M.S. Seshadri | T. Jacob John

Need for a Comprehensive Vaccine Policy in 2020 | UPSC

M.S. Seshadri is former Professor and HOD, Clinical Endocrinology Department, CMC Hospital, Vellore , T. Jacob John is former Professor and HOD, Clinical Virology Department, CMC Hospital, Vellore

DISEASE BURDEN AND CONTROL

• GETTING A GRIP : Herd immunity plus herd effect reduce the overall disease burden in the community ; in other words, the disease is controlled.

• FOR EVIDENCE : Disease frequencies must be documented both at baseline and on an ongoing basis, through systematic surveillance.
• MITIGATION POLICIES : So, control interventions include a vaccination programme and disease surveillance.
• The extreme form of control is ‘elimination’ of transmission of the microbe in a whole country.

• UPROOTING THE PANDEMIC : Eradication is global elimination of an infectious disease.
• APPROACH : The hierarchy of human mastery over infectious microbes using vaccines ranges from individual protection and community control, to elimination and eradication.

• SUCCESSFUL CAMPAIGNS : Severe Acute Respiratory Syndrome (SARS) was eradicated in 2003 without a vaccine, using ‘non-pharmacological interventions’, or NPI, systematic case detection, contact tracing and quarantine.

• TRACKING MECHANISM : History of travel from affected countries and fever-screening identified potentially infectious persons who were quarantined for breaking transmission chains.
• TRANSMISSION RATES ARE HIGH : COVID-19 novel coronavirus transmission occurs from infected persons before the onset of fever and from infected but totally asymptomatic individuals.
• RETARDING THE TRANSMISSION : So, we cannot stop transmission; but with face masks, hand hygiene and avoiding crowds we can retard transmission.

VACCINE CANDIDATES AND INDIA 

• TOP CONTENDERS : Three COVID-19 vaccines have claims of about 90-95% protective efficacy — BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna) and Sputnik-V (Gamaleya Institute).
• COMPELLING TRANSITS : Hopefully they will soon get registration for general use in their respective countries of origin.

PHASES

• Sputnik-V is under phase 2-phase 3 vaccine trials in India, by Dr. Reddy’s Laboratories.
• Another vaccine, ChAdOx1 nCoV-19 (Oxford-AstraZeneca), manufactured under licence by Serum Institute of India as Covishield, is undergoing phase 2-phase 3 trials in India.

• An indigenous vaccine candidate, Covaxin (Bharat Biotech), found safe and immunogenic in phase 1 and phase 2 trials, is now under phase 3 trial.
• If found safe and effective, it will, hopefully, get registration in the first or second quarter of 2021.

IMPLEMENTATION

• IMMUNISATION PROGRAM : In India’s national Universal Immunisation Programme (UIP), policy is defined, vaccines procured and supplied by the Union government and vaccination implemented by State governments.
• HANDLEBARS OF VACCINE ADMINISTRATION : So, policy development is the function of the central government — States must implement the action plan emerging from policy.
• SURPASSING LIMITS : States have the freedom to surpass policy limits if no fund is sought.

MIXED SIGNALS

• MUCH NEEDED DESIGN : A comprehensive vaccination policy is yet to emerge as evidenced by the divergent views expressed by different dignitaries.

• COHESION AND REGRESSIVE PLANNING : On November 3, “Union Health Ministry has asked State governments to refrain from making isolated plans for vaccine distribution.
• AT CENTRAL LEVEL : New Delhi has already set up an expert committee on vaccine administration.
• STATE LEVEL : States were asked to set up committees under Chief Secretaries of each State to ensure time-bound implementation of the Center.

PRIORITY SEQUENCE AND MISSED OUT PARTIES

Union Health Minister identified the priority sequence for vaccination:

1. Health-care workers and ‘corona warriors’
2. Citizens above 65 years; those between 50 and 65
3. Those below 50 who have co-morbidities
4. Finally general public

• This represents a preventive medicine approach.
• Obviously, New Delhi has not considered a public health goal of control or elimination.

UNANSWERED POLICY ISSUES

• STRENGTHENING COLD CHAIN SUPPLY : Sputnik V, Covishield, Covaxin — need only the standard cold chain available to the UIP, except that any new vaccine will require significant additional cold chain space.
• PRIVATE MARKET PLAYERS : All vaccines in the UIP are available in the private sector too.
• USER FEES OF THE VACCINE : Under the UIP, vaccines attract no user fee, but the private sector bills the beneficiary.

MAJOR ISSUES UNANSWERED

• CONFINEMENT POLICY : An important policy issue is whether vaccination should be confined to only uninfected individuals.Or should it be for all people?
• IDENTIFICATION : In the first case, how should uninfected individuals be identified ?
• DATABASE : All test results of infected subjects are available on a computer data base and that is one way to identify those who were already infected.
• IMMUNITY TEST BEFORE VACCINATION : Should COVID-19 antibody or T-cell immunity be tested for reserving vaccination for non-immune persons?
• CHILDREN : What will be the policy for vaccinating children?
• TEACHER AND STUDENTS : Will not vaccinating teachers and students make school reopening safe?
• OLD AGE HOMES : Many senior citizens are protected from exposure to infection by cocooning within homes.How will they be reached at old age homes?