COVID-19 vaccines: Much ado about known unknowns 

This week in health: risk-benefit analysis for vaccines, India’s food safety challenge and how a computer science conundrum could transform healthcare.

May 06, 2024 08:34 pm | Updated May 08, 2024 09:51 am IST

Image for representational purpose only. File

Image for representational purpose only. File | Photo Credit: PTI

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There are things we know that we don’t know. At least statistically, we are told that for every 100,000 people, at least 164 are likely to die from air pollution; 17 due to traffic collisions; nine will succumb to alcohol-related diseases. Do we know if our lives will make up one of these statistics? No, but we breathe, drive and drink. These are known unknowns; once discovered, they demand due care and caution. Uncertainty is built everywhere, and more uniquely in medical research, where findings are sometimes confounding if not looked at in the broader sense, and thereby harder to communicate.

 The recent COVID-19 vaccine scare is a tale of exploiting and weaponising this uncertainty. The events unfolded like a detective mystery in reverse. AstraZeneca admitted in a U.K. court recently that its vaccine Covishield can cause a rare side-effect called TTS (Thrombosis with Thrombocytopenia Syndrome), which causes blood clots. The submission created a firestorm in India, given Covishield was largely used in India’s immunisation programme. Several reports have erroneously claimed that the Covishield side-effect was made public for the “first time”; The controversy has reached the Supreme Court with a petition to set up of a panel to study the risk factors. The Karnataka Health Department recently served notice to a private law college for spreading false rumours about Covishied. Like firefighters, health experts and doctors are reiterating that all Adverse Events Following Immunisation (AEFI) are routinely monitored. 

This court admission is not new information, doctors say. This risk was identified and flagged back in 2021; packaging was modified to insert information associated with the side effects; even the WHO wrote about it first in May 2021 and then in 2023.Read Bindu Shajan Perapaddan’s report on the rare vaccine side-effect is “no secret” and they are “well aware of the warning which has been available in India as an insert with the vaccine since the time it was introduced for general public here”. Also, every vaccine, from Polio to Hepatitis B, has side effects and risk-benefit analyses often decide the course of action. During COVID-19, global health stakeholders weighed the risk of TTS from the AstraZeneca vaccine against deaths and ICU admissions prevented. Studies since then suggest that the Covishield vaccine risks were minimal compared to benefits. A retrospective study by two Kozhikode doctors of almost 3,000 adverse reactions found only 2% of deaths were “consistently associated with the administration of the vaccine and others were coincidental”, reports A.S. Jayanth. A senior Health Ministry official notedthat “TTS can also occur in the absence of vaccination.

To put this risk into perspective: the risk of dying from a traffic collision is at least five times higher than dying from TTS caused due to a COVID-19 vaccine. But to be sure, this is not much ado about nothing: India can take many more strides in strengthening regulatory processes and improving the surveillance of AEFI. A political reading of scientific events however only lends power to anti-vax movements. The storm will settle and fire will be extinguished only to be flamed another day; the dust and detritus however threaten to deflect attention from a public health conversation on India’s vaccine readiness and the need for greater transparency in clinical trials. 

It is poetic the Covishield controversy coincides with World Immunization Week observed from April 24 to April 30. 2024 marks 50 years since the WHO launched the Expanded Programme on Immunization (EPI), as the eradication of smallpox virus was on the horizon. India launched the EPI (later renamed as the Universal Immunisation Programme) in 1985. Chandrakant Lahariya and Rakesh Kumar outline the success and struggles of the EPI in the last five decades, lessons that can be applied to improving India’s adult vaccine coverage. 

While vaccines are facing the heat online, food safety and quality are up in smoke elsewhere. Over the last couple of weeks, we have been tracking food safety issues in India — among them, how the FSSAI had its hands full with Nestle’s sugar-infused baby products and possible contamination in Indian spices. Action soon followed. Food industry members recently welcomed measures, introduced by the Food Safety and Standards Authority of India (FSSAI) and Spices Board of India, to maintain quality checks of food products sold in domestic and international markets. Activists noted that despite having stringent food safety frameworks, India continues to grapple with a lack of on-ground implementation. Recent reports also suggested that FSSAI has allowed high levels of pesticide residues in herbs and spices. The Union Health Ministry rejected these claims and called them “false and malicious”. The standards of maximum residue limit were decided by a scientific panel based on latest findings and international norms, they said. 

There’s no smoke without fire. In this explainer, Saptaparno Ghosh and I break down the international concerns around Everest and MDH, the health impact of the pesticide ethylene oxide, and why the incident symbolises a larger crisis within the food regulation industry. It’s not just pesticides contaminating food. Tamil Nadu officials flagged the use of liquid nitrogen in food and drinks served in restaurants. R. Sujatha writes how improper handling or consumption can cause severe damage to the skin, mucous membranes, and internal organs.  

A new ADB report noted India is one of the lowest among the Asia Pacific nations when it comes to health insurance for older people. The country needs to expand universal health coverage to meet the needs of an ageing population and sustain growth momentum, it said. India is undertaking a wider set of reforms, part of which was to remove the 65-year age cap on insurance. Tune in to this conversation between G. Sampath and public health expert T. Sundararaman to know more about how IRDAI’s proposed measures will pan out. 

The same ADB report also acknowledged improved coverage of Ayushman Bharat, the government’s flagship programme, which provides cashless healthcare to 40% of India’s population. Part of the programme is the Pradhan Mantri Jan Arogya Yojana (PMJAY) that promises a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation. However, PMJAY’s reach and impact is contentious: hospitals in some States have reported they are owed hundreds of crores in dues, and some are reportedly turning away or taking in fewer PMJAY patients. Zubeda Hamid moderates this insightful conversation on whether PMJAY’s design needs to be changed to make it more sustainable

Health matters made their way to the courts again, this last week. Ishita Mishra provides the latest update on the Patanjali case, the Uttarakhand State Licensing Authority told the Supreme Court it has suspended the licences of 14 products sold by the Baba Ramdev-owned Patanjali Ayurved and Divya Pharmacy. The declaration came with an apology and a promise that it would commit no deliberate or willful act which would disobey any orders of the Supreme Court. If you recall, the Indian Medical Association had filed a petition against Patanjali’s “misleading” ads that claim to cure chronic conditions and denigrate the field of allopathic medicine. 

The Madras High Court also flagged a worrying trend in medical education, in this report by Mohamed Imrranullah S. Students secure admission in postgraduate medical courses in government colleges by readily signing bonds to serve in public hospitals for two years after their studies, but subsequently try to wriggle out of this obligation. “The bond is... nothing but a service to humanity and to the poor sections of the society who are unable to get paid treatment,” the Bench said. 

In gender news, a separate Madras High Court Bench also recorded the Union Government’s statement that for people who want to change their sex in passports, it is not necessary to produce a sex reassignment surgery/surgical reconstruction certificate. The petition was filed in 2019; the counsel claimed that a request for a change in sex from male/female to transgender should not require certificates since such claim related to self-identity. 

In this piece, Rehnamol Raveendran writes about why political parties must recognise menstrual leave for women, which will in turn boost access to menstrual hygiene, women’s rights and gender equality. Any legislation for menstrual rights makes implicit the right to menstrual hygiene management facilities and equity for all women. 

The election season coinciding with severe heatwave conditions has an unexpected casualty: a shortage of blood donations. In Karnataka, ever since the Model Code of Conduct (MCC) came into force on March 16, hardly any blood donation camps have been conducted. While educational institutions, where camps are usually held, are closed for the summer vacation, even those who want to donate are not keen due to the severe heatwave conditions. several of the 217 private blood banks are not able to meet even 50% of the demand as their supply mainly depends on voluntary blood donation camps, reports Afshan Yasmeen

Elsewhere, health stakeholders are hoping to enter the electoral fight. Siddharth Kumar Singh writes about a former nurse contesting the Lok Sabha elections from Telangana. Bharathi Dasari’s mission is to extend essential amenities such as electricity and healthcare services to the underserved; pay adequate attention to pregnant women; updating the curriculum of nursing colleges where “bureaucratic obstacles stall their progress”. In the Odisha Assembly Elections, Dr. Purna Chandra Mohapatra, a renowned gynaecologist, is BJP’s pick to fight from the Cuttack-Barabati seat, writes Satyasundar Barik.

The ongoing electoral theatre is packed with polarising speeches pitting one community against others. Ever wonder if science has an explanation as to how bias operates in our society, or where the ‘us versus them’ idea stems from in the brain? Reeteka Sud reports on a fascinating study that found while people say they believed in the equality of all races, they also harboured implicit biases in favour of socially advantaged groups. Behind cultural narratives that insist “they are bad people”, she writes, “remember that somewhere behind this statement is a misappropriated bit of brain biology.” 

Our tail piece for this week is a computer science conundrum that could transform healthcare. A cryptic puzzle called the P vs NP question has assailed bright minds, but solving this math problem could unlock a new era in medical science too, writes C. Aravinda. Read along to dig deeper into this arithmetic challenge that, if solved, could redefine healthcare. 

From the Health page

Preeti Zachariah writes about a book that offers a holistic take on the obesity crisis

Why a group of University of Hyderabad scientists are recommending mangoes for gut health

Tamil Nadu experts say cancers in adolescents and young adults are a growing cause of concern. 

How poor identification of brain death cases is impacting organ donations, reports S. Vijay Kumar. 

As mistrust and misinformation mill about, one lesson from Shakespeare comes to mind: Happy are they that hear their detractions, and can put them to mending. 

For many more health stories, head to our health page, and subscribe to the health newsletter, here

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