The Union Health Ministry’s list of 20 comorbidities that make people in the 45-59 year age group eligible for a COVID-19 vaccine is seen by some medical professionals as too narrow.
“The list of comorbidities provided by the Health Ministry is overly restrictive and complicated. Many conditions, including obesity, have been left out,” said Dr. Gagandeep Kang, Professor of Microbiology at CMC Vellore.
“The focus seems to be on people with severe diseases and combination of comorbidities,” Dr. Anant Bhan, a researcher in global health and bioethics based in Bhopal said.
Hypertension is one of the common conditions that increases the risk of progressing to severe COVID-19 disease and even death. However, people with hypertension alone are not eligible unless it is accompanied by other diseases such as diabetes or conditions such as angina. “The initial focus has been on severe forms of a disease or condition. In a month or two, we may see less severe forms of diseases included,” says Dr. D. Prabhakaran from the Public Health Foundation of India (PHFI), Delhi and one of the two members who prepared the list for cardiovascular diseases. There were two members for each thematic disease who prepared a list, and the final list was prepared based on suggestions from each group, he said.
Across the world, people with comorbidities have been identified as a high-risk group wherein the person infected with SARS-CoV-2 virus has a greater chance of becoming critically ill and even dying. The risk is higher in older people with comorbidities. India, as part of the second phase of vaccination, made people aged over 60 years and those above 45 years with comorbidities eligible to get a vaccine from March 1.
Besides being restrictive, the focus is on people with more than one comorbidity. With each comorbidity increasing the chances of severe disease and death, focusing on people with more than one comorbidity would have been acceptable in case of vaccine shortage. But with millions of doses of both vaccines already available in India, it is not clear why the focus is on diseases at an advanced stage, said Dr. Giridhara Babu, epidemiologist at PHFI, Bengaluru.
Many unaware
“Large sections of the population don’t even know if they have comorbidities. It would have been better had we followed the U.K example, which has gone with age bands instead of comorbidities,” Dr. Kang added. “It would have been easier to cover more people at risk with age cut-offs.”
Diabetes is one of the major comorbidities resulting even in death in COVID-19 patients. However, only those with over 10 years of diabetes plus hypertension are eligible for vaccination. Similarly, only those with end-stage kidney disease and on haemodialysis are included. People with stroke are eligible only if they also have hypertension or diabetes. However, many suffer from stroke caused by aneurysm or haemorrhage caused by arterial block in the brain even in the absence of hypertension or diabetes.
While asthma and chronic obstructive pulmonary disease (COPD) have not been specified, the list includes those using corticosteroids for a “prolonged period” as being eligible. How long is “prolonged” is not defined.
Dr. Prabhakaran said there is evidence that people with more severe forms of disease are at a greater risk of dying or becoming critically ill with COVID-19 disease and hence the focus has been on vaccinating these people on priority. Dr. Bhan said when vaccinating people with severe disease, there should be greater vigilance for serious adverse events and safety.
Unlike other diseases, more conditions of cardiovascular disease have been included. “Cardiovascular disease is a spectrum, which may not be the case for other diseases,” Dr. Prabhakaran explained.
“They should have ideally included people in institutional care, like people with mental health conditions or those accessing healthcare facilities often as these people are at higher risk,” says Dr. Bhan.
