A month into India’s vaccination drive, when the earliest recipients are due for their booster shots, it appears the numbers of eligible frontline workers showing up to get inoculated is only reducing. Experts are concerned that this could affect the rate at which we achieve herd immunity.
There was so much anticipation worldwide for a vaccine that could be effective against Covid-19 that most countries put in place strict rules for qualification to receive the vaccine. In India, 11 states agreed to begin administering the vaccine in January, and were worried that people might try to get the shot out of turn.
As it happened, the three states that started vaccination on January 16—Bihar, Telangana, and Tamil Nadu—had dismal reports about the turnout. In Tamil Nadu, only 99 of a planned 600 doses were administered on the first day. A month on, the daily turnup at government hospitals is sometimes as low as 10 people.
While two vaccines—Covishield, which has seen four trials across the United Kingdom, Brazil and South Africa with 24,000 participants; and Covaxin, manufactured by Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR)—are being given in India, the majority of centres are using the Covaxin.
Among the reasons for hesitation among healthcare workers is the three-page consent form they have to sign, with such daunting clauses as one that states they will be monitored for adverse effects, and also the lack of published data about the efficacy of Covaxin. The Phase 2 trial of the vaccine had less than 400 participants. Although the company states that the Phase 3 trial—which is ongoing—has 26,000 participants, its safety and immunogenicity data has not been made available, and the speed with which it was given approval by the government has raised eyebrows.
The official word is that the vaccine has been approved for “restricted emergency use”. Can mass vaccination be termed “restricted emergency use”? It is only fair that people who are taking a vaccine be aware of the side-effects for which they must be prepared. It is particularly important after news broke out that 29 elderly people died in Norway after receiving the Pfizer vaccine. The efficacy of the Oxford-AstraZeneca vaccine Covishield has also been questioned.
Under such circumstances, it is quite natural for healthcare workers, who have endured nearly a year without the vaccine, to want to wait out the next few months.
However, the slow rate of vaccination is not helping the cause, with pockets in Bombay and Bangalore erupting with new cases. There are several options ahead of Bharat Biotech and the government.
Naturally, the most sensible would be to publish all available data about the safety and efficacy of the vaccine. The hesitation of the company to do this, in combination with the speed of government approval, has made people wonder whether the approval might be politically motivated. Efficacy data about the ChAdOx1 nCoV-19 vaccine, which is being manufactured in India as Covishield, was published in the prestigious medical journal The Lancet in December. The vaccine has demonstrated an efficacy of 70 percent in the Phase 3 trials. The trial period, lasting from April to November 2020, was relatively short. Reliable data about short- and long-term side effects in specific populations could not possibly have been collected over such a small duration. Covaxin went into Phase 3 trials as late as November 2020. The withholding of data may well be seen as lack of transparency.
If the government cannot force Bharat Biotech to make the results of the trials public, there is another option to ensure widespread vaccination—the creation of back-up lists. With educational institutions opening up, students and teachers remain vulnerable to transmission. The administration of the vaccine to the elderly and otherwise immunocompromised population is expected to begin in March. However, if the turnout at the centres is low, we are only losing time that could prove to be precious by going with a single list and no backups. Why not start vaccinating other vulnerable populations, irrespective of age?
Of course, the awareness campaign must be more widespread, coherent, and detailed. Decades after vaccination against polio began in India, the country was declared “polio-free” by the World Health Organisation in 2014. But in 2018, polio vaccines were found to be “contaminated” with the virus, sparking panic among takers and prospective takers. There is a group of people, often parents of small children, who are anti-vaccination. Worse, there are those who believe the pandemic is a conspiracy by governments and big businesses, pharma companies included.
For as long as we are content to complain about reluctance without taking proactive steps to boost the numbers, status quo will persist for months. And clusters of cases will continue to erupt.
Nandini is the author of Invisible Men: Inside India's Transmasculine Networks (2018) and Hitched: The Modern Woman and Arranged Marriage (2013). She tweets @k_nandini. Her website is: www.nandinikrishnan.com