An effective vaccine may be the only real protection against Covid-19 as it stands, but don’t pin your hopes on getting it anytime soon. As India’s death toll from Covid surpasses one lakh, knowledge from the scientific community and government officials suggest that it could take up to two years from now to get the long-awaited vaccine.
This is not only because the formidable task of administering the vaccine to more than 1.3 billion Indians, in a massive exercise, never done before, is one that will put the system to the test at every step, but also because there are several imponderables involved. in the process. process. Here’s a sample: once the vaccine gets the necessary regulatory approvals by the first half of 2021, this in itself is a big “ yes, ” statutory agencies and manufacturing companies have to navigate the minefields. cost per dose, the establishment of a cold chain. , organizing an adequate number of trained people to press the needle and increasing production lines without compromising other vaccines necessary for immunization.
“Upon regulatory approval, it would take a minimum of a year before the vaccine is available to the common man,” said K Srinath Reddy, president of the Public Health Foundation.
The first of these steps, choosing the right vaccine for commercial launch, is extremely critical. Any adverse medical reaction would not only give a blow to the body to people’s faith in the Covid-19 vaccine, but would also be counterproductive to existing immunization schemes. The good news is that there is enough information on potential vaccine delivery challenges that could alert authorities to what could go wrong and help fill the gap.
Crossing the cost hurdle
Globally, there are more than 180 vaccines in various stages of development in laboratories, while nine have entered the third and most crucial part of the clinical trial. This is remarkable given that, traditionally, vaccine development takes almost 15 years. With the pandemic killing more than one million worldwide, the process has accelerated around the world resulting in Phase III clinical trials within 11 months of disease notification.
Three vaccines are being tested in India and regulatory approvals are being sought for a fourth. But the first two likely to come through are the AstraZeneca Serum Institute-Oxford University vaccine (ChAdOxnCoV-19) and the Russian-developed Sputnik-V. Assuming they pass the clinical trials with flying colors, the first hurdle for the government will be setting a price for the buyer. Last month, the executive director of the Serum Institute of India, Adar Poonawalla, asked if the government has Rs 80,000 crore in its kitty to pay for the vaccination of all Indians. Calculations on the back of the envelope show that for a population of Rs 138 million, this translates to approximately Rs 290 for one dose and Rs 580 for a two dose regimen.
The government faces obstacles of cost, storage and who to vaccinate first
Considering that the company had previously discussed delivering the vaccine at a cost of Rs 225 per dose, it could be assumed that other expenses are included in the Rs 290 price band. While this may be an acceptable price for those in the middle and upper classes, it may not be an acceptable price for the government, which would have to purchase the vaccine for public use.
“290 rupees is not a viable price for the government program. Even at a price of (say) Rs 40 per dose, the (Indian) government would need close to a billion dollars, “said Ramanan Laxminarayan of the Center for Disease Dynamics, Economics and Policy, Washington DC.
Union Health Secretary Rajesh Bhushan said he also disagreed with Poonawalla’s estimates. The government has created a committee on Covid-19 vaccines that has met five times so far to deliberate on issues related to vaccine procurement, distribution, and costs. “We have calculated the required amount in the meetings and currently, that amount is available with the government,” Bhushan said.
The X factor, however, is the chance that a foreign vaccine (such as the ones being developed by Moderna or Pfizer) will outperform the others in the race. “It would be difficult negotiations then and the terms and conditions of those negotiations would be important in deciding the availability of the vaccine for ordinary Indians,” Reddy said.
Planning the who and how of vaccination
Once the first challenge is overcome, the government would have to grapple with an equally complicated and politically charged issue of who to vaccinate, given that the stock is limited.
“The first priority would be the doctors, nurses and health workers. Later it can be administered to the elderly and people with comorbidities. But with studies showing that more than 65% of people affected by Covid-19 have a comorbidity, the government must initiate an exercise to identify the people who would receive the vaccine, “said Shahid Jameel, virologist and director of the School of Trivedi Biosciences. , Ashoka University. The policy must be transparent with the participation of all state governments, Reddy added.
The third obstacle is a great logistical challenge. While there is a cold chain for the polio vaccine, the Covid-19 vaccine simply cannot be carried for two reasons: first, it takes a lot more storage space, and second, the vaccine (depending on the outcome of the trial). clinically, obviously) may need a higher temperature than what is provided in a simple refrigerator.
Added to this complication is a rule that does not allow ANM and ASHA workers to administer an injection (due to lack of proper training), leading to the key question about the availability of an adequate number of doctors and nurses to vaccinate. to a billion – more population. “It is a logistical nightmare and it takes a gigantic effort,” Laxminarayan said.
Fighting the unknowns of Covid-19
Even after these challenges have been successfully overcome, there is no answer to the final question: How long will the protection last? Will this be an annual vaccine like flu shots or will protection be maintained for a longer period? Experts are divided on this.
“So far, scientific evidence suggests that Covid-19 vaccines are unlikely to be efficient for more than a year, as the antibodies are not durable enough. But since the T cell (passive immunity) remains, it is possible that in the future an infected person will contract the infection again, but that will not lead to disease. But you can’t say anything definitively in the absence of a long-term study, ”said Jameel from Ashoka University.
“Since no one has followed the virus for a long time, there is little data on how long immunity lasts. It can be five months or five years; no one knows right now. “
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