IASbhai Daily Editorial Hunt | 30th Nov 2020
Success is going from failure to failure without losing your enthusiasm.” – Winston Churchill
EDITORIAL HUNT #267 :“Need for a Comprehensive Vaccine Policy in 2020 | UPSC”
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
Clear the fog, draw up a clear vaccination policy
India’s COVID-19 control plan of actions can be the nucleus for building a much-needed public health infrastructure
SYLLABUS COVERED: GS 3 : Vaccine : Disease
What is in the best interests of the country ? Should vaccination be used in India as preventive medicine for individual protection, community control or elimination? Discuss -(GS 3)
- Concept of Vaccines
- Top Vaccine contenders in the race
- Vaccine Administration
- Priorities and distribution
- Way forward
CONCEPT OF VACCINES
- VACCINES ROLE : Vaccines play a major role in human mastery over infectious diseases.
- IMMUNITY BOOSTERS : Vaccine can induce immunity only in the vaccinated individual.
- HERD IMMUNITY : When a vaccine is rolled out as a national or global programme and increasing proportions of people are vaccinated, ‘herd immunity’ level increases and disease frequency decreases in the vaccinated population.
- APPLYING BRAKES ON TRANSMISSION : That decelerates transmission of the microbe in the whole community.
- HERD EFFECT : This results in decreasing disease frequency even in the unvaccinated segment of population — a phenomenon called the ‘herd effect’ of vaccination.
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.
- 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.
- 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.
- 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:
- Health-care workers and ‘corona warriors’
- Citizens above 65 years; those between 50 and 65
- Those below 50 who have co-morbidities
- 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?
MINOR COMPLEXITIES AHEAD
- DETERMINING AGE GROUP : Experts must determine the age groups to be covered for disease control.
- VENUE : Where will vaccination be conducted ?
- USER FEES : Will vaccination be with or without user-fee?
- ADVERSITIES : In case of any adverse reaction, how and where will that be diagnosed and treated?
- MASTER DETAILS : A computerised master list with details and mobile numbers of all vaccinated subjects needs to be maintained for the purpose of post-vaccination follow up to document rare side-effects.
- ELEPHANT IN THE ROOM : The central and State governments in general and Health Departments in particular have a mammoth task ahead of them.
- SETTING AN EXAMPLE : It is a big challenge to protect the life and the health of citizens, and also a huge opportunity to eliminate the novel coronavirus from India, setting an example to the rest of the world.
With will and wisdom we can, and should, accomplish this.
SOURCES: THE HINDU EDITORIAL HUNT | Need for a Comprehensive Vaccine Policy in 2020 | UPSC