In vaccine race last lap, the key steps for India

Context: Evaluation of candidate vaccines for COVID­19 should be done on technical parameters and programmatic suitability.

 Characteristics of an ideal COVID-19 vaccine:

• Immunity of a high degree (90% + protective especially against severe illness),
• Broad-scale (against di?erent variants) and durable (at least ?ve years);
• Should be safe (little or no side-e?ects);
• Should be cheap (similar to current childhood vaccines);
• Should be programmatically suitable: single dose can be kept at room temperature, needle-­free delivery, available in multidose vials, has long shelf life and is amenable to rapid production.

Challenges before the vaccine distribution policy:

• The dilemma of choice: The recent vaccines develop by Pfizer and AstraZeneca shows different but not all characteristics of an ideal vaccine yet.
• Lack of cold storage infrastructure: Since most vaccines would come in two doses, lack of adequate cold storage will pose a hurdle.
• To immunize poorest and most vulnerable: including migrants/refugees, people with disabilities along with old age persons with co-morbidities.
• Pay and get: One major challenge is that many people would be willing to pay for the vaccine and ask for expedited access, putting the strain of governments procurement and distribution.
• Well, spread out coverage: Their remains a risk of focal outbreaks keep occurring in areas with poor vaccine coverage.
• Lack of prioritization policy: details of the policy are not available on the public domain.

Way Forward: Need for a concise recipient prioritization policy:

• A post-licensure surveillance system: to effectively monitor the side effects or delayed effects of the vaccines.
• Ranking by risk category: The World Health Organisation (WHO) has issued guidelines for prioritization of vaccine recipients. Ranking of groups should be done for e.g.
  • By risk category (risk of infection or the adverse outcome or economic impact);
  • By programmatic ease of vaccination: based on their captivity (health­care workers, organized sector, workplace, schools) and existing channels of vaccination(women and children).
    • Phase 1: Vaccines for health care workers should be kept at this phase at their own facility and can also be used for policemen.
    • Phase 2: The workplace and school-based vaccination roll­out could be the second phase of vaccination.
  • Employ social mobilization: By an outreach or camp approach (booths along with web-enabled appointments facilitated by civil society).
    • For e.g. Social mobilization e?orts during the Pulse Polio campaigns, Aadhaar card enrolment and elections serve as good models.
  • A ring immunization strategy: e. immunizing the population around reported cases or even earlier.
  • Dealing with the pay and get: Till Phase 1, the government should not concern with other groups; however, it should allow market-driven prices after it.

 Conclusion: Thus, choosing, paying for vaccines and their administration by governments are going to be most challenging with no easy answers.