Open Covid-19 vaccination to 18 years and above

Vaccine as a response to the pandemic has been excellent so far despite the current inadequacies in our health systems. However, it is now time to up the ante. Over 6.87 crore people in India have so far received one dose of the vaccine and around 96 lakh both the doses, as on April 2.

However, measured on a per-capita basis, total number of vaccines we have administered is amongst the lowest in the world. We have only four jabs per 100 people, Israel has 114.58 per 100. Our scientists have created an indigenous vaccine, we have exported vaccines to countries in need and have truly embodied the spirit of ‘Vasudhaiva Kutumbakam’. However, we cannot lockdown our economy, we need to go out to work, schools need to reopen, elections need to happen.

With a dangerous increase in the number of cases, we may just be running out of time, and very quickly at that. We have not seen any significant ramp up of our vaccination programme which is required urgently to have the desired impact. Vaccination is important as it provides good protection against severe disease and reduces the transmission. We are dealing with not just imported mutations but also native mutations, perhaps missing some too as sequencing is limited.

The sequencing effort needs a definite boost. In addition to reinforcing the triad of using masks, hand hygiene and social distancing, it is time to now open vaccination for all 18 years and above. With the right approach, issues around vaccine manufacture and supply, maintaining the cold chain and administering vaccines can be easily tackled. Partnering with the large private sector will be helpful.

Unfortunately, vaccine hesitancy is a reality and needs to be tackled head on with reinforcing the correct messaging. It is good to note that all 45 years of age or above will now be eligible to get vaccinated. However, it is the younger population that goes out to work and is at risk of exposure to the virus and hence need the vaccine as much.

As per sources, 6.5% of Covid-19 vaccine doses in India are wasted, suggesting that over two million doses have gone to waste so far. Each Covishield vial has 10 doses in total, while a Covaxin vial contains 20 doses — each dose being 0.5 ml (for one person). Once opened, all doses must be administered within four hours, otherwise, it goes to waste and the remaining doses must be destroyed.

The wastage of vaccine varies across states: UP -9.4%, Tamil Nadu 3.7% and Himachal Pradesh 1.4%. It will be prudent for states to learn from each other to target zero-vaccine wastage. The Central Government may also consider publishing daily, state-wise data about the number of doses supplied to each state. This is likely to improve vaccination drive, especially in laggard states. In fact, though health is a state subject, the pandemic response needs to be unified.

Importantly, vaccine doses come with an expiry date and it would be criminal wastage if the vaccines were to expire unutilised. In fact, the first batch in Karnataka is set to expire in May 2021. It may be worthwhile to consider consolidation of vaccine centres as small centres may have higher wastage, though this may not be possible in difficult terrain or special populations. Further, we need to look at doing additional studies on vaccine stability to increase shelf life.

In addition to expanding vaccine coverage to all 18 years and above, we need to look at making the process seamless and drudgery-free. It may help to move the vaccine centres closer to the population- public buildings, libraries, sports stadia etc, can be roped in as vaccination centres. Where possible, open air environments should be preferred over AC buildings to prevent vaccination centres becoming hot spots for spread.

Adequately equipped ambulances stationed on-site can help provide emergency response in case of an allergic reaction, the occurrence of which, for vaccinations in general is one per million. Management of delayed reactions to the vaccine like fever, myalgia, pain at injection site etc, can be guided through digital healthcare as has been done in the case of home isolation of Covid positive cases and telemedicine consults.

Furthermore, we also need to consider other vaccines for emergency use approvals, open market access to vaccine with requisite checks, involve corporates to organise vaccine camps and incentivise hospitals to have round the clock vaccine service and even explore vaccinating the foreign nationals on Indian soil in coordination with their embassy/consulate.

Every single person who is vaccinated is one less opportunity for the virus. Time is of essence here, and in this race against the virus, time is not on our side. The question is not whether we can roll out the Covid vaccine for all, but can we afford not to?

(Dr Arora is Vice President-Asia, Day to Day Health; Dr Swaminathan is Director, Infectious Diseases & Infection Control of a Bengaluru-based hospital)