Needle-Ready? India’s Covid Vaccination Preparations

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The Covid vaccine is here. As India readies itself for the largest vaccination drive in the world against Covid-19, there’s a lot of hope, anxiety and apprehension in the air. Here’s everything you need to know. 

India has begun its vaccination drive against Covid-19 on 16 January.  Mock Drills have been going on and hopes are high that with vaccination the country would be able to successfully tide over the pandemic, which has so far claimed more than 1.5 lakh lives and infected over a crore people in the country.  

Like in other countries, several vaccines have been competing for approval in India too. Last week, the Drugs Controller General of India (DCGI) approved for restricted emergency use the Oxford Covid-19 vaccine Covishield manufactured here by the Pune-based Serum Institute and the indigenously developed ‘Covaxin’ of the Hyderabad-based Bharat Biotech. 

The approvals were given based on the recommendations submitted by a Covid-19 subject expert committee (SEC) of the Central Drugs Standard Control Organisation (CDSCO). The District Collector or District Magistrate is responsible for the entire planning of vaccination drive including beneficiary registration, microplanning and vaccination at the planned session site. 

The first phase of inoculation

In the first phase, the most vulnerable would get priority. This group includes the public and private healthcare workers, such as doctors, nurses, medical officers, paramedics, medical students and other medical staff. The phase also intends to cover the frontline and municipal workers. They include the central and state police department, the armed forces, civil defence and prison staff, disaster management forces, home guard and other personnel who are deployed at Covid-19 containment zones and those above 50 years of age.

About 30 crore people are in the line list to get vaccinated in the first phase. The senior citizens will be picked from the latest electoral list for the Lok Sabha and Assembly elections. Even though the cost of the Covid vaccine for the general public has not been announced yet, the most recent reports suggest it will be free for the frontline workers. The rest of the population will be considered in the subsequent phases of vaccination, not for now. 

CoWIN

People can register for the Covid vaccine on the government-sponsored digital platform, CoWIN (Covid Intelligence Network). The Centre is likely to make it open and available for all once the first phase is over. This platform will provide real-time information on vaccine stocks, their storage temperature and individualised tracking of beneficiaries of the vaccine. The platform would have a bevy of useful features. It automatically allocates the vaccination session for those registered; creates unique health IDs for each individual; verifies identities; and generates a digital certificate for the vaccinated upon the successful completion of both the doses of the vaccination. 

More than 75 lakh beneficiaries have registered already on the CoWIN platform, according to Dr Harsh Vardan, Minister of Health and Family Welfare. He also mentioned that people must be aware of the fake CoWIN app which is circulating on the internet.

The vaccination process

The registered participants would need to assemble at the appointed venue at the given time. After they get the Covid vaccine they will move to an observation room for 30 minutes where medical professionals will check them for reactions. A medical team of five will oversee the process. The vaccination schedule will be over only when an individual takes two doses of vaccine, 28 days apart.

The administered vaccine on entering the human body will perform three key tasks: 

  1. Identify the virus 
  2. Create antibodies 
  3. Produce killer cells to eradicate the virus from the body. 

Antibodies will develop a fortnight after the second dose.

But that’s easier said than done

The greatest challenge in this process is the mobilisation of the vaccine. Variation in the temperature level and exposure to other external factors such as light may affect the potency of the vaccine or may damage it fully. India, being a hot and humid geography, faces a great challenge in terms of transportation, storage and handling of the vaccines. Cold storages are hence being used to transport them. 

Union health secretary Rajesh Bhushan said India currently has 29,000 cold chain points where the approved vaccines, Covishield and Covaxin, can safely stay. Refrigerated trucks will carry the vaccines from manufacturing units to the airport. They are transported in ice packed thermocol boxes in the air cargo. At present, there are four main vaccine store depots – Kolkata, Mumbai, Chennai and Karnal in Haryana. From there, vaccines will get distributed to State stores and district stores and to primary health centres and community health centres through refrigerated trucks. 

The other Covid vaccines

While two vaccines have been approved in India, several other vaccine candidates are too in the fray for approval. The main obstacle apparently is the temperature requirements, or the optimal temperature of the vaccine when compared to the country’s temperature level. For example, the Pfizer and Moderna vaccines which have been approved in several countries including the US and the UK by now, are still pending approval in India. The temperature range for Moderna is -20oC and Sputnik -18oC. These stand the chance of being approved in India considering their optimal temperature. But for Pfizer it’s a long shot considering that it needs to be stored in -60oC to -90oC.

The government hopes that this vaccination drive will be successful. The mock drills have been smooth so far. With training sessions for vaccinators, updation of the database of beneficiaries, cold chain management, session allocation and reporting of Adverse Event Following Immunization (AEFI), hopes are high that this would be the road back to normalcy.

However, even as the expectations soar, quite a few apprehensions about the approved vaccines also emerge.

Controversies on the approved vaccines

As the government goes ahead with its preparations, questions have been pouring in from several quarters about the safety, efficacy and possible side effects of the vaccine. Bharat Biotech’s Covaxin received a hurried approval before publishing its Phase-3 trial results and efficacy data, raising suspicions about its safety and triggering a controversy. 

In the case of Covishield, while it was being considered for approval in India, ironically, it had no data from Indian trials. Complicating things further, Krishna Ella, MD of Bharat Biotech and Adar Poonawalla of Serum Institute, engaged in some mudslinging against each other’s vaccines. Things became worse when it turned into an egregious case of vaccine nationalism. Politicians did not waste the opportunity to jump into the fray and bat for the ‘swadeshi’ Covaxin and bash the ‘angrezi’ Covishield.

The Covid vaccine economics

While controversies continue to boil on one side, the finance ministry has allocated Rs 480 crore for the operational expenses phase of the vaccination drive. The cost of the vaccine would be over and above this. The fund would be disbursed to the states depending on the number of registered beneficiaries from each state. The target is to vaccinate 13 lakh people per day and 30 crore by August 2021.

According to a research report by the State Bank of India, the cost of the world’s largest Covid vaccination drive would be about 0.3 per cent-0.4 per cent of the GDP. Estimating the cost of a dose of vaccine as ₹100-150, the report calculates the cost of vaccinating 30 crore people would cost around ₹21,000 –₹27,000 crore. “Vaccinating another 50 crore will cost ₹35,000-₹45,000 crore. This would mean a total cost of around 0.3 per cent-0.4 per cent of GDP,” it says. 

How will the public support the massive vaccine drive? Are we putting a rope to the eye of a needle or are we making real progress in our fight against one of the worst pandemics modern times have seen? The coming weeks and months will give us the answer. 

– Anu Thankachan

The Other Side of Covid Vaccine Race 

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