Getting On With The Jab

There was hope and optimism as the Covid-stricken world waited for a vaccine that will shield it against the deadly SARS-CoV-2 coronavirus. Indeed, research outfits and pharmaceutical companies across the world were inching closer to developing such a vaccine. And then came the news from the UK of a new variant of the virus that was more virulent in nature. By mid-December, about three months since it was first detected, the new strain accounted for two-thirds of cases in London. Panic reigned once again. The UK went in for tighter curbs on movement and mixing of people.

The advent of the new strain in the UK coincided with a more severe second wave of infections in the United States. The fear and prospect of further mutations of the SARS-CoV-2 coronavirus made countries and regulators give authorisations to a handful of vaccine candidates for emergency use in early January 2021 even though they were still in various stages of clinical trials. A worldwide drive to vaccinate people was just around the corner. India, too, gave its go-ahead to two candidates, the Oxford-AstraZeneca vaccine produced by the Serum Institute of India in Pune and named Covishield, and Bharat Biotech’s vaccine developed in collaboration with the National Institute of Virology and called Covaxin. The approvals came barely two weeks before the launch of a nationwide drive on January 16 to inoculate Indian citizens. Monica Vasudev, MD. Allergy & Immunology, Internal Medicine, Advocate Aurora Health, Wisconsin, United States says, “People question the safety and effectiveness of the vaccine given how fast it was produced. Its speed was not secondary to cutting corners, but because of a united global effort with international collaborations among scientists, increased dedicated funding, rapid set up of trials and reduced delays in approval processes.” Vasudev’s argument applies to, among others, Covaxin vaccine as well, whose phase III clinical trials are still underway. According to Vasudev, the speed of development is also because the mRNA vaccines are synthetic and could have been manufactured very quickly compared to the traditional influenza vaccines. “The fact is that high quality research shows a greater than 90 per cent efficacy rate. Immunity from previous infection with Covid-19 is variable. Immunity from immunisations is strong and consistent. These Covid-19 vaccines are a perfect example of using risk/benefit analyses to utilize our knowledge, training, and belief in the scientific processes used,” she says.

Glitches Galore 

India’s vaccination drive started with 3,006 sites across the country on January 16 amid debate as well as fear in some quarters over the speed with which the regulators gave restricted emergency approval to Covaxin. It came as a dampener when a group of healthcare workers from the capital refused to take the shot. Glitches were reported from elsewhere in the country. In Assam, for instance, only a little over 2,000 health workers could be vaccinated on January 18 against the daily mandated target of 6,500 due to a snag in the Co-Win app server. Then, on January 16 itself, nearly a 1,000 doses of the Covishield vaccine were found in a partially frozen condition at the Silchar Medical College & Hospital. The Co-Win app or the Covid-19 Vaccine Intelligence Network, created to help track the progress of the vaccination drive and help with registration of the subjects developed glitches on day one, resulting in some states halting the inoculation process. All in all, the first couple of days of this mammoth task proved to be eventful but the administration is confident that the next couple of weeks will see all such glitches ironed out.

HARD DRIVE
A look at the first three days of the pan-India vaccination drive that was launched on January 16

* 3,81,305 beneficiaries have been vaccinated
* 1,48,266 beneficiaries were vaccinated till 5 pm on January 18
* 580 cases of AEFI (Adverse Event Following Immunisation) reported
* Two deaths reported: Male aged 52 years from Uttar Pradesh due to cardiopulmonary disease (not related to vaccination). Male aged 43 years from Karnataka due to anterior wall infarction with cardiopulmonary failure.

Archana Chatterjee, Dean, Chicago Medical School & Vice President for Medical Affairs, Rosalind Franklin University, US says the success of a mass vaccination campaign depends on a lot of things. “Appropriate risk categorization for vaccine recipients and allocation of vaccines to highest risk groups first, safety and security of the vaccine and vaccinators, cold chain integrity, and mechanisms for follow- up for second doses (when needed) as well as reporting of vaccine adverse events are all essential, particularly in a resource-limited setting,” she explains. Private Sector Involvement The mammoth scale of the task – 300 million people including healthcare workers, frontline workers and the people most at risk are targeted for immunisation by July – has prompted a call for involving the private sector in the vaccination rollout. “Given the vast numbers that we are in India and for successfully inoculation of the entire population in an appropriate time frame, we have to involve the private sector. If hospitals, corporates, other organizations want to buy the vaccine, we should allow that to happen,” says Adar Poonawalla, CEO, Serum Institute of India, the maker of the Covishield vaccine. Corporates such as the Mahindra Group and RPG Enterprises etc. have expressed interest in securing the vaccine to vaccinate their employees.

Their thinking is that they should take responsibility of inoculating their employees rather than have the government subsidise them. While this would certainly help in inoculating a significant portion of India’s vast populace in a timely manner, and help the economic engine to start firing on all cylinders sooner than later, the more also runs the risk of putting the socially and economically weaker sections at a disadvantage. In other words, equitable distribution might not happen. In our country the disparity among classes is so vast that such a scenario would certainly prove detrimental to the primary goal of vaccinating the entire population. A set of stringent guidelines needs to be put in place to ensure equitable distribution.

Arvind Sharma, Partner at Shardul Amarchand Mangaldas & Co believes the government at the moment should be preoccupying itself with more pressing issues before it. According to him, since India’s drug regulator has granted emergency approval for use of the Covid-19 vaccines before they completed phase III trials and adverse events (including deaths) are being reported worldwide due to use of vaccines, it is advisable that at this stage, the government tracks the number of vaccine doses manufactured and administered, adverse events reported, and undertakes steps to vaccinate the population in a phased manner. “Of course, if the vaccine is freely available in the market, the privileged class will seek and receive immediate access. However, efforts should be made by the government to ensure that necessary subsidies are given to ensure that the vaccine reaches the needy, in a fair and equitable manner,” he said in response to the issues of free availability of the vaccines and equitable distribution.

A Jab for the Economy? 
According to a report by the Bill & Melinda Gates Foundation and the Eurasia Group, ensuring equitable access to Covid-19 vaccines would benefit not just the global economy but would help the world’s ten major economies significantly, giving them a boost of $466 billion by 2025. The report found that by contributing to the ACT-Accelerator(Access to Covid-19 Tools) -- launched by the World Health Organisation -- that supports the development and equitable distribution of Covid-19 treatments and vaccines, advanced economies would benefit significantly. Back home, there is optimism about the economy getting a boost and hiring across sectors increasing once the vaccination drive gets underway. “We in RPG have given go-ahead for capital expansion, possible acquisitions. Demand is looking robust. If vaccines (are) successful, economy may do record growth by Q3 of 2021,” tweeted Harsh Goenka, Chairman, RPG Enterprises on Jan 15, a day before the launch of the vaccination drive. Indian companies are seeing a gradual recovery from the devastation caused by Covid-19. Large as well as small and medium enterprises are showing intent to increase their workforce. As per the latest Employment Outlook report by TeamLease that looks at Q4 (Jan-Mar) of FY 2021, Indian employers are showing an intent of 27 per cent with regard to hiring, which is 6 per cent up from the previous quarter. Sectors such as healthcare, education, e-commerce and technology startups are showing maximum inclination to hire with sales and marketing as areas where the hiring focus will be higher. The report has found that metros and Tier-1 cities are showing higher intent of hiring as compared to Tier-2 and Tier-3 cities, with Delhi, Bangalore and Mumbai as some of the cities that are likely to see a higher increase.

The study noted that small (19 per cent) and large (34 per cent) businesses would hire more employees during Q4 as compared to medium-sized enterprises. All this is welcome news as jobs are directly linked to the health of the economy. More jobs would mean quicker recovery. However, quicker recovery would also be dependent on quicker inoculation of India’s population. The task of producing nearly 400 million doses and getting them to people across the vast and varied landscape that is India will not just be challenging but, more importantly, also take time, everything else being normal. If the past is anything to go by, then it’s worth keeping this fact in mind: India’s largest vaccination drive so far was aimed at immunisation of over 400 million children against measles and rubella, and took three full years to complete!