To take or not to take – The Indian vaccination dilemma

This article was exclusively written for The European Sting by Ms. Purva Shah and Ms. Rajvi Chaudhary, two intern doctors at Baroda Medical College and SSG Hospital, India. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

On 16th January, 2020, India started the largest vaccination drive in the world by releasing two vaccines – Covishield (UK developed Oxford-AstraZeneca vaccine) and Covaxin (locally made vaccine by Bharat Biotech and Serum Institute, Pune).¹ Over and above the common hurdles faced worldwide like fast-paced clinical trials and the problems of mass production, the challenges in India are aggravated by the pending result of the third phase of clinical trial for Covaxin.

The high-priority groups consisting of healthcare workers, senior citizens, and people with co-morbidities will get vaccinated in the first round of the vaccination drive. However, they won’t be able to choose which vaccine they get. Is it ethical to expose these high priority groups to a vaccine whose safety and efficacy is still unknown due to the awaiting results of its clinical trial (third round)? Is it morally correct to provide different qualities of vaccines to health workers who work side-by-side in similar working conditions? Also, the use of Covishield in India is based mainly on large-scale trials conducted in Brazil, South Africa, and the UK in addition to relatively much smaller trials conducted in India. Hence, the efficacy and immunogenicity of Covishield for the Indian demography and climate still remains questionable.² With just two vaccine distributors for a population of over 1 billion,³ will the government be able to match the demand with adequate supply?

With an over-ambitious goal to vaccinate 30 crore people in mere six months, the government will inevitably have to redirect resources and man power allocated to other, equally important if not more, health programs. For example, the Universal Immunisation Program (UIP) for infants and children, antenatal care for pregnant females, and the Revised National Tuberculosis Program (RNTCP) have faced severe setback due to the aforementioned diversion of resources.⁴

India being a tropical country, maintaining a cold chain with sub zero temperatures becomes a difficult and tedious task.⁵ With over 600,000 villages in India according to the 2011 census,⁶ providing the COVID vaccine in rural areas will be an uphill task with several technical snags and server crashes.

Policy making and planning are not enough to ensure a smooth distribution in the world’s largest democracy. Transparency and trust between multiple levels of the government along with agile decision making in case of unanticipated glitches and setbacks becomes a necessity rather than a luxury.

Once the vaccination of high risk groups ends, will vaccines be available free of cost to the general population, at a subsidised rate, or at the market rate? In case of demanding a payment against vaccination, will the disparity between the Indian poor and rich be highlighted once again? In case of distributing vaccines free of cost, will people trust its quality and more importantly, will our government be able to sustain this arrangement in the long run?

With all the ethical, economic, social, and scientific challenges the only question arises today in the Indian subcontinent is, “To take or not to take?” With the aim to achieve ideal governance, flawless execution, and methodical problem-solving skills, we can solve the current Indian vaccination dilemma.

References

1. https://www.bbc.com/news/world-asia-india-55748124
2. https://www.thehindu.com/sci-tech/health/vaccine-dilemma-to-take-or-not-to-take-covaxin/article33577223.ece
3. https://www.census2011.co.in
4. https://scroll.in/article/983517/what-will-it-take-to-vaccinate-india-against-covid-19
5.  https://www.hindustantimes.com/india-news/covid-19-vaccination-lack-of-facilities-and-other-challenges-for-india/story-lb6qKOUogrhtOLrz7HpfYN.html
6. https://censusindia.gov.in/2011census/Listofvillagesandtowns.aspx

About the author

Purva is an intern doctor at Baroda Medical College and SSG Hospital, India. She worked under Dr. August Lynne to find a relationship between lipids and the progress of Alzheimer’s disease. She is the National Head Assist, Education at WYHF (World Youth Heart Federation) and a Student Editor at IJMS (International Journal of Medical Students) for the year 2020-21. She is the medical head for a local NGO where we are trying to improve the health and sanitation of slum kids. Having published papers on thyroid disorders and novel diagnostic criteria for anaemia and having secured STS-ICMR, 2019-20, she wishes to dive deep into the world of research.

Rajvi is an intern doctor at Baroda Medical College and SSG Hospital, India. She is deeply interested in how modifications in lifestyle, appropriate exercise and diet bring positive change in everyone’s life which in turn decreases the chance of being physically as well as psychologically ill. She wants to get affiliated with research related to holistic medicine and wishes to bring the concept of  wellness to the masses. After graduation she is going to work at a Primary Health Centre (PHC) in rural India. With the help of local non-governmental organisations (NGOs), she wishes to spread knowledge about indigenous diseases and their treatment which the general population lacks due to high illiteracy rates in certain areas.