United Kingdom (UK), the wait for a post-Covid world seems to have got shorter. New developments are taking place each day; in India, the Serum Institute of India (SII)’s Covishield and Bharat Biotech’s Covaxin stand just weeks away from getting regulatory clearances led by Pfizer, claiming the waiver of clinical trials in accordance with special provisions under the New Drugs and Clinical Trials Rules, 2019 and based on the results of its United States (US) trials. Who would’ve thought that vaccine generation which had till date been a decades’ long process would get abridged to a period of a year? Given the magnitude of this feat, it is only fitting to earmark 2020 in golden letters in the legacy of science.

However, does vaccine inception guarantee its distribution to one and all? While the vulnerability and essentiality clauses of the selection criteria call for prioritizing front line workers and senior citizens as the first beneficiaries of the inoculation drive and with politicians and bureaucrats in the mix, ordinary citizens will ultimately bear the brunt. Indians are very shrewd when it comes to making connections for claiming benefits. This will manifest in the form of those having political connections and resources getting an upper hand in the vaccination drive. By 2021, it has been estimated that 800 million Indians would have to be inoculated to meet the requirement of the herd immunity objective. Nonetheless, with no clear public vaccine rollout plan in place, it remains to be seen who all will make the cut.

Vaccines are our best bet against the virus, but not much is known about their capability to break the chain of transmission or indeed the efficacy of each vaccine. Apart from this, side-effects after being inoculated have also not been explored properly till date, courtesy of emergency approvals. When the news of an officer-bearer contracting Covid-19 after being injected with Covaxin made the rounds recently, the question of vaccine efficacy was raised again. Also, there is news of several volunteers of the same vaccine testing positive during trials. Given this, it would not be wise to let our guards down at such a critical stage. This calls for a need to tone down our over-optimism regarding the vaccine and adhere to the social vaccine which demands adherence to the 3S principle- social distancing, shielding through masks and sanitizing.

Even if the vaccines get accelerated approval, their storage and transportation will prove challenging. With Pfizer requiring temperatures as low as minus 70 degree Celsius for storage, its distribution in India will be problematic. But with new developments and use of dry ice, the vaccine vial can be stored for up to five days at refrigerated (2-8 degree Celsius) conditions. Given the burgeoning demand for the vaccine, this should not be that difficult to manage. Covishield, on the other hand, can be originally stored at refrigerated temperatures (2-8 degrees Celsius) without a need for thawing. With the Centre and states bolstering cold chain infrastructure, it is the administration that remains. Here is where we can reap the benefits of our past experiences. Our Universal Immunization Programme and Pulse Polio have won wide appreciation. With lakhs of centres across the country, the polio vaccine can be stored at minus 20 degree Celsius. Through our learning curve developed under these programmes and utilizing support from Primary Health Centres (PHCs), Community Health Centres (CHCs), ASHA workers and ANMs (Auxiliary Nurse Midwives), a network of professionals can be established to ensure that the vaccination reaches every beneficiary. Besides, Electronic Vaccination Intelligence Network (e-Vin)) transformed into Co-VIN will provide a schedule of all beneficiaries along with the dates allotted to them for vaccination, their vaccine centres as well as who administered the vaccine to whom. The objective is to ensure real-time monitoring of the beneficiaries to determine any adverse effects of the jab. Work is in progress to boost the database with the details of the beneficiaries. If we are able to execute this plan well, then last mile connectivity issues will no longer be an arduous task.

Another point that must be considered is long the vaccine-induced immunity will last? This is crucial given the fact that immunity developed against the Sars-CoV-2 is not indelible. No wonder, even after four rounds of sero-surveys in Delhi, the average percentage of people exhibiting antibodies remains just 25%. This is so because antibodies developed against the transmissible virus wane after a period of time. This implies that even people infected with the virus remain at a risk of reinfection as witnessed in a number of cases worldwide. On that account, does it make sense to inoculate such a vast number of people without knowing the duration of immunity post injection? What if a new strain develops before achieving the target?

Other than this, demands are being made to categorize the vaccine as a public good. Is this a worthwhile request given the uncertainty looming the immunization? With the government facing a fiscal crunch, it needs to be examined whether the vaccine will be subsidized and, if so, whether the recipient will be a person from the below poverty line cardholder category or whether everyone can avail of it.

Finally, can the vaccine emancipate us from the reign of protective equipment, face masks and sanitizers? We, as doctors, will scrutinize the UK closely since it was the first country to approve the mass vaccine rollout. With all these considerations, it might be premature to be over-optimistic about the vaccine. Let us wait for things to become clearer.