IASbhai Daily Editorial Hunt | 30th Nov 2020

Success is going from failure to failure without losing your enthusiasm.” – Winston Churchill

Dear Aspirants
IASbhai Editorial Hunt is an initiative to dilute major Editorials of leading Newspapers in India which are most relevant to UPSC preparation –‘THE HINDU, LIVEMINT , INDIAN EXPRESS’ and help millions of readers who find difficulty in answer writing and making notes everyday. Here we choose two editorials on daily basis and analyse them with respect to UPSC MAINS 2020-21.

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

HEADLINES:

Clear the fog, draw up a clear vaccination policy

CENTRAL THEME:

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

MAINS QUESTION:

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)

LEARNING:

Concept of Vaccines
Top Vaccine contenders in the race
Vaccine Administration
Priorities and distribution
Way forward

INTRODUCTION:

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.

So, vaccination is ‘preventive medicine’.

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.

Need for a Comprehensive Vaccine Policy in 2020 | UPSC

BODY:

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.

In epidemiology, the common word control has a specific meaning: ‘deliberate reduction of disease frequency to a desired level, validated with evidence’.

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.

EXAMPLE

Measles and rubella have been eliminated in Sri Lanka through sustained vaccination achieving high coverage.

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.

EXAMPLE

Smallpox and cattle plague have been eradicated using their respective vaccines.

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.

Success was possible because virus transmission occurred only after individuals developed fever.

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.

The likelihood of Sputnik-V getting registration in India is probably high, possibly before end-2020.

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.

EXAMPLE

Delhi used the Measles-Mumps-Rubella vaccine when the central government policy was only for Measles vaccine.

ALSO READ : FAIR DISTRIBUTION OF COVID-19 VACCINE

MIXED SIGNALS

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

The Drugs Controller General of India is the clearing agency, not the ICMR.

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.

On November 19, the Puducherry Chief Minister announced that COVID-19 vaccination will be provided free under the State Budget.

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

Workers in essential services are missed out.

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.

Need for a Comprehensive Vaccine Policy in 2020 | UPSC

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?

IASbhai Windup:

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?

India does not practise public health surveillance.

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.

Data management has to be meticulously planned and executed

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

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