Clear the fog, draw up a clear vaccination policy


India’s COVID-19 control plan of actions can be the nucleus for building a much-needed public health infrastructure.

  • Vaccines play a major role in human mastery over infectious diseases. Vaccine can induce immunity only in the vaccinated individual. 
  • So, vaccination is ‘preventive medicine’. When a vaccine is rolled out as a national or global programme and increasing proportions of people are vaccinated, ‘herd immunity’ level increases and disease frequency decreases in the vaccinated population. 


Disease burden and control

  • In epidemiology, the common word control has a specific meaning: ‘deliberate reduction of disease frequency to a desired level, validated with evidence’. 
  • The extreme form of control is ‘elimination’ of transmission of the microbe in a whole country. 
  • The hierarchy of human mastery over infectious microbes using vaccines ranges from individual protection and community control, to elimination and eradication.
  • So far, smallpox and cattle plague have been eradicated using their respective vaccines. Severe Acute Respiratory Syndrome (SARS) was eradicated in 2003 without a vaccine, using ‘non-pharmacological interventions’, or NPI, systematic case detection, contact tracing and quarantine. 
  • Success was possible because virus transmission occurred only after individuals developed fever. 
  • History of travel from affected countries and fever-screening identified potentially infectious persons who were quarantined for breaking transmission chains. 
  • So, we cannot stop transmission; but with NPI (face masks, hand hygiene and avoiding crowds), we can retard transmission.


Vaccine candidates and India

  • Three COVID-19 vaccines have claims of about 90-95% protective efficacy — BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna) and Sputnik-V (Gamaleya Institute). 
  • Hopefully they will soon get registration for general use in their respective countries of origin. 
  • ChAdOx1 nCoV-19 (Oxford-AstraZeneca), manufactured under licence by Serum Institute of India as Covishield, is undergoing phase 2-phase 3 trials in India. 
  • The likelihood of Sputnik-V getting registration in India is probably high, possibly before end-2020. 
  • An indigenous vaccine candidate, Covaxin (Bharat Biotech), found safe and immunogenic in phase 1 and phase 2 trials, is now under phase 3 trial. 
  • In India’s national Universal Immunisation Programme (UIP), policy is defined, vaccines procured and supplied by the Union government and vaccination implemented by State governments. 
  • So, policy development is the function of the central government — States must implement the action plan emerging from policy. 
  • States have the freedom to surpass policy limits if no fund is sought. 


Unanswered policy issues

  • Fortunately, the three front running vaccines for India — Sputnik V, Covishield, Covaxin — need only the standard cold chain available to the UIP, except that any new vaccine will require significant additional cold chain space. 
  • All vaccines in the UIP are available in the private sector too. An important policy issue is whether vaccination should be confined to only uninfected individuals. 
  • All test results of infected subjects are available on a computer data base and that is one way to identify those who were already infected.
  • Many senior citizens are protected from exposure to infection by cocooning within homes. 
  • The vaccination stations should be staffed with trained personnel and supervised by medical doctors. 
  • The site must have a waiting area and a post-vaccination staying area to manage any untoward reaction during the first hour.
  • A computerised master list with details and mobile numbers of all vaccinated subjects needs to be maintained for the purpose of post-vaccination follow up to document rare side-effects. Data management has to be meticulously planned and executed.
  • The central and State governments in general and Health Departments in particular have a mammoth task ahead of them.
  • It is a big challenge to protect the life and the health of citizens, and also a huge opportunity to eliminate the novel coronavirus from India, setting an example to the rest of the world. With will and wisdom, we can, and should, accomplish this.
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