A Scoring System To Ensure High Risk Individuals Get Immunised First, Says AIIMS Director As India Approve COVID-19 Vaccines For Emergency Use

New Delhi: The Drugs Controller General of India (DCGI) has approved on Sunday (January 3) Astra-Zeneca-Oxford’s COVID-19 vaccine Covishield, manufactured by the Serum Institute, and indigenously developed Covaxin of Bharat Biotech for restricted emergency use in the country. This has paved the way for a massive inoculation drive in the country under which 30 crore people will be vaccinated. NDTV spoke to Dr. Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS), Delhi, to learn about the vaccines approved for emergency use.

Also Read: Scientists Outline Steps For Safely Receiving COVID-19 Vaccine

NDTV: Two vaccines have been approved for emergency use, your first reaction?

Dr Guleria: It is a great way to start the new year. What is encouraging is not only the fact that both the vaccines are made in India and one of them is truly make-in-India. Therefore, this means that we are not dependent on any other part of the world to supply us the vaccine. It also gives more confidence that these vaccines are safe in our population and we will not have a shortage as we did in the early days of the pandemic when we had to rely on other countries for PPEs (Personal Protective Equipments) and N-95 masks.

NDTV: 30 crore people have been identified in priority groups. What quantity of vaccines are currently present to inoculate these many people?

Dr Guleria: The data suggests that Serum Institute of India has around 5 crore doses currently available, as far as stockpiling is concerned. But after the green signal, they can produce vaccines on a regular basis which could be provided to the government. We are also hopeful that other manufacturers who are conducting final stage trials will also get approval. So, in a short span of time, we will get multiple manufacturers and that will increase the number of doses that are available to us to vaccinate the large population in the country that needs to be vaccinated. Once you have an ongoing supply chain, then you need to keep on having the production going on a regular basis to feed in the need in terms of providing the doses which can then be distributed across the country and as other vaccine manufacturers come in, the number of doses available in the next few weeks will increase and therefore, we will be able to vaccinate a larger number of people in the coming few weeks.

NDTV: How to identify people with comorbidities who are below and above the age of 50?

Dr Guleria: We have developed criteria for this. We are building a scoring system for comorbidities- whether it is diabetes or chronic respiratory diseases or chronic renal diseases or some other diseases. We try to see how we can score the comorbidities because even in that we have to prioritise. For example, there is a person who has well-controlled diabetes and is only on diet and there is another person who has been on insulin for 10 years or has suffered kidney damage because of diabetes or has developed eye problems. In such cases, the person with long-standing diabetes becomes a high priority than a person who is stable. Hopefully, by the end of this week, we will have some objective criteria based diagnosis for comorbidities which can be done even at a smaller hospital.

NDTV: How to get the vaccine?

Dr Guleria: There is a proper mechanism in place, according to which, once we have the priority groups identified, their data is uploaded into the App and the dashboard that the government of India has developed which is called as CoWin. Once this is done, it is then coordinated with the number of doses available at the site that has been designated for the vaccination. Then the individuals, names of whom have been uploaded, get a text message on their registered number providing them with the information about the time, date and venue of their due vaccination. At the vaccination site, when the individual turns up on the assigned date and time, the trained vaccine administrator will inoculate them.

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NDTV: How much will the cost of the vaccine and who will pay?

Dr Guleria: Currently, the vaccine cost is being supported by the government as part of its immunisation programme. So, I don’t think it will cost anything to the person who is getting vaccinated.

NDTV: How many doses are needed for the vaccine to be effective?

Dr Guleria: For the AstraZeneca vaccine, the second dose is given on Day 28 of taking the first dose. From the data that we have, we know that the first dose gives some immunity, but to really get the best immunity, you have to the second dose because it give good T-Cell immunity also and therefore, it gives you a higher level of immunity and for a longer period.

Now, in the United Kingdom, because of the increasing number of cases, they have changed their goal post for AstraZeneca vaccine and have decided that a person could get the first dose and the second dose can be given from Day 28 to upto 12 weeks from the day of receiving the first dose. They have some data of trials where the second dose was given later which shows that the immunity was maintained in the same way. The advantage of this regiment is that you can give a larger number of people at least one dose and theoretically give them some immunity.

This can be difficult because you are changing your goal post and you are having too much of a wide range to fix the date of vaccination. However, it also tells us that 28 days is not sacrosanct and as we roll out a vaccination plan in our country, we will have some sort of levy towards the second dose which will be helpful logistically. But currently, we will stick to the previous schedule because that is what was done during trials in the country- we give it on Day 0 and Day 28.

Also Read: Opinion: Epidemic Preparedness In Terms Of Healthcare Infrastructure

NDTV: What is the efficacy of COVID-19 vaccines approved?

Dr Guleria: The efficacy of the AstraZeneca-Oxford’s COVID-19 vaccine, based on the data that has been made available in the public domain, ranges from 70 per cent to more than 80 per cent and that is acceptable as far as the protection of a vaccine is concerned. It also has very good protection in terms of severity of illness and hospitalisation.

As far as the Bharat Biotech’s vaccine is concerned, we know that it is using the inactivated whole virion vaccine platform that has been used for other vaccines also in the country. So, we are comfortable with the platform. But, we need more data and that is why the authorisation which has been given is very precise that this is only approved for an emergency situation keeping in mind the fact that we have a variant of coronavirus which is now being leading to a huge spike in the number of cases in UK, Europe and the USA. So, I think what was probably felt was that we need to be proactive rather than reacting later on and thus, we should have another vaccine available, in case, the number of cases start surging suddenly and we need to inoculate more and more people. But the trial has to continue and we have to get more robust data in terms of safety and efficacy.

So, for the first few weeks, I think that the Bharat Biotech’s vaccine will be a backup and AstraZeneca-Oxford vaccine being manufactured in the country by the Serum Institute of India will be preferred more.

NDTV: What is the percentage of people in India who need to be vaccinated?

Dr Guleria: It is tough to answer because we are looking at two things. First is the percentage of people whom we need to vaccinate who have comorbidities and thereby we can decrease the mortality. Now this will again depend on two things: if we are able to cover people with comorbidities who are more than 50 years and covering a small per cent of people who are below 50 years of age but have comorbidities. The second is, how many relatively healthy individuals we need to cover so as to break the chain of transmission and bring down the cases. It will also depend on how many people have already got the infection and there is some level of immunity against the coronavirus already present in our population. Combining this with the number of people who will be receiving the vaccine will actually dramatically decrease the number of cases. So this is something we will come to know we start vaccinating a large number of people.

Also Read: All Set For Roll-Out, Just Waiting For COVID-19 Vaccine To Arrive In Delhi: Minister Satyendar Jain

NDTV: By when do you think, we will be able to cover 30 crore people?

Dr Guleria: I would say, it will take at least 4-5 months. But it will also depend on the regulatory approvals in the future of the vaccine candidates still under trials.

The vaccination will most probably start within two weeks.

NDTV: How important is it for frontline workers and their families to get a jab as they are constantly exposed?

Dr Guleria: It is very important. Because the doctors and nurses are well-versed in the infection control practices but when we talk about the other frontline workers like sanitary staff, we have to remember that they have not gone through any formal training of infection control. A lot of them are exposed to the infection at a high level because of the nature of their work which sometimes involves being in close contact to the patients. Therefore, it is very important that we cover them.

Also Read: Dry Run For COVID-19 Vaccination In All States, Union Territories On January 2

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.