While efforts to find a vaccine for COVID-19 are under way the world over, the likely availability later this year or early next year cannot by itself be construed as the last frontier in the fight against the virus, asserts G.V.S.Murthy, director of Indian Institute Public Health-Hyderabad .
“Deployment and utilisation of vaccine will be the most important challenge as billion-plus individuals cannot be immunised at will,” he points out. Any vaccine before being released into the market will have to undergo stringent testing through clinical trials for safety, side-effects, effectiveness and adverse events in humans.
‘Needs stocking’
Fast-tracking is possible only in developing a vaccine but human trials have clinical and ethical issues to be carefully considered. “Such a lengthy process means the vaccine cannot be used for the present pandemic but needs to be stocked in sufficient quantity for possible future outbreaks,” observes Mr. Murthy.
COVID-19 is not going to be a ‘one season fantasy pandemic’ but will dig its heels deep enough to trouble all of us in virus transmission favourable seasons, year after year, just like influenza virus, he affirms and provides an interesting insight into its vaccine usage.
In 2009, there was an outbreak of swine flu in humans from a virus infecting pigs (H1N1 strain) with India having 27,236 cases with 981 deaths; in 2010 it saw 20,604 cases with 1,763 deaths. Cases of H1N1 flu are being reported every year and except in 2016, there have been 28,798 to 42,592 cases till 2019 and between 1,218-2,990 deaths during these years.
There were two peaks in 2017 with many deaths, especially in Gujarat, Maharashtra, Rajasthan and Madhya Pradesh which are also witnessing high COVID-19 cases, explains Mr. Murthy, also professor, London School of Hygiene & Tropical Medicine,UK. Most private facilities do not report most flu infections they see are not laboratory confirmed and hence, the numbers could be under-reported.
Flu also causes significantly higher deaths among the elderly — those with co-existing conditions like diabetes and hypertension, etc.; is highly contagious with infection risk. However, unlike COVID-19, it has a known treatment and a cost-effective vaccine too.
Gap in dose distribution
World Health Organisation and Global Alliance for Vaccines and Immunization have ensured vaccine production to be ramped up to 6.4 billion doses. But, despite the pandemic in 2009 and 2010, vaccine doses distributed was only 1.1 per 100,000 population in India in 2011, though it increased more than 400% compared to 2008!
Influenza vaccine has been available for more than 60 years now but the uptake has not been commensurate with the recommendation it has to be given to high-risk groups every year — healthcare workers, pregnant women, children aged six months to eight years of age and individuals with suppressed immunity.
Low uptake
Vaccine uptake is abysmally low at just 11% in tertiary care hospitals, even among doctors. About 1.5 million vaccine doses imported and another large quantity manufactured by Indian firms to “immediately immunise healthcare and emergency service personnel” had to be destroyed “because of lack of demand”.
“It happened within a year of the pandemic surfacing and causing many deaths — higher than in the COVID-19 outbreak here till date,” the public health official asserts. So, personal hygiene like regular hand washing, covering mouth and nose while coughing/sneezing, self-isolating when sick and avoiding close contact with those who are sick — tenets since the last century — are as vital as anti-virals and vaccine.
