Need for comprehensive & transparent covid-19 vaccination policy

VACCINATING INDIA

Udayan Hazarika

(The writer can be reached at udayanhazarika@hotmail.com)

The country had started its Covid-19 vaccination programme Phase-I on 16th January 2021 for its healthcare workers and frontline staff and thereafter for the aged ones in the month of March last as usual with much publicity and campaign. The Prime Minister was put at the centre of the programme in which his role confined not only in the opening of the programme but also extended by pausing for a photograph to be put in the middle of the vaccination certificate issued to the person vaccinated which was only to be removed later by an order of the CEC of India. This indeed is a disgraceful act and the PMO must take the responsibility for this act of negligence. One major objection raised from various circles concerned is that although there is a Vaccination Policy for India yet before resorting to Covid-19 vaccination, the Government should have laid down a specific Covid-19 Vaccination Policy or a type of SOPs. At the time of approval, the two registered vaccines namely Covishield (AstraZeneca's vaccine manufactured by Serum Institute of India) and Covaxin (manufactured by Bharat Biotech Limited) were at various levels of trials. Of the three clinical trials conventionally required, both had cleared the Phase-I i.e. to assess the safety, its response to immunity and determination of doses which is done using small numbers of participants and Phase-II to test the safely and degree of immunity that it generates utilising about 100 persons. Till the time of its Clarence however, the Covaxin did not to pass the Phase –III trials in India which requires the vaccine to be clinically applied to at least one thousands of participants to determine its effectiveness. Why the government was in such a hurry to grant emergency use authorization (EUA) by the Central Drugs Standard Control Organization (CDSCO) in India has not been explained convincingly.

As the salt composition of these two vaccines is different, their degree of effectiveness in terms of immunity is bound to vary. This point should have been brought to the notice of the public and now at least losing no time, should be explained especially to them who are presently lining up for getting the vaccines. The citizens must be given opportunity to choose the best vaccine. The cases of relapse even after vaccination should be studied in-depth and the findings should be highlighted from the point of view of numbers of such cases corresponding to each vaccine. There is news about such relapses and detailed information should be made available to the public so that people know the actual facts and can decide further course of action. So far there is no information about the findings about such cases. Such indifference from the part of Government would be counterproductive- and in fact is one of the basic reasons why people in large numbers are not coming forward for vaccines. Government's Covid -19 vaccination policy as and when prepared must touch upon this point and lay down elaborately how to sensitise people in such cases.

Government have identified private hospitals for the purpose of vaccination. But not all these hospitals have same kinds of vaccines – if one has the Covaxin the other has the Covishilds. Each such hospital should invariably announce which vaccine that they are actually dealing with and their effectiveness. The contra indications and side effects of each vaccine should also be announced. All vaccines have their side effects- some occurs immediately after the vaccination while some emerges in course of time and some again appears only at the time of taking the consequent doses. In the present cases, the side effects are mentioned differently by different hospital staff. Mechanisms should be established to collect information about the side effects and reactions from the vaccinated persons. Occurrences of rise of body temperature or fever appear to be most common side effects which are sometimes followed by vomiting. In some cases only vomiting occurs for a small stint or sometimes diarrhoeas and whole body pain. All these occur usually for a short duration. There are also instances in which patients having pain in the body gets relieved of the pains for at least a week after taking the vaccines. All these side effects should be collected and compiled into a small video clip in easy languages and should be played repeatedly in the vaccination centres for the knowledge of the public.

It is not to be forgotten that both Covaxin and Covishield are still at the trial stage only. Their effectiveness is yet to be measured and confirmed. From the point of view of SII, Covishield is only a shield to protect persons from covid-19; it is yet to be ascertained whether it is bullet proof shield or not. However, it can be considered as a shield from death- even if a person gets infected by Covid-19 after the vaccination, Covishield will protect him from the threat to life as reported by SII. The available government data cannot confirm the length of immunities developed by a person after getting vaccinated. Evidently, the result will vary from person to person but at present it cannot be said to be a full-fledged Covid-19 eradication vaccine. It is said that at least six month should be length of immunities. But that is not confirmed as yet. So for the time being we may accept the vaccines as temporary relievers. Government must make studies of the vaccines prepared by other countries. Recently, the Russia made sputnik has been approved for EUA. But as usual information is in dark as to what led government to approve this particular vaccine?

Of the many questions raised about the vaccines, one important question is after vaccination when actually it starts working on the human body and starts showing its effects? Views vary from person to person. Some say that it takes 10 days; WHO says, most of the vaccines in the market take effect only after two weeks. According to the Serum Institute of India (SII), it takes 15 days to start immunities and by 28th day, 70 per cent immunity is achieved. Therefore, the Institute suggests that there should be a gap of at least 12 weeks from first dose of vaccine to second dose to get the ultimate immunity of the vaccine. But Government of India on its own has reduced the gap between the two doses to 4 weeks although the reasons were not stated for reducing the gap. Recently, the government has clarified that to get the best benefits of immunity, the time leg should be enhanced to 8 weeks. So vaccination or no vaccination, the status is similar while talking about taking protection.

There have been serious complaints lodged by various States that Central Government has been discriminating the non-BJP States regarding supply of the vaccines. Many non-BJP States (Maharashtra, Chhattisgarh, Telengala, West Bengal, etc) have already written to the Centre for adequate supply of vaccines. Maharashtra Health Minister Rajesh Tope has categorically stated that, "Gujarat has a population of 6 crore, they got 1 crore doses. We have a population of 12 crore, we got 1.04 crore doses." Government should come out with a transparent policy stating criteria on which supplies to the States are determined. Any subjective decision fixing supply to the States would only lead to chaos. The Central Government needs to come above narrow politics on such crucial issue where life and death of persons is involved. The question has also been raised by the former Prime Minister Manamohan Singh. But the PM Modi preferred to remain silent on the issue. His colleague Minister of Health while attempting to answer Mr Singh failed to reply any of the questions to the point.

In an unsigned press release issued by the Press Information Bureau on 20th April 2021, Government of India has declared its vaccine policy for the Phase-III. The policy inter alia states that from 1st May onwards the stakeholders will be able to purchase vaccines from open markets for persons of any age above 17 and allowed both the producers of the vaccines to sell out 50 per cent of their products to the stakeholders at a pre-determined price. Government of India should not have left the prices to be determined separately for the States. The States should have been allowed to get the vaccines at the same terms and conditions as applied to the central govern. This will open up a hole for further corruption on the matter. This move should have been done much earlier which would have saved many lives in the critical states. As per available data, not even 40 per cent of the target (of the 30 crore only 12 crore have been vaccinated so far) set for vaccination have been achieved so far.