Quest for the COVID Cure
Can a vaccine help in a battle against an enemy of this magnitude, in a country with several weaknesses like weak primary care, shortage of healthcare workers and uneven healthcare workforce? What if the virus mutates, by the time the vaccine comes out? HE asks three different experts about all you need to know about the vaccine.
Soumitra Bhuyan, Assistant Professor at Rutgers University
Around the world, about 40 Clinical Trials are going on, the majority of these are in Phase 1 and Phase 2. About 9 Clinical Trials are in Phase 3 going through large-scale efficacy tests. Even though some of the vaccines under development may work to protect against COVID-19, getting 1.35 billion people vaccinated is another thing. There may be high-cost associated with the production. India is a leading manufacturer of vaccines. However, India is significantly behind when it comes to universal vaccinations. Around 60% of the Indian children received basic vaccination. Although it has improved in the last decade, there is a long way to go to achieve universal coverage.
Regarding COVID-19 vaccinations, even in the United States, some people are not sure if they will get it. One recent study reported about 67% of the respondents would receive the vaccine if recommended to them. It will all depend on our perception of the vaccine at that time. There is so much misinformation around COVID. Considering India will have access to the vaccine and considering it has high efficacy, it will take at least 2-3 years to make the vaccine accessible to all Indians.
Even though there is news about India buying a Russian Vaccine, they may require to do a phase-2 and phase-3 trial on an Indian population. Vaccine efficacy differs between population groups. There may not be a one-shoe-fit-all solution.Given that, some experts, including those developing the vaccine candidates, say we should at best expect a vaccine that can minimise the effects of the disease, rather than provide the "sterilising immunity" that would protect people from infection entirely."
The world may see a vaccine by the end of this year or early next year. Maybe there will be multiple vaccines with different levels of efficacy. The first vaccine may not offer the best protection. Prevention is the gold standard, but it is not straightforward to achieve it. This stage, our goal is to find a solution to protect ourselves against the infection (SARS2-CoV-2) or the disease (COVID-19). Vaccine efficacy differs between population groups. There may not be a one-shoe-fit-all solution. There will be multiple vaccines with an increasing level of efficacy.
In India, the government's commitment is not clear. There is no clarity on guidelines for vaccine developers. As India is the global hub of vaccine development, it will be challenging to get the priority right. I think the first responders and the healthcare workers should get the vaccine first, followed by the elderly, and those with chronic illness. Again, there is a significant ethical dilemma. The overall strategy for immunisation is not clear. The policymakers should develop a roadmap and communicate with the public. Or else, like many other things, the rich who can afford it will get and the poor will have left behind. There is a lot of misinformation about vaccination. Millions of families, even in a developed country like the US, have missed vaccinating their children in the last few months. There is another anti-vaccine movement. The true casualty of COVID-19 will continue to emerge for many years to come.
COVAX co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO, is a wonderful initiative, truly a global collaboration working with governments and manufacturers to ensure COVID-19 vaccines. This is the need of the hour. I think the regulatory bodies are approving the steps in record time. Usually, some of these regulatory steps take months to approve.
So, is vaccine India's way out of the current situation?
Absolutely, Not. Wearing masks, maintaining social distancing, with good practice of hygiene is still the key. I see another dangerous trend, i.e. antibiotic abuse. Self-medication and antibiotic misuse are rampant in India. India is the world capital in antibiotic misuse, and it is a crisis. COVID-19 is making it much worse. It is a viral disease with a few people having coexisting bacterial infections, and antibiotics are not effective against viral infections such as flu or COVID-19. This is another crisis in making. Overall, India needs some major reforms to strengthen the healthcare system, particularly the primary care.
Dr. Harish Pillai, CEO – Aster India, Aster DM Healthcare
The Moderna vaccine from the USA and the one being developed by Zydus Cadila from India are the two most likely ones to come up as backup vaccines. I expect a successful vaccine to be developed by Q4 of this fiscal or by the Q1 of next fiscal. It would take at least two quarters once the vaccine is made available to the general population. What can we expect from a COVID-19 vaccine? These are all matters of speculation. We do not have a proper answer until the Phase 3 trials are over. There would be more than one successful vaccine which would be available. I believe the Indian manufacturers would be able to supply our domestic needs and that of neighbouring countries and our extended broader neighbourhood. Who should be vaccinated first? The first should be healthcare workers followed by the armed forces and the vulnerable population, who may be immunocompromised or above 60 years. Policymakers can decide based on health and national security. Therefore, the recommendation would be for healthcare workers and members of the armed, paramilitary and police forces. The government can vaccinate immunocompromised, and those above 60 after that. It is a nature of human beings to believe in conspiracy theories, and nothing much can be done other than re-enforcing education. India is in an advantageous situation because of our vaccine manufacturing capacity.
The quick identification of vaccines is mainly due to the role of artificial intelligence, machine learning, where we can create computer models and can mimic the biological architecture and behaviour of the virus. The new age cutting technologies such as AI-augmented algorithms, deep learning, machine learning and quantum computing are all able to bring down the enormous time required for analysing various permutations & combinations of virus behaviour, and appropriate response to the same. Way out of the current situation involves a combination of factors. We need to reinforce the wearing of masks, social distancing, hand hygiene, strict measures in specific containment zones, herd immunity followed by mass vaccination.
Feroz Ikbal, Assistant Professor, Tata Institute of Social Sciences, Mumbai
Vaccination for viral influenza is not very useful. That’s why those who are taking flu vaccines need to take the vaccines every year, preferably before the winter season starts. COVID 19 can be tackled by vaccination is a myth. But if we want a safe and reasonably efficient vaccine, it may take at least 2-3 years. By the time the virus can undergo mutations. The critical thing to understand is that a vaccine is not a panacea for this epidemic.
The Indian health system has huge logistical and supply chain issues for medicines and vaccinations. NFHS Surveys says that a large number of children are not vaccinated in the universal immunisation programs. Even if a vaccine comes, it may take a few years, and by the time, new strains of the virus can appear. Our health system cannot have a single agenda of vaccination for COVID alone as we already have a triple burden of communicable, non-communicable and mental illness.
In India, public sector vaccine manufacturing units were closed a few years back citing quality issues, and we are heavily dependent on private sector institutes like Serum Institute of India. Pricing will be an essential issue for the broader population to access in the context of India. But the government can issue a compulsory license so that monopoly is not established. However, companies will be looking at the volume of the Indian market.
It took around 200 years to eradicate smallpox. Similarly, polio also took decades to be nearly eradicated with vaccination.
Given the capacity of Pharma companies and new modes of production, it may be possible to produce adequately. But the major issue is safety and efficiency. The government should give the vaccine to those who are going out and not based on any specific age group.
Vaccine hesitancy has been considered as one of the significant public health problems, even in developing countries. But the collective fear COVID 19 has created a felt need for vaccination across the world.
To a larger extent, initiatives like COVAX will help in developing vaccines. The synergy among the various players can be of great help.
The advanced manufacturing practices will help enhance production and in distributing. A vaccine is not a single solution to come out of this crisis. Strengthening our health system is very important at this point. We need to live with this pandemic and many other pandemics in the coming years. “Social vaccination” is a crucial long term investment.