Covid vaccine and challenges in pandemic prevention

With the Drugs Controller General of India (DCGI) making its recommendation for the use of the vaccine developed by Oxford-AstraZeneca across the country, the door is now open using a preventive tool against the coronavirus. A nation-wide roll out of the vaccine is imminent. At the same time two other vaccines developed in India have also gone through their third phase of trials and their reports are going to be reviewed by the experrt committee.

It is incumbent on the regulatory authorities to be on the guard against the pitfalls that are likely when the wait for the vaccine happens together with the pharma firms' race for a slot in the market. While an operation of unprecedented proportions gets mobilised, every step is crucial and demands the highest level of vigilance. The experience of the health network of India so far is limited to dispensing of preventive vaccine for children.

Identifying priority sections across different age-groups, including other priority segments in time and administering two doses to each recipient at the prescribed time all demand extensive preparation and machinery. And in a scenario with more than one vaccine securing approval, it also needs to be ensured that every recipient gets the same vaccine jab. The CoWin app has been prepared for this, but even then at the level of implementation, meticulous co-ordination of the health workers among central-state-local administration strata need to be ensured. This is an area that requires attention of the people too.

In the hurry for developing a vaccine and to tame the pandemic, it is accepted that pharmaceutical research could not be made fool-proof in compliance with stringent requirements. There has been a compulsion to reduce the number of the phases of trial. There is also a natural pressure on the expert panels to fast-track the process of approval for the vaccine. Compounding these are the complications engendered by a new variant of the virus, inferred to be more transmissible. By the time it was detected to be present more in Britain, the world had started its first phase of vaccination.

The new transmissible virus with its reach created a new challenge to the very vaccination exercise. It became essential to vaccinate as many people as possible and as fast. The strategy Britain adopted at this stage was to delay the second dose and to use that extra time to administer the first dose to more people. But this is fraught with the hazard that with the prolonging the gap between thw two doses, the efficacy of the vaccine may be diminished – an example of caution giving way to urgency.

Until fool-proof methods of prevention are developed, such protocol together with preventive vaccination will need to go hand in hand. In short, when extensive vaccination is undertaken against a pandemic the world is not used to, there has to be consistent follow-up tests and continual critical evaluation, in parallel with putting required facilities in place.

Along with many other lessons, Covid has taught us also about the importance of governmental involvement and service in health sector. In places where the health services are under public sector, the impact of Covid has been relatively lower; preventive action is that much easier too. In India, even as Kerala had higher spread of the disease, it did not lag behind in prevention and treatment, reflected also in lower death rate. The case of America, believed to be the most modern and strong country, is quite different. In addition to the government investment in service sectors being weak, the Trump administration even withdrew the existing benefits of Óbamacare.

That was the reason why America had to stand baffled at the advent of Covid, which also caused its death rate to rise. Although the situation in Kerala is better, in many other states of India, public health sector suffers from neglect. The steadily falling percentage of government investment in health and education sectors is a phenomenon the country has been witnessing over the last three to four decades. Governments have been unresponsive to words of caution against this trend. And now it has taken Covid-19 for every one to be convinced about it.

The standing committee of parliament has evaluated the consequences of the Covid crisis and submitted its report. A major recommendation of the panel is that there should be a comprehensive public health law. With the field of public health being let free for the private sector with its element of exploitation, crores of the country's poor are in a state with no access to basic health services. Although the parliamentary committee does blame the exploitative mentality of the private sector for this, it cannot be forgotten that it is the ruling establishment that created, and is creating such a state of affairs. When we come to a new phase in the fight against Covid, we need to rectify such defects too.