COVID-19 Immunization Program – Issues and Execution

The research and development for COVID-19 vaccine has been going on at a tremendous pace, and due to the efforts of scientists all over the world, the human trial of vaccine has started few months ago in many parts of the world. Just a week ago the vaccine developed by Pfizer-BioNTech was given to a 90-year-old British woman making UK the first country to roll out vaccine on its citizens. This was first of 8,00,000 dosages prepared by the company ready to be injected. Canada also has approved the vaccine by Pfizer while the US authorities have decided to use it only during emergency cases as of now. As of this writing, the US authorities have also approved Moderna vaccine for emergency use. In India, the Serum Institute of India (in collaboration with Oxford – AstraZeneca) and Bharat Biotech (with its indigenously developed Covaxin) are the front runners to release the vaccine and are expected to get approval from Drugs Controller General of India (DCGI) soon. While Pfizer India is also in discussions with the Indian government authorities to release its vaccine, there is a likelihood it might be little delayed due to the pricing and stringent storage requirements.

Even though we are just a few steps away from the vaccine, it doesn`t certainly mean that we are going to get back to our normal lives soon. Most people assume that the vaccine will be analogous to a magic wand that will just completely eradicate the disease and we will no longer have to follow the social distancing norms neither do we have to wear masks. But this is absolutely wrong! The vaccine has just been tried under laboratory conditions and the way it will act in a large human population is still a matter of assumption. It is not even claimed by any laboratory that their vaccine will destroy the virus and will make the person 100% immune. Most vaccines that are available mainly focus on reducing symptoms and complications among patients to reduce the death ratio and not eliminating the virus. So even after distribution of vaccine starts, gloves, masks, and social distancing will be a part of our daily lives. If we get a successful vaccine with least side effects, it will still take a minimum of one year to stop person to person spread of virus. Some vaccines, for infections like smallpox and rinderpest, were efficient enough to wipe out the disease completely, but effectiveness of something like the flu vaccine mainly depends on the season. The flu vaccine prevents patients from getting severely ill and developing major complications but we still know that a large number of people will get infected.

The list of problems continues when we look into distribution aspects of the vaccine. The first issue is about the cost and claim of monopoly of vaccine. Most of the researches are funded by private firms, these firms invest on research and claim the intellectual property rights that grant makers a period of exclusivity to invent and market their creations. These private firms risk their investment in researches and are completely dependent on the profit they will make by selling the vaccines. If they do not get the profit, why will they invest in research next time? Although there are leaders and foundations that are coming forward to donate to support ‘Lives over Profit’ scheme and to support the development of low-cost and easier to deliver vaccines but the private firms still hold a large share. Also, there is no replacement for private funding. It’s true that without public funds from agencies like the German Federal Ministry of Education and Research or the U.S. Biomedical Advanced Research and Development Authority, drug developers might not have developed the vaccines so quickly. But here, the funding mainly reduced risk and accelerated rate of production. The primary research work was still conducted by scientists in the private sector. Even if the government decides to support these researches, it will only make the procedure more complex because this will empower the politicians and there appointees to choose which researches to fund. This will politicize the whole research and development industry.

The sudden outbreak of COVID-19 pandemic earlier this year led to a huge demand of protective gears, masks, gloves and medicines causing their acute shortage worldwide. Many health workers had to lose their lives because of lack of protective gears due to uneven distribution of these resources. Many countries fear about the arrival of a similar situation when it is the time for vaccine distribution against the novel corona virus. There are 214 vaccine development projects for COVID-19 across the globe, out of which only thirteen are ready for the testing phase and seven have been approved for limited or emergency uses in some countries. Most of the research work is going on in the developed countries, few in developing and almost negligible in poor countries. So even if we do get a successful vaccine, the powerful countries will naturally have the hold on most of the vaccines available. They will obviously stock the major production for their citizens and the poor countries will get access only to the leftovers. Also if the developed countries have rights over these vaccines, they will add in their political interests while giving these to other countries.

Most of the COVID-19 vaccines available must be transported and stored at negative 70 degrees Celsius which is far below the requirements of standard vaccines (2-8 degrees Celsius). As a result an efficient chain of cold storages is a pre-requisite for distribution of vaccines, something which poor countries can hardly afford. Developing countries especially India is investing in manufacture of cold storage these days because of the uneven distribution of them in our country. Gujarat has about six or seven storages while the state of Jharkhand which has about the same population as the former has only one cold storage as of now.

Developing countries are coming forward to play a role in this immunization program and to make sure that everything is not controlled by the rich developed countries. In India and South Africa, pharmaceutical companies are already in contact with the local partners to make their vaccines available. The Serum Institute of India has also reached an agreement with AstraZeneca for development of about 1 billion dosages of vaccine for the low income countries. These two countries have also written a petition to the World Trade Organization (WTO) asking to suspend some intellectual property rights on COVID-19 vaccines.

The next problem is to whom should be immunized first. How will the government decide who should get the dosage before others? Should the senior citizens be vaccinated first? Or is it the essential service workers, who expose themselves often to the virus, for ethical reasons we owe them something for their selfless service throughout the pandemic? Further, on what basis will we classify a service as essential? The medical staff should be vaccinated first because their role is very clinical in fighting the virus or the police and army or maybe the fruit seller and the food supplier who delivered the eatable to our doorstep during the lockdown? And after all this, we also have the politicians and other bureaucrats who would like to get a hold on the vaccine to protect themselves and their families first.

India, due to its huge population and second highest number of active cases, faces an additional problem of mass vaccine requirement. With large requirements of dosages comes the large demand of health workers who will carry out these vaccination programs. To make these vaccines available to remote locations in India like the Northeast and Ladakh is another cause of concern because of the low temperature requirements of the vaccines. The vaccine should also come at reasonable costs because two-thirds of India’s population is below poverty line. The government also has mentioned in its COVID-19 vaccine guidelines that vaccine need to be given in batches of 30 people and the doctors need to monitor these people for minimum 30 minutes to check on any complication or side effect. India is the world`s largest vaccine manufacturer, providing more than 60% of stocks that the developing countries get, so the officials are certain that the production rate is not a reason of concern for them. In addition, India`s experience in various successful immunization programs will also come in handy in the fight against this once in a century health crisis.

-Priyanshi Mishra (Freelancer)

Picture Credits: / Reuters

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