Inoculating India against COVID-19: Challenges Ahead
In the wake of the COVID-19 pandemic that had left many governments scrambling towards lockdowns and led to a massive failure of numerous public sectors worldwide, especially in the US, the public health crisis is now about to become a phase of the past. Vaccines against the novel coronavirus made harnessing cutting edge m-RNA techniques are being developed by national and international teams of scientists at a breakneck pace never seen before. Amidst all the gloom caused by the virus, these vaccines have finally emerged as the silver lining in the darkest cloud. It usually takes close to half a decade, if not more, for a vaccine to clear its trials. But in a significant breakthrough, on January 16, 2021, merely ten months after the WHO declared the COVID -19 a pandemic, the Indian government cleared Covishield, a vaccine developed by the British pharma giant AstraZeneca in collaboration with Oxford University and Serum Institute, an Indian firm. The vaccine had cleared its trials in December 2020 in five countries with reportedly a high success rate.
However, Covishield is not the only frontrunner in India; the indigenously developed Covaxin developed by Hyderabad based Bharat Biotech collaborated with the National Institute of Virology, Pune, is another traditional vaccine that uses an invert virus to produce antibodies against the disease when injected into the body. Five other Indian companies - Gennova Biopharmaceuticals, Zydus Cadilla, Reliance Life Science, Mynvax and Serum Institute, are also on relentless pursuits to produce a vaccine. They are now in the pre-clinical trial stage. Barring these, many more major vaccines are being internationally developed, such as Russia's Sputnik V made by its Gamaleya Institute, The Pfizer and Moderna vaccines. These vaccines have shown promising results and have proved to be a bright light at the end of this dreary tunnel. All the vaccines have shown an efficacy rate of above 90%. In an incredible feat, the WHO reported that over 150 COVID-19 vaccines are under the pipeline across the globe. What was once a distant dream has today become a shining reality within the grasp of nations worldwide.
Two candidates in a neck to neck race have triggered an unprecedented boost to Vaccinology innovation in India.
Here are the major similarities and differences between them based on two factors. The first being the Platform. Covaxin is an inactivated vaccine that has been developed by Bharat Biotech in collaboration with the ICMR and the National Institute of Virology, Pune. It is based on the tried and tested Platform of dead viruses. The vaccine is developed using a whole virion inactivated Vero cell technology. Inactivated vaccines do not replicate and are, therefore, unlikely to revert and cause pathological effects. They contain dead viruses incapable of infecting people but still instruct the immune system to mount a defensive reaction against infection, whereas Covishield is based on a viral vector platform. A chimpanzee adenovirus called ChAdOx1V is the vector that has been modified to carry the coronavirus spike protein into the human cells. While the injected cold virus is harmless, it serves as an instruction manual for the body to fight against similar viruses.
As far as the dosage regimen is concerned, both these vaccines follow a two-day vaccination regimen -- given 28 days apart. Both vaccines don't require subzero storage, no reconstitution requirement and are ready to use liquid presentation in multi-dose vials stable at 2-8°C. The efficacy data of Covaxin is now available and has been recently released. The company says that the interim data shows 81% efficacy, but the trials are still on. The efficacy percentage of Covishield stands at 70%. Covishield is approved for restricted use in an emergency that may prevent COVID-19 disease in an individual above 18. It has also been noted that Covishield takes three weeks to produce the required immunity, and people are still at risk of contracting the virus despite being vaccinated. Covaxin has received a restricted use authorization in a clinical trial mode. Both vaccines do not have a market use authorization clearance yet from the Drugs Controller General of India because both vaccines are still in phase 3 of their trials. The vaccines are being administered free of cost at government hospitals and health centres, while 250 rupees is being charged for it in private health care facilities.
The sheer haste with which the vaccines have been developed undoubtedly has led many to be sceptical and wonder whether companies and their research collaborators have skipped necessary safety hoops. Inoculating a big country like India has its own set of unforeseen challenges like:
1-Vaccine Supply: According to reports from the Ministry of Health and Family Welfare, India plans to vaccinate 250 million people by July 2021. As of now, AstraZeneca's Covishield is the primary vaccine. However, despite vaccine manufacturers claiming output in millions, the WHO has predicted a shortfall. According to an Oxfam report, 51% of the promised supply of covid vaccines will be cornered by wealthy nations who only account for 13% of the global population.
For a country like India to achieve herd immunity, it needs 60% or 800 million people to be vaccinated. This demand supersedes the current vaccine supply rate prevalent in the country.
2-Logistics and Cold Chain Supply: Vaccinating a population of 1.4 billion is a daunting task by itself, more so when 52% of India's 29,000 cold chain points are concentrated in just six states, namely Maharashtra Karnataka, Tamil Nadu, Rajasthan, Gujarat and Andhra Pradesh. Although the "Made in India" vaccines do not require subzero temperatures, they can be stored at room temperature for a limited period only.
3-Vaccine Hesitancy: Currently, vaccines are the safest bet against the COVID-19 virus, yet people still maintain their scepticism regarding their efficiency given the quickness with which they are being manufactured. Social media, too, can be blamed for adding doubts amongst the common masses. However, it has been seen that the fear and hesitancy is greater in the United States than in India. Besides this, the Niti Ayog too confirmed in a statement that there is no risk of thrombosis or blood clotting due to the use of Covishield. The Ayog urges more and more people to get vaccinated after doubts were raised post some discrepancies in the vaccine's UK trials.
However, with these daunting challenges being subdued in the long run, the country is staring at a potential second wave. Hence in this regard, the revised vaccination guidelines allowing people over 45 to get vaccinated can be hailed as a timely move by the government. It intends to prioritize the age group most vulnerable to the disease as they constitute 88% of India's total 1.6 lakh fatalities.
Sources:
- "Is it safe? Will it work?", India Today, December 5, 2020, https://www.indiatoday.in/magazine/cover-story/story/20201214-is-it-safe-will-it-work-1746437-2020-12-05
- "4 Challenges For India's Covid Vaccine Drive" Times of India, January 11, 2021, "https://timesofindia.indiatimes.com/india/4-challenges-for-indias-covid-vaccine-drive/articleshow/80210223.cms
- "Small group of rich nations have bought up more than half the future supply of leading COVID-19 vaccine contenders", Oxfam International, September 17, 2020, https://www.oxfam.org/en/press-releases/small-group-rich-nations-have-bought-more-half-future-supply-leading-covid-19
- "88% Of Covid Deaths In India In Age Group Of 45 Years And Above: Centre" NDTV, March 24, 2021, https://www.ndtv.com/india-news/88-per-cent-of-covid-deaths-in-india-in-age-group-of-45-years-and-above-centre-2398245
- Covishield vs Covaxin: Similarities And Difference between India's Covid Vaccines, India Today, March 05, 2021, https://youtu.be/yqGS3yIoz5I