As India launches an ambitious effort to vaccinate 300 million people against the coronavirus within six months, it is using two domestically produced vaccines but approved under very different circumstances.
One is CoviShield, the vaccine developed by Britains AstraZeneca and the University of Oxford, whose clinical evidence shows it is about 70% effective in preventing COVID-19 and is being produced in India by the Serum Institute, the country’s largest producer.
Next is Covaxin, developed by an Indian company in collaboration with the government, but whose performance in late-stage clinical trials has not yet been published. However, health authorities approved the vaccine for limited emergency use.
Government health officials promise both medicines are effective and say Indians lined up in the first phase of the shootings will not be able to choose which medicine to take.
Many countries around the world are using more than one vaccine, Health Secretary Rajesh Bhushan told reporters on Wednesday. There is no such possibility [of choice] available to any of the beneficiaries in these countries.
Uncertainty over Covaxin’s purpose is just one challenge facing India as it presents one of the greatest vaccines in world history.
Starting Saturday, the vaccines will be administered to 30 million medical professionals and front-line workers, followed by another 270 million aged 50 and over or those at risk due to other diseases. Prime Minister Narendra Modis promises to complete the first phase by August to put India, which has the heaviest coronavirus burden in the world after the United States, on track to defeat COVID-19, experts say.
But populist Modi is known for bold utterances that do not always materialize. Experts warn that the lack of transparency around Covaxin threatens to undermine public confidence in inoculation.
Whatever happened, it has created a perception that vaccines are not the same, said Prashant Yadav, a senior fellow at the Center for Global Development in Washington who studies the Indias healthcare supply chain. This has the potential to create delays and more friction in a process that we ideally want to be as smooth as possible.
Although China and Russia have also begun administering domestically produced vaccines while the drugs are still in the testing phase, India stands out for approving the two drugs based on different standards.
The AstraZeneca-Oxford shooting was approved January 1 by an expert panel based on data from trials in Britain and Brazil. On the same day, the panel asked Hyderabad-based Bharat Biotech, a well-known manufacturer of more than a dozen vaccines sold worldwide, to provide more information about the effectiveness of its Covaxin stroke. which was still in the third critical phase of the trial clinic
The panel approved Covax the next day, but offered little public explanation as to why. Indian news media also have reported irregularities in vaccine testing, with some volunteers saying they were made to believe they were taking an approved stroke by not taking part in a trial. The company denies wrongdoing allegations.
The vague process has led to allegations that the government has rushed the vaccine into use to promote the nationalist Modis mantra of a self-sustaining India.
Controversy always raises suspicions, said K. Sujatha Rao, a former Indian health secretary. So the government is obviously trying to communicate confidence in security aspects. But the process can affect perceptions.
Stocks are high for a country that has recorded more than 10 million coronavirus infections and 151,000 deaths, among the most in the world. India’s economy shrank by 10.3% in 2020, according to the International Monetary Fund, and weeks of protests against new agrarian policies have further hit the Modis government.
However, early fears that the coronavirus would dump garbage in overcrowded slums and overload rural areas with poor health infrastructure have not passed. The daily tissue count for new infections peaked in mid-September and has fallen steadily since then, which officials see as a sign that herd immunity may have begun to be maintained. For example, in the southern state of Tamil Nadu, studies suggest that 60% to 70% of people have been exposed to the virus, making it impossible for them to become infected again.
The number of vulnerable people is exhausted or nearly exhausted, so the curve is falling, said Chandra Mohan, a senior health official at Tamil Nadu. In these circumstances, the use of vaccines is good, but the little extra time taken here or there to ensure proper use will not make any difference.
To prepare for vaccinations, India conducted clothing testing across the country in recent weeks, with health workers gathering at medical centers, enrolling patients, rolling up their sleeves and collecting data on everything except actually injecting people.
India is relying on an existing immunization program that administers routine shots to 55 million people each year. Health officials have trained more than 200,000 vaccinators, prepared 90,000 refrigerators and freezers to store vaccines, and rushed to create an online portal to track recipients and supplies of medicines.
If all goes well and if the plans are really executed as designed, it could very well be an example of how to make a very wide distribution of the vaccine, said Yadav of the Center for Global Development.
Among the obstacles is the availability of vaccines. The Serum Institute has released 70 million doses of CoviShield, the AstraZeneca-Oxford shock and is expected to increase production to 100 million doses per month by March, but that would still be less than the 600 million doses India needs for the first phase . . The company has indicated it will focus on supplying India for several months before exporting doses to other countries.
Bharat Biotech reportedly has a stockpile of 20 million doses of Covaxin, with the aim of producing 700 million more by the end of the year.
Indian officials have indicated they have no plans to inoculate the entire 1.3 billion people in India, believing the country can achieve herd immunity after the first phase of the shootings, which will cover less than a quarter of the population .
Experts say the country has plenty of health workers, syringes and cold storage facilities, vaccines should be kept at a temperature of 35.6 to 46.4 degrees, but worry that other immunizations may be delayed or forgotten as the system focuses on COVID-19.
Anant Phadke, senior advisor ia health care charity in the western city of Pune, said the infrastructure for vaccinating newborns and pregnant women was already overloaded.
Over the past 40 years, the staff has not grown in line with the population, he said. The existing public health system is barely managing the workload. If the existing staff has a large burden of [COVID-19] inoculation, may preclude routine vaccinations.
Pune, in the state of Maharashtra, is cross the most affected districts in India, with more than 350,000 cases of coronaviruses. Officials said their biggest challenge would be reaching rural areas, where people often have to travel for hours to get to a health center.
Bhagwan Pawar, a local health official in the western city of Maan, 100 miles from Mumbai, said area health centers had plenty of storage space and 48 hours of backup power in the event of power outages. Health workers aim to vaccinate 100 people per location per day, he said.
Local health officials declined to comment on the safety of the government-backed Covaxin vaccine. By Avinash Bhondve, former president of Indian Medical Assn. in Maharashtra, said the medical community had its suspicions.
The government has not ensured it is 100% safe, he said.
Times staff writer Bengali reported from Singapore and special correspondent Parth MN from Mumbai.
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