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Immunisation for COVID-19 Is a Public Health Exercise – Not a War Game

Immunisation for COVID-19 Is a Public Health Exercise – Not a War Game

A health worker and a volunteer take part in a nationwide trial run of COVID-19 vaccine delivery systems, in New Delhi, January 8, 2021. Photo: Reuters/Adnan Abidi.

After almost a year of the pandemic, and in record time, we have among us a few ways to immunise ourselves to COVID-19. This is thanks in most part to the world’s scientific and medical workers, who literally worked overtime to create not one but multiple vaccine candidates.

The world and India have already suffered a lot at the hands of the pandemic and various governments’ response to it, both health-wise and socio-economically. We lost many lives both to the disease and its socioeconomic implications. As such, a vaccine today represents both protection from a fast-spreading virus and a return to the previous normal to the extent possible.

India has been working out the logistics of the vaccine candidates’ delivery on a war-footing. The Indian air force is to transport vaccine candidates from key points and deliver them to various cities, at which point the candidates will be distributed to all districts in refrigerated trucks. This is a commendable effort, and I complement the Government of India and the state governments for this effort.

However, what many don’t seem to realise is that large-scale vaccination is not a military exercise at the border – where, by the generals’ orders, you amass troops, arms and ammunitions, and attack the enemy in coordinated fashion. In war, we have no need of changing the opponent’s mind. Large-scale vaccination to quell a pandemic is a public health exercise that needs changes of mind. Specifically, its success requires the voluntary and willing participation of millions of people. We need to convince people to take the vaccine candidate.

The pandemic has affected many parts of India badly and there is also a widespread fear of the disease. So it’s likely that people may come forward to be vaccinated with great enthusiasm, and the government’s vaccination programme may automatically be successful.

However, our history of vaccination programmes isn’t very good. India has needed many years and millions of human-hours to bring up children’s vaccination rates to 75%. The polio vaccine is orally administered and easier to transport and distribute than the COVID-19 vaccine candidates will be. But the Indian government still needed over three decades to eradicate the disease once the programme began. And in this effort, the government also launched a massive media campaign, commissioning advertisements with stars like Amithabh Bachan encouraging people to ensure their children received the oral polio vaccine, and assuring them that there were few side effects.

So we must only expect that we will need to work harder to control COVID-19. The first set of people to receive the vaccine candidates will be healthcare workers; those employed by the state may be more willing to take the vaccine candidates than private-sector workers. High-risk groups may also be eager considering severe COVID-19 can be fatal.

In India’s big cities, we know that many people either know someone who died of COVID-19 or was hospitalised. Such dispiriting experiences may drive them to get vaccinated. But at the same time, the country’s urban centres are also rife with misinformation, especially on WhatsApp and the social media. In addition, and as some small surveys have indicated, there is some vaccine hesitancy as a result of traditional beliefs and a lack of proper communication.

Unfortunately, scientific and technical information about the vaccine candidates in India hasn’t been easy to find. The government has granted “restricted emergency use” approvals to two vaccine candidates in India. But basic information about each candidate is missing. You may have noticed other medicinal products accompanied by notes, printed by the manufacturer, describing the composition, its indication and contraindications, dose, routes of administration, side effects, efficacy, pharmacological details, etc. Such information should accompany the vaccine candidates as well.

In fact, it’s surprising the big companies behind each of these candidates haven’t prepared and released such information – either before or immediately after the drug regulator’s authorisation – so that doctors could be convinced of the candidates’ utility.

When I checked with some practicing doctors and public health professionals, none of them said they had perused any of these details. If a doctor doesn’t have the right information about each candidate, how will she be able to advise her patients to take it?

An ’emergency use authorisation’, as defined in the US and the UK, implies that the vaccine candidate will be qualified for use in specific contexts after it has been carefully evaluated, and with mechanisms in place to monitor those who have received it.

It isn’t clear if the two vaccine candidates will be available only with a doctor’s prescription or if the government can auto-prescribe them for all citizens. Vaccines included under national programmes generally don’t require prescriptions, but there is also no clarity on whether either of the two candidates will be inducted into such a programme. We also don’t know if the candidates have been approved by the National Technical Advisory Group for Immunisation. Will the government make a one-time exception?

Then again, these are straightforward issues and the government is likely to already be working on ways to resolve them. But the companies manufacturing the candidates must provide scientific information to India’s doctors, so that the doctors can then help the people in their care make the best choices.

The government must also provide the candidates’ details in advance so that there is no room for public suspicion. The COVID-19 vaccination drive is set to be India’s largest adult vaccination programme. No one wants it to not succeed. To this end, we need the right information to change people’s hearts and minds, and take the vaccine. Journalists must also be convinced of the evidence for the government’s decision making.

What will ultimately beat India’s COVID-19 epidemic is the vaccine in people’s bodies – not vaccines in the stores that no one wants to take. I hope the various governments, companies and civil society will take up the corresponding task of easing access to scientific information composed in lucid language.

Dileep Mavalankar is the director of the Indian Institute of Public Health, Gandhinagar.

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