Clear the Fog, Draw Up a Clear Vaccination Policy

Context: A comprehensive vaccination policy can reduce the overall disease burden through herd immunity and herd effect.

Hierarchy of human mastery over infectious microbes

• Individual protection: A vaccine can induce immunity only in the vaccinated individual. So, vaccination is ‘preventive medicine’.
• Community control: When increasing proportions of people are vaccinated, ‘herd immunity’ level increases, and disease frequency decreases in the vaccinated population.
  • For evidence, disease frequencies are documented both at baseline and on an ongoing basis, through systematic surveillance.
• Elimination: The extreme form of control is ‘elimination’ of transmission of the microbe in a whole country. eg. measles and rubella have been eliminated in Sri Lanka.
• Eradication: is the global elimination of an infectious disease; So far, smallpox and cattle plague have been eradicated using their respective vaccines.
  • Eradication can also be achieved without a vaccine, using ‘Non­Pharmacological Interventions’(NPI), systematic case detection, contact tracing and quarantine.
  • eg. Severe Acute Respiratory Syndrome (SARS) was eradicated in 2003 without a vaccine.

Prospects of vaccination in India:

• Presence of possible vaccines candidates: 3 COVID­-19 vaccines claims of 90­-95% protective efficacy; BNT162b2 (Pfizer­BioN­ Tech), mRNA­1273 (Moderna) and Sputnik­V (Gamaleya Institute).
• Presence of policy framework: Under the Universal Immunisation Programme (UIP), vaccines procured and sup­ plied by the Union government and vaccination implemented by State governments.
  • States have the freedom to surpass policy limits: if no fund is sought. There are precedents:
    • Delhi used the Measles/Mumps/Rubella vaccine
    • Sikkim unilaterally used human papillomavirus vaccine to prevent cervical cancer in women.
  • Availability of standard cold chain: under the UIP.
• Vaccine Prioritisation Framework: Health­care workers and ‘corona warriors’; citizens>65 years; those between 50 & 65; those <50 who have co­morbidities; and finally general public;

Challenges to vaccination in India:

• Inability to stop transmission: Since the CO­VID­ transmission occurs from infected persons before the onset of fever and from infected but totally asymptomatic individuals.
• No goal for elimination: Workers in essential services are missed out in prioritisation, and the government has not considered a public health goal of control or elimination.
• Requirement of cold-storage: New vaccine other than the three undertrials will require significant additional cold chain space.
• Involvement of the private sector: Under the UIP, vaccines attract no user fee, but the private sector bills the beneficiary.
  • It is unclear whether the insurance companies will reimburse the recipients of a private sector vaccine.
• Lack of public health surveillance: India does not practise public health surveillance which makes it difficult to monitor the control trajectory of COVID­19 over time.
• State-Centre Tussle: While various states have sought to develop their own plans, Centre has asked states to refrain from making isolated planes for vaccine distribution.

Way Forward: Address the objective questions related to -

• Determining the age groups: to be covered for disease control.
• Place of vaccination: whether on fixed stations of health care clinics.
  • The vaccination stations should be staffed with trained personnel and supervised by doctors.
  • Improve public health infrastructure
• Pricing of the vaccine
• Diagnostics and treatment of adverse effects: Vaccine related data management has to be meticulously planned and executed for
  • Post-vaccination follow-ups;
  • Development of computerised master list with details of all vaccinated subjects.

Conclusion: It is a big challenge to protect the life and the health of citizens, and also a huge opportunity to eliminate the novel coronavirus from India, setting an example to the rest of the world.