Lack of data, doubts over trials and vaccine quality – India’s dangerous recovery cocktail

As India gears up to roll out a national vaccination programme, Bharat Biotech and Serum Institute's barbs at each other will only add to vaccine hesitancy.

The civil defence staff will play crucial role in giving security and organising inside the vaccination centre | Photo: Manisha Mondal | ThePrint

For most countries around the world, the current Covid-19 challenges are twofold – limiting the spread of the disease and carrying out vaccination fast enough to outpace the SARS-CoV-2 virus. But the question uppermost in the minds of health officials is whether vaccine manufacturers can supply sufficient doses for the latter goal to be achieved.

India is yet to roll out the Covid-19 vaccination programme but its two leading manufacturers – Serum Institute of India (SII) and Bharat Biotech, the only ones to have got approvals for their respective candidates Covishield and Covaxin – are increasingly sounding like anti-vaxxers, with each running down the other. It has left the Narendra Modi government in an unenviable position of playing the role of a referee at a time when it is already anticipating some amount of reluctance even among priority groups of healthcare and frontline workers to take the shot.

The battle within, the damage done

Serum Institute of India CEO Adar Poonawala, in the first flush post approval, had said: “There are only three vaccines (that) have proven efficacy – Oxford-AstraZeneca, Pfizer and Moderna. Everything else has proven to be safe, just like water.” Poonawala drew sharp retaliation from Bharat Biotech CMD Dr Krishna Ella, who called the trials held for AstraZeneca – which the SII is all set to manufacture and market as Covishield – “lousy”. He also questioned the very technology used in Covishield when he said: “Adenovirus vector-based vaccines may not work when administered next year because there will be an immune response to both the Spike protein and the adenovirus vector. From the third dose onwards, the antibodies against the vector will attack it and even the spike protein will not be expressed.”

Sources said both companies were pulled up by the government, which told them to stop the tirade and get on with the job at hand rather than making a spectacle and adding to the anti-vaccine noise.

On Tuesday, the two companies buried the hatchet and issued a joint statement conveying their combined intent to develop, manufacture and supply the Covid-19 vaccines for India and overseas.

“The more important task in front of them is saving the lives and livelihoods of populations in India and the world. Vaccines are a global public health good and they have the power to save lives and accelerate the return to economic normalcy at the earliest,” the statement read.

But, government officials fear, the damage may have already been done.

“What happened should not have happened. This is extremely undesirable, that is why they have been pulled up. Here we are doing all to ensure public trust and all of that comes undone when this happens,” a senior government official told me. Dr V.K. Paul, chairman of the National Expert Group on Vaccine Administration forCovid-19, when asked which vaccine he would prefer, said Tuesday: “I will take the vaccine that my ministry of health chooses for me.”

Vaccine hesitancy has already taken root

The Modi government has already put in place a plan to tackle vaccine hesitancy in the Covid-19 communication strategy, which it has also shared with the states. These include community engagement (especially in traditionally vaccine-resistant groups), real-time round-the-clock monitoring of digital media to tackle miscommunication and misinformation, and creating a pool of editors who will talk about the importance of vaccines in their articles to build trust among citizens.

However, a survey by online platform LocalCircles in December found that 69 per cent Indians who participated are vaccine hesitant.

It may be counter-intuitive but India’s downward Covid-19 graph, while being good news, will further queer the vaccine hesitancy pitch. It is a well-known fact in public health that as vaccines become successful, people forget the vagaries of the diseases they prevent. It is one of the reasons that the US has seen the emergence of measles and other vaccine-preventable diseases in the last few years.

“The only thing preventing most diseases from coming back is the fact that an average of 86% of the world’s children now receive basic vaccination — as measured by receiving three doses of a diphtheria-tetanus-pertussis-containing vaccine — up from just 5% in 1974. This is a huge accomplishment, but it has also helped create a false sense of security that modern medicine can make infectious disease a thing of the past,” GAVI CEO Seth Berkley wrote in 2019.

India’s Covid-19 numbers – there are currently 2,28,083 active cases of which 20,346 were reported on Thursday – may also create a false sense of security among citizens. It was perhaps not the best time either to give an accelerated approval to Covaxin without any efficacy data and without any evidence of it actually working against the mutant UK strain as government officials have claimed. Dr Ella, in his press conference on Monday, promised that his company Bharat Biotech will provide evidence of the vaccine working against the UK strain in a week. But top government officials say that Covaxin’s efficacy data may still be at least a month away.

The lack of data, doubts raised about the quality of clinical trials, and the quality of the newly approved Covid-19 vaccines even before a single shot has been administered in the national programme, make for a dangerous cocktail. Even a Makar Sankranti rollout, as promised by Uttar Pradesh Chief Minister Yogi Adityanath, may not be able to undo the damage done.

Views are personal.