The vaccination programme needs to be speeded up. Here are some suggestions
As a fresh wave of COVID cases engulfs the nation, the government needs to urgently rethink its options and move faster than it has so far. With new virus mutations to cope with and too few people vaccinated, it is clear that the COVID threat is unlikely to go away in a hurry. Trying to go for another lockdown is not an option. Not only would it destroy whatever little economic recovery that we have seen so far, it is unlikely to do any better at controlling the virus than it did the first time when an unplanned, sudden lockdown was not followed aggressively by testing and isolation that were necessary.
India’s vaccination has got off to a mediocre start despite our boast of being the vaccine factory of the world. So far, a little over 7 crore doses have been administered. To put it in perspective, our population is 136 crore, and a person needs two doses about 6-12 weeks apart for maximum protection. And it is far more clear how long the protection will last with many scientists feeling that annual vaccinations will be required from now on. More importantly, it is not clear whether either vaccine will be able to protect people from the fresh mutations that are coming to light.
The issue has been decision making at both union government and regulatory levels. The US, the UK and EU talked to specific vaccine companies and placed firm orders for supplies once the vaccines were cleared by their respective drug regulatory authorities. The Indian government had only a loose understanding with the various firms who were rushing to develop indigenous vaccines or manufacture under licence the vaccines developed abroad. It was only after two vaccines – Covishield by Serum Institute of India (SII) which was essentially the Indian licensed version of the Oxford/Astra Zeneca vaccine and Covaxin, which was developed by Bharat Biotech in collaboration with ICMR – were given emergency use authorisation by the Drug Controller General of India (DCGI), the regulator, that the government moved to negotiate final prices and place initial orders.
This was one reason why the vaccination programme in India kicked off nearly a fortnight after the regulatory clearances were secured – though in the US and UK, the first vaccinations happened within 24 hours of the vaccines getting the regulatory nod in those countries.
The Indian drug regulator triggered its own controversy by clearing Covaxin without waiting for its Phase 3 trials to be over, but with a strange caveat. In essence, it had taken the manufacturers claims of efficacy at face value. Possibly this was done to give the government a choice of vaccines and negotiate better prices with both companies instead of having to deal with only one company that had secured the regulatory clearance.
The initial vaccine rollout also suffered from logistical and digital issues. The CoWIN platform created specifically to monitor the vaccination had multiple hiccups for the first few days. The strict schedule, the timings and the inability to let people know where they would be vaccinated created its own problems resulting in high wastage and even eligible people missing their turns in the first few days.
Luckily, while those were sorted out quickly enough and can be understood for a programme of this magnitude. However, the vaccine rollout has remained sluggish for several reasons. First, the government has been placing orders piecemeal – roughly every month it orders fresh doses. It has only now told SII and Bharat Biotech to prioritise domestic orders over what would go abroad. Two, union government has so far dictated everything from which state gets which vaccine and in how many doses at a time to time and centre at which vaccine must be taken. States have had little flexibility in the matter though they are supposed to be in charge of implementation. Third, a poor and lacklustre communication has also ensured that lots of people, especially the poorer ones, do not get their jabs even if they are eligible. The fourth issue has to do with the regulator which has not cleared any new vaccine despite several vaccine applications. Some of these vaccines have enough data and have cleared regulatory scrutiny in other countries.
With the COVID cases spiking once again and crossing the peak of last year, the government needs to work closely with states and the regulatory authority to speed out the vaccine rollout. And also make it easy for all age groups for which the vaccine has proven safe to take it. (Testing on vaccine safety and efficacy for those under 15 years of age is still going on for many vaccines).
It should also try and use diplomacy to get vaccine makers to give licenses for contract manufacturing to Indian companies which could quickly scale up volume of production. And persuade the US to release the raw materials such as filters and bioreactor bags that could potentially hold up vaccine production in India.
Given that the bulk of the new cases are coming from high density urban areas in specific states, an accelerated and aggressive vaccination programme for everyone in these areas could do a lot to check the spread of the virus. Talking to the DCGI to speed up data scrutiny of promising vaccines could also help.
The bogey of inadequate cold storage chains and some vaccines requiring special storage facilities is also not as much of a hurdle as they are made out to be. These vaccines that require special storage could be supplied to the bigger cities where such facilities are available while other vaccines that do not require such stringent storage requirements can be sent to other places.
Monetary and other incentives that will allow the vaccine firms scale up production would also help. If it is a question of budgets, the union government can tell the most affected states that while the centre will pay for a certain number of vaccines, the states are free to order over and above these directly from vaccine firms.
Finally, the government needs to communicate that the war on Covid is far from over. The social distancing and PPE norms need to be followed stringently to reduce the number of transmissions. Though no political party will like it, in the interests of the population, election rallies need to be minimised and perhaps done only via virtual screens instead of drumming up potential voters to physically attend the rallies. All these steps will do a lot to bring the pandemic under control.