Health

COVID-19 vaccines: Too many hurdles, still

 
By Vibha Varshney
Published: Friday 09 July 2021

Even if India manages to procure enough doses to inoculate its adult population by 2021, poor distribution networks and lack of skilled personnel will hinder its vaccination drive India is the global hub of vaccine production. It is also one of the very few countries that managed to develop an indigenous vaccine in record time. By last December, the country was all set with its COVID-19 operational guidelines to ensure a smooth rollout of the vaccines.

The government was so confident of its ability to meet domestic demand that it allowed more than 60 million doses to be exported or donated to other countries between January and March. Yet when the devastating second wave engulfed the country in April, the vaccine drive failed (see “Undecided”).

While people across the country struggled to secure vaccination slots on the national CoWin dashboard, the Centre worsened the situation by deciding to extend the vaccination net to include all adults under the age of 18 years. It was decided that the additional vaccines will be procured by the state governments, which clearly failed because of the global shortage and the fact that states have never procured vaccines in the past. Some of the states even unsuccessfully tried to float global tenders to forge deals with vaccine manufacturers. When the desperation peaked, the Supreme Court had to step in to make some sense out of the chaos.

On June 7, amid criticism of the government’s confused vaccine policy, the Centre announced universal vaccination. According to the latest policy, 75 per cent of the vaccines needed would be purchased by the Centre and provided to the states. 25 per cent of the vaccines would be available to private hospitals for which they would need to pay more and would be able to charge accordingly ( Rs 150 over the cost price). This universal rollout will begin from June 21.

India has the daunting task of vaccinating its entire adult population of nearly one billion by the end of this year. This will require almost two billion doses. In the first six months, the country has managed only 0.25 billion doses. To be able to deliver the 1.75 billion more doses in the remaining half of the year, the country needs at least 250 million doses a month. However, according to a Press Information Bureau release, only 120 million doses have been sanctioned for June, suggesting that the progress remains slow.

The Centre, though, is confident that the vaccine availability will shoot up in the coming months. It is relying on the SII and Bharat Biotech, the two major suppliers of vaccines in the country, to deliver 0.75 billion and 0.55 billion respectively by the year-end. The country is also hoping to import 0.16 billion Sputnik V vaccines, bringing the total to 1.5 million doses between August and December. The remaining shortfall is expected to be bridged by imports and newer vaccines (many of Indian origin). The Centre has in the past announced that Indian Immunologicals Limited will start producing Covaxin from September 2021 and Haffkine Institute and BIBCOL will start production of Covaxin from November 2021.

While the numbers add up, past experience suggests that the country must be ready for the slips between the cup and the lips. The delivery of Sputnik V vaccine has already been delayed from June to August.

The government also has the option of dose stretching to reduce the demand. For example, studies now show that people who have been infected by the virus might remain safe by taking a single dose. The government needs to take quick decisions on such aspects if it wants to help the people.

The other side of India’s vaccination challenge is ensuring speedy delivery of the doses, specially in the most peripheral places. Under the current universal immunisation programme, the country administers some 390 million doses to newborns and pregnant mothers in a year. For COVID-19 relief, the country will need to deliver an additional 250 million doses a month for the rest of 2021.

The country will need new infrastructure and more importantly skilled health personnel to deliver the extra doses. A vaccination centre needs at least five people, including a trained vaccinator.

It will also have to ramp up its rate of vaccine delivery. As on June 12, the country has 42,883 vaccination centres that have delivered 3.34 million doses, or 78 doses per centre per day. T Sundara-raman, global coordinator of People’s Health Movement, says rolling out COVID-19 vaccination without fixing the delivery challenges will lead to distinct problems: the vulnerable population will be left out and vaccine quality will take a hit due to limited availability of cold storage facilities and human resources.

As a virus jumps from one host to another and from one environment to another, it mutates. In the case of SARS-CoV-2 virus, these mutations have resulted in variants which can extend the pandemic. Many of the mutations have occurred in the very proteins that have been used to cook up the vaccine. WHO has so far identified four variants of concern (mutations linked to rapid spread in human population) and four variants of interest (mutations with genetic changes that can lead to rapid spread in the future).

The delta variant, which was predominant in India’s second wave, is almost 40 per cent more transmissible than the alpha variant, first reported from the UK in November 2020. The alpha variant itself is around 50 per cent more transmissible than the original virus isolated from Wuhan in December 2019. So time is of essence.

“More infectious variants increase the percentage of population that needs to be vaccinated to achieve herd immunity. Variants that partially evade immune responses are able to cause re-infections and breakthrough infections. All this makes it harder to control the pandemic,” says Shahid Jameel, director, Trivedi School of Biosciences, Ashoka University, Sonipat, Haryana.

What the world needs
The five pillars on which the global vaccination  policy should rest

Ensure adequate supply

  1. Free up technologies through TRIPS waiver1, C-TAP2
  2. Increase production facilities
  3. Promote collaborations for raw materials

Set a system for equitable distribution via COVAX

  1. Restrict hoarding
  2. Fund the facility
  3. Increase transparency on industry deals

 Protect people

  1. Increase transparency in trials
  2. Set up a system for monitoring adverse effects
  3. Set up a compensation system

Improve delivery

  1. Provide the vaccine free of cost
  2. Ensure access and increase rate of delivery
  3. Manage \issues around the digital divide

 Improve pandemic preparedness

  1. Monitor variants
  2. Provide rational treatment
  3. Promote pandemic-appropriate behaviour to
    control spread

1) India and South Africa have floated a proposal at WTO to suspend patents on products needed to control the pandemic
2)COVID-19 Technology Access Pool by WHO for sharing intellectual property, technology and data to increase access to medical products

 

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