New Delhi: The Narendra Modi government’s challenge of smoothly rolling out vaccines for Covid-19 has an unexpected task on its to-do list — putting to rest worries that a small section of doctors, nurses, and other healthcare workers has about being inoculated.
The Ministry of Health had announced Saturday that the vaccine rollout in India would begin 16 January, starting with healthcare workers, then moving to frontline workers and people above the age of 50.
A handful of doctors ThePrint spoke to expressed doubts about the safety and efficacy of the vaccines, and some displeasure about the lack of clarity around them as well as the sign-up process for inoculation. However, the medical practitioners are not saying they won’t take the vaccine, with senior doctors insisting that awareness campaigns are the need of the hour.
“Everyone is worried. But we have decided awareness campaigns are the way out,” said Dr B.L. Sherwal, director of Rajiv Gandhi Super Specialty Hospital in the national capital, a Covid-only facility until 1 January.
“I will personally hold an interactive session to help them get rid of their inhibitions, and share data about the current Covid-19 vaccines and similar vaccination programmes carried out earlier, among other things. I will be the first one to take the vaccine from the hospital so that it helps build trust among doctors, nurses and paramedical staff here,” Sherwal said, adding that hesitancy among healthcare workers was “natural human behaviour”.
Hospital administrators and public health specialists are hopeful that once vaccinations begin, it will have a domino effect and encourage those who are apprehensive.
“Hesitancy might only last for the first 3-4 days, after which people, including healthcare workers, might realise it’s worth giving a shot,” said Dr D.S. Rana, chairman of Sir Gangaram Hospital in Delhi.
“At the end of the day, it’s a voluntary procedure. Once people see others getting it, they might change their minds,” Rana added.
ThePrint reached Health Secretary Rajesh Bhushan for a comment via calls and messages, but received no response until the time of publishing this report.
Concerns about safety and efficacy
On 3 January, the Drug Controller General of India gave emergency use authorisation to Serum Institute of India’s Covishield (developed by Oxford University and AstraZeneca) and Bharat Biotech’s Covaxin, even though the latter hadn’t published any efficacy data, and AstraZeneca had made a dosage error during trial.
The Indian Medical Association put out a statement Monday, encouraging all its 3.5 lakh members to “voluntarily come out to get vaccinated first to show to the world that these vaccines are safe and efficacious”.
“We stand with the scientists to endorse the safety and efficacy of both these vaccines, so public awareness and countering myths on vaccine percolating in social media shall be our priority. Our modern medicine doctors will vouch for the safety, quality and professionalism in this difficult time and support the emergency approval for the usage of vaccines,” read the IMA’s statement.
However, the doctors ThePrint spoke to emphasised that they weren’t against vaccines, but expressed some hesitation over Covaxin and Covishield because of hasty approvals and lack of efficacy data. The government hasn’t announced which vaccine will be supplied first, or if both will be supplied together.
“Taking these vaccines makes me uncomfortable, because the scientific rigour to approve these vaccines was not followed through. I will take the vaccine because I feel I don’t have a choice given the circumstances. I’d be more confident if norms were followed,” said a doctor from Rajiv Gandhi Super Specialty Hospital, requesting anonymity.
Dr V.K. Gupta from the Lajpat Nagar Mohalla Clinic in the national capital told ThePrint that while he was willing to take the vaccine in the “larger interest of things”, there was some scepticism among his colleagues.
“I am part of multiple WhatsApp groups with doctors, and this is all everyone is talking about these days,” said Gupta. “They feel there should have been more data regarding the trials. While the names of many doctors have been sent to the government, there might be a few who back out when the time arrives.”
A senior doctor from PGIMER Chandigarh also said some healthcare workers in the institute were concerned about the efficacy of Bharat Biotech’s indigenous Covaxin in particular.
“While it is good news that vaccines have been approved, it’s too early to ask people to get vaccinated as there isn’t adequate efficacy data yet,” this doctor told ThePrint. “Many nurses and doctors have second thoughts about taking the dose.”
Dr Adarsh Pratap, president of the Resident Doctors Association at AIIMS, New Delhi, said it “wasn’t uncommon” to find scepticism among doctors, and that counselling such doctors could result in a “catch-22 situation”.
“It is a tricky situation because while we are trying to counsel people, there are doctors within the association who have concerns,” said Pratap. “Doctors willing to take the vaccination in the first phase might motivate the ones who are sceptical about this to eventually get rid of their fears.”
Dr Anish Sinha, associate professor at the Indian Institute of Public Health, Gandhinagar, said vaccine hesitancy, even among healthcare workers, is routine, and can be dealt with if “big personalities” and community leaders come forward to take the shot first.
“There are some state- or city-specific healthcare personalities, and it helps if they take the vaccine first. I have seen this among doctors who initially were completely against getting the vaccine to now having softened their stance after they see someone they know get it,” he said.
“The influencer behaviour might also come in handy — senior doctors should get the vaccine, and post images on social media so that those who are still in fear feel motivated,” Sinha added.
The greater good
Several doctors say it’s important to weigh the pros and cons.
“We may joke among ourselves about being guinea pigs, but we are looking forward to the vaccine. In an emergency situation, it’s important to look at the greater good that can come out of it,” said Dr Jyotsna Ranga, a doctor based in Ajmer.
Dr Rafique-uz-Zaman, a transfusion specialist at Apollo Hospital, Kolkata, agreed. “In a pandemic, decisions have to be made quickly. It’s not an issue for me, and in my group of colleagues, we are confident about taking it,” he said.
Fortis Healthcare’s medical operations head, Dr Bishnu Panagrahi, added: “The people of our hospital are enthusiastic and no one has expressed any hesitancy to us. We’ve followed all the government’s guidelines, and have been led from the beginning by an internal Covid expert committee.
“Naysayers exist everywhere. India is one of the biggest vaccine manufacturers in the world, and it’s important to look at it positively. It’s also important to remember it is a voluntary procedure, and no one can be forced.”
Dr Anupam Sibal, group medical director at Apollo Hospitals, said no instances of hesitancy or scepticism have come to his notice.
“There is absolutely no degree of scepticism among the doctors here. If the need arises, we will articulate all the benefits and advantages of taking the vaccine, which are available in the public domain,” Sibal said.
Information about vaccines, sign up process
The availability of information about these vaccines in the public domain is another issue doctors have flagged.
Dr Sinha from Gandhinagar said: “Vaccine candidates should have had a leaflet or product description in the public domain by now, so that even doctors know what ingredients have been used instead of relying on WhatsApp forwards or Facebook for such information.”
Another issue healthcare workers have raised is the lack of information about the sign-up process for vaccination, as well as a general lack of communication about the programme.
“I heard that all our information has been sent to the concerned government, but I am not sure about whether that constitutes a registration or if the registration happens later. I believe our hospital has sent our information, but I was not asked,” a doctor at one of Delhi’s Max Hospitals told ThePrint. “I would like more information. I would like to know which vaccine I’m going to get. All the information I have so far is through the media.”
A doctor at the Kamineni Institute of Medical Sciences in Telangana, a vaccination centre, felt similarly, saying: “I would like to be informed about what exactly the sign-up process is. I think our data has been sent to the government, but I’m not clear about when I will have a say. We weren’t informed about when our data was sent. There has been no direct communication.”
The government began collecting information to form a database of healthcare workers who would be the first to be inoculated. However, this process hasn’t been uniform — some districts are allowing workers to sign up for the vaccine via registration links, while other districts have asked associations and hospitals to send details to the government directly, without informing the workers.
“There is variation (of vaccine registration) even at the local level. For example, in Ahmedabad, the municipal corporation has been sharing an online link for people to register for the vaccine, while there is no such thing in other districts,” said Sinha.