How to get a final victory over COVID Menace?
First case of Covid in India was reported on 27th January 2020. The galloping spread since then is known to all of us. In our population of 1.30 billion the reported cases till date have been 2.82 crores with 3.32 lack deaths, which according to many is a gross under reporting. How can we get herd immunity, by getting most of our population affected, so that the pandemic is tamed?
The consequences of the fulminant infection were very visible during the 2nd wave, in the months of March, April this year. There were no hospital beds available, acute shortage of oxygen, black marketing and hoarding of drugs was rampant. Cremation and burial grounds had waiting lists, the sacred Ganges with floating bodies and river banks stinking with putrefying corpses. More than 1170 doctors succumbed to COVID, while treating infected patients, much higher than that in the USA which had higher number of cases and higher mortality.
Waiting for herd immunity to occur by disease transmission will be disastrous. The answer is to vaccinate as many people as possible. The numbers will be huge even if we decide to take a very conservative figure of 70% for achieving the herd immunity. This will be the only cost-effective remedy looking at the fragile health care facilities we have. The resultant infra structure to face calamities like COVID, have already been witnessed. India spends only 1.5% of the GDP on the health sector.
The answer would mean vaccinating 58.2 crore subjects above the age of 18 years in the first instance. It is also clear that for the best protective results 2 doses are needed. In addition, as we see a threat for even younger populations (< 18 years) in the ensuing waves, another 468 million children may have to be included in the program in times to come.These are mind boggling figures. China has vaccinated till date 60 crores followed by USA 29 Crores. Till date we have been able to use 21 Crore doses with only 4.33 Crore people fully vaccinated (3.3% of the population). The task is stupendous and depends upon how early we can get the required vaccines.
The vaccination program in India started on 16th January 2021. The number of people vaccinated has however not been going up steadily. Between 27th February to 2nd April, 16 lack vaccinations were done per day, these increased to 28 lacs / day in April but declined to 17 Lacs / day in May. A reduction of around 3 crores between April and May. Availability of the vaccine in adequate quantities remains a major issue. Our vaccination program was started by the Govt for people more than 45 years of age. However, during the 2nd wave in March-April, it was clear that younger population was also getting involved rapidly with serious consequences and needed protection.
By not ordering vaccines from different sources when these became available in USA and Europe in December 2020, put us back on the burner. This was followed by exporting a part of our stocks of the Astra-Zeneca for whatever reasons but glorifying it as vaccine diplomacy did not make much sense. Perhaps the forthcoming predictions of the 2nd wave coming was taken lightly. It is hoped that the domestic production is speeded up and also procurement from other countries including the Russian vaccine Sputnik and their collaborations with Indian companies are encouraged. There are some vaccines from Indian companies in clinical trials and hopefully some of these would be positive and add stocks to our kitty. In spite of this, the target of vaccinating 58 crore people twice by the end of 2021 looks over ambitious.
The processes of vaccination have to be simplified. Keeping the facility for people with COVIN app only will exclude half of our population which does not have smart phones. Vaccinations at home for elderly and physically and mentally challenged people also needs to be considered. Keeping a differential pricing for different states and yet controlling the number of doses allowed is not justified. Asking the states to procure the vaccine from international markets is also amateurish. Vaccines are sold to the country’s government and not to the states.
The goal of the vaccination is to prevent severe disease by conferring immunity and thus minimize the need for oxygen therapy and hospitalizations. Severe disease can be prevented by even one dose therefore as many people as possible should have at least one dose. It’s efficacy against the Indian variant however has not been studied adequately. The interval between 2 doses has been a subject of scientific interest and longer gaps seemingly give better immunity besides allowing the first dose to be administered in larger numbers. The UK policy of reverting back to 4 weeks is based upon the availability of the vaccine for the 2nd dose after immunizing all their adults. The data after 6 to 8 weeks of 2nd vaccine can only be generated by our health authorities since this protocol has been used only by us.
There is a need to increase production by utilizing our facilities optimally. Of the 21 units in the country which have been capable of producing vaccines only a few have been operational. HLL Biotech, which runs the Chengalpattu Integrated Vaccine Complex near Chennai, has been sitting idle for the last 9 years after being set up. It is only producing sanitizers now. Likewise a few other public sector units: CRI Kasauli ( HP), Pasteur institute of India , Coonor, Tamil Nadu and the BCG vaccine Guindy, Chennai, Tamil Nadu are just a few units waiting for license renewal for several years now.
It is time the country consolidates all the existing facilities including those in public sector and present a unified face to produce and import as much as possible to expeditiously vaccinate most of the adult population. This is the only way to get herd immunity at the earliest. The only “mantra” to win against this war against Covid is vaccinate all.
Prof U Kaul, a known cardiologist, is founder Director Gauri Kaul Foundation. He is a recipient of Dr B C Roy Award and Padma Shri.
