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How Will India Manage COVID-19 Vaccination Coverage?

As the world awaits a COVID-19 vaccine to end the pandemic, how can India, an important vaccine manufacturer, ensure vaccine for all?

How Will India Manage COVID-19 Vaccination Coverage?
Highlights
  • Safe and effective vaccine is the topmost priority: Expert
  • COVAX aims to procure and deliver 2 billion doses of vaccines by 2021 end
  • Prioritising who gets the vaccine first is crucial: Expert

“India’s research and manufacturing will be critical to fight COVID-19 especially for making vaccines on a large scale,” billionaire philanthropist Bill Gates said at the Grand Challenges Annual Meeting 2020 in October. Addressing the meeting, Mr Gates delved upon the difficulties in vaccine development and diagnostics of COVID-19. The business tycoon said India is ‘very inspiring’ as it has made huge strides in improving the health of its people in the last two decades. And now, India’s research and manufacturing will be critical to fight COVID-19 especially when it comes to making vaccines at a large scale, Mr Gates said.

Also Read: India Should Build COVID-19 Vaccine Confidence, Identify ‘Hesitancy Hotspots’: Immunisation Expert Heidi Larson

While the vaccine research and manufacturing for India may not seem like a challenge at the moment, with the country being home to a few of the world’s biggest vaccine manufacturers like Serum Institute and Bharat Biotech, however, concerns regarding an equitable vaccine distribution remain. Serum Institute has claimed capability to manufacture at least 300 million doses of the Oxford University COVID-19 vaccine. Bharat Biotech, on the other hand, had claimed last month, it will manufacture as many as a billion doses of a single-dose vaccine.

History shows that normally it takes 4-5 years for developing a vaccine as promising results in lab cannot be demonstrated in humans. Safety of vaccine is of paramount importance, and it takes a long process to demonstrate safety. With the advent of advanced technology, genetics and augmented intelligence this process is expected to be shortened. Nearly 323 vaccines are under various stages of development worldwide. Of them 9-10 are expected to be available by early next year, across the globe, Dr Ravi Wankhedkar, Treasurer of the World Medical Association 2019-21 and former National President of the Indian Medical Association tells NDTV.

Dr Wankhedkar says that discovery of a safe and effective vaccine for COVID-19 at the earliest appears to be one of the solutions in controlling this pandemic till the time a safe, affordable and effective medication is available. Discovery of such a vaccine is itself a big challenge, he added.

Also Read: How Do Indians Feel About The Highly-Anticipated COVID-19 Vaccine? A Survey Reveals

But how will a COVID-19 vaccine be distributed?

The even bigger challenge will come after the discovery of vaccine in the form of the actual process of vaccination. Priority should be for healthcare workers and vulnerable population, Dr Wankhedkar stated.

While the Union Health Minister Dr Harsh Vardhan has maintained that the government’s expert groups are still working on a vaccine distribution plan, he hinted at the prioritisation criteria for vaccination process.

Prioritisation of groups to be vaccinated shall be based on key considerations, first is the occupational hazard at the risk of exposure to the infection and second is the risk of developing severe disease and increased mortality, he said at the fifth episode of his weekly Sunday Samwaad on October 13.

Dr Sharad Gupta, said that ironically, one of the world’s biggest vaccine-producing nations faces one of the greatest global challenges in getting its 1.3 billion people immunised.

As a country, we do have an effective immunisation programme for babies and pregnant women but there is no such particular campaign in place for the rest of the population, especially the senior citizens, who are the most vulnerable to COVID-19. Our healthcare system is overburdened, has been pushed to breaking point by the pandemic in many areas particularly the rural parts, where the people barely have access to healthcare at all, Dr Gupta said.

Furthermore, when it comes to the logistics, Dr Wankhedkar says that the production, storage, distribution, inoculation, among other factors will be challenging as well.

Making the glass vials available, packaging materials, syringes, transportation worldwide, maintenance of cold chain are just a few of the logistical issues. Financing this entire operation is another big issue. Further for inoculation to the last person would involve the same over worked, understaffed fatigued human resources of health department. Priorities will have to be decided who gets the vaccine first, which countries and then which population in that country, he explains.

Another worry is the scale and the tracking, how will the government track among the 137 crore people, as to who got the vaccine and who didn’t.

This is where COVAX initiative comes in, Dr Wankhedkar says. It is expected that with such unprecedented global crisis all countries would be more than willing to work together, he added.

Also Read: Coronavirus Explainer: What Is COVAX Initiative?

COVAX initiative was launched in April by WHO, Gavi Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI); and aims to ensure that everyone in the world has access to the COVID vaccines. The initiative was triggered by global leaders’ call for a solution to accelerate the development and manufacture of COVID-19 vaccines and equitable access to them for people in all countries.

As per WHO, COVAX initiative aims to ensure global access to vaccines against the novel coronavirus by buying and distributing vaccination shots fairly around the world.

The initiative wants to bring together governments, global health organisations, manufacturers, scientists, private sector, civil society and philanthropy, with the aim of providing innovative and equitable access to COVID-19 diagnostics, treatments and vaccines. COVAX’s aim is to procure and deliver 2 billion doses of vaccines by the end of 2021, said WHO.

The WHO goes on to further describe COVAX as an “invaluable insurance policy” for all countries to secure access to safe and effective COVID-19 vaccines when they are developed and approved. WHO Director-General, Dr Tedros Adhanom Ghebreyesus said,

COVID-19 is an unprecedented global crisis that demands an unprecedented global response. Vaccine nationalism will only perpetuate the disease and prolong the global recovery. Working together through the COVAX Facility is not charity, it’s in every country’s own best interests to control the pandemic and accelerate the global economic recovery.

Also Read: Exclusive: Serum Institute’s Adar Poonawalla On The Status of Coronavirus Vaccine ‘Covishield’, Its Pricing And More

The United States, which is the worst affected country by COVID-19, is not part of the COVAX program, calling it ‘too constraining’ and citing different political reasons. Earlier this year, the Trump administration said it was withdrawing support for WHO, saying they were too heavily influenced by China, which last month announced it would be part of the COVAX program.

Unfortunately, as time passes by, multilateralism is being overtaken by ‘Vaccine Nationalism’. Developed countries have already pre-booked vaccines spending billions of dollars; the Lower-Middle Income Countries (LMIC) like us along with poor countries will be the biggest losers. Nearly 180 countries have joined it until now, said Dr Wankhedkar.

COVAX initiative aims to have two billion doses available by the end of 2021. A few of these countries that have joined the COVAX initiative are Japan, Israel, the UK, Brazil, Canada, Norway, China and Switzerland. Dr Gupta however says that only nine vaccine candidates are a part of COVAX portfolio at present.

Of these 9 candidates, the Oxford vaccine and Moderna’s vaccine are in phase 3 clinical trials. And nine more candidates are currently being evaluated for inclusion. All COVAX participating countries will have equal access to these vaccines once ready. In the first phase of distribution, all countries will receive doses equal to 20 per cent of their population, he said.

Dr Gupta further says that the COVAX initiative provides access to a portfolio of vaccines. By joining this coalition, India will not be required to negotiate individually with multiple manufacturers. COVAX has access to several vaccine candidates, so being a part of this group of countries would provide a guarantee for securing early availability of vaccines for at least 20 per cent of the country’s population in the first phase, he explained.

Also Read: Nine Months Into The COVID-19 Pandemic, Which Vaccine Candidates Are In The Final Stages Of Trial? 

In order to ensure that no one is left behind in such an important immunisation drive, Dr Gupta says that COVAX could be a major step forward and India, moreover, being an important vaccine manufacturer, can bargain for a few things in exchange for its participation.

Firstly, India can bargain for inclusion of at least two vaccine candidates from India in the portfolio, provided the candidates fulfil COVAX’s requirements; second, at least 20 per cent of all vaccine manufacturing for COVAX should be done in India; and lastly, India should have a seat at the tables of all major decision making bodies when it comes to COVAX initiative.

While India was ‘in talks’ with the WHO for participating in the COVAX initiative, no further confirmation was made from either of the side. When NDTV reached out to the Union Ministry of Health, the spokesperson declined to comment on the current situation, citing decision making process as ‘confidential’. A spokesperson from the Union Ministry of Health, on the condition of anonymity, said,

India’s financial commitment to this scheme is as yet unclear. There are many things that are at stake here. If we have appropriate manufacturing and distributing capabilities, it might not work in our favour if we join COVAX. However, on the other hand, while we are trying that the vaccine remains free for the poor or maximum of Rs 120-150 in retail value, there are tremendous costs with actually administering vaccine to a person. The cost of administering a vaccine could be as much as the vaccine itself. This is a viral vaccine and culturing them is harder and costlier than bacterial vaccines. Also this has to be injected 30 days apart, which is much more expensive than say, the oral polio vaccine. There is a significant cost and somebody has to pay, he added.

Despite all the factors that look like positive outcome of joining the COVAX initiative, Dr Gupta points out some factors, that according to him maybe a topic of concern for the government.

First off, the huge upfront cost commitment to join COVAX is a major consideration. Moreover, COVAX is currently facing criticism for its population-based distribution policy as well as lack of transparency. Quite evidently, not all countries are equally affected by the pandemic. Also, population-based distribution doesn’t account for factors like the number of senior citizens and the number of people with comorbidities in a country, which India has highlighted, could be their vaccine distribution strategy, being an immensely populous country, according to Dr Gupta.

However, despite these limitations of COVAX, the initiative as a whole promotes equality, cooperation between nations, by prioritising the low and middle income nations, which may be overlooked otherwise. It will be interesting to see what India decides about joining COVAX , being an important vaccine manufacturer and the second most populated as well as second worst-hit country by the virus, Dr Gupta signed off.

Also Read: Coronavirus Explained: What Are The Phases In The Clinical Trials Of The COVID-19 Vaccine?

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 (WaterSanitation 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 pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

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