As Covid-19 cases continue to rise across the world, people are eagerly looking forward to any update about a potential vaccine. Vaccines are under trial in several countries, including India, and the health ministry said earlier this month that it was expecting Covid-19 vaccine supplies to be available from early next year.
Dr Gagandeep Kang, professor of microbiology at Christian Medical College Vellore and one of India’s leading medical scientists, told HuffPost India that while the government’s timelines sound “optimistic”, it would work out only if “absolutely everything goes right and the government has the funding, logistics for supply, storage and delivery of vaccines and a granular prioritisation plan for identifying and reaching those who will get the vaccine in each phase”.
Union Health Minister Harsh Vardhan on Sunday said that the coronavirus vaccines currently in trial in India are 2-dose and 3-dose vaccines. “Vaccine by Serum Institute of India and Bharat Biotech require 2 doses while the Cadila Healthcare vaccine requires 3 doses. For other vaccines in pre-clinical stages, the dosing is being tested,” he was quoted as saying by The Hindu.
Kang, who is the former head of a now-disbanded ICMR panel on Covid-19 drugs and vaccines, also pointed out in the email interview that the government will have to invest not just in the potential vaccine but also the people and health infrastructure that will be administering it.
“Availability and access require investment from the government. Protecting public health should be a priority at all times, not just now,” said Kang.
Kang added that the Rs 80,000 crore figure quoted by Adar Poonawalla, CEO of Serum Institute of India, for vaccine procurement and distribution, “is not unreasonable, it is Rs 650 per person”. The government had disputed this number.
Kang also answered questions on a realistic timeline for vaccine availability, the challenges of vaccine distribution and the funds required for the process.
1. India’s health secretary recently said Covid vaccine supplies are expected to be available from early next year. The government has also said that about 25 crore people are likely to be inoculated by July 2021. How realistic do you think this timeline is?
These seem like very hopeful and optimistic timelines. They might be feasible if absolutely everything goes right and the government has the funding, logistics for supply, storage and delivery of vaccines and a granular prioritisation plan for identifying and reaching those who will get the vaccine in each phase. I hope that the plans and timelines will become clear in the near future.
2. Once a vaccine is discovered, how long would it take for large-scale production and supply? When can India realistically expect to achieve mass immunisation?
Vaccines are already in testing phases, but none are in clinical efficacy testing (in the sense of reliable data on the prevention of disease) in India. The government has taken a proactive step in permitting for at-risk manufacture. This means that if we are lucky, in that the Indian-made vaccines are successful, then we will have possibly several hundred million doses available readily when the vaccines are licensed, which will be in 2021.
I think mass immunisation will take at least 2-3 years, if we mean vaccinating the whole country.
3. What are the challenges with vaccine distribution in India?
Supply logistics, particularly if the successful vaccines are not ones made in India, and storage logistics because we do not know the volume, temperature and duration of storage. Delivery logistics — how to get and deliver the vaccine to the people to be immunised, transport, facility, identification of individuals, getting them to the facility or going to them for immunisation (all the more complicated if two doses are needed). Monitoring logistics — measuring who got vaccine, when, who has been missed etc.
4. How can India ensure the availability and affordability of vaccines for all?
Availability and access require investment from the government. Protecting public health should be a priority at all times, not just now.
5. How can India develop a proper immunisation programme for remote and rural areas as well?
Innovation is essential, identifying people and getting to them with vaccinators and vaccines. We used elephants for polio, could we use drones and satellites now?
(Ed—The Wall Street Journal reported in 2000 that Sobhan Sarkar, the Indian government doctor who was commanding the efforts to eradicate polio, “dispatched brigades of elephants, camels and military helicopters laden with vaccine to far-flung regions, from desert and jungle settlements to snowbound Himalayan enclaves.”)
6. Serum Institute’s CEO has said that around Rs 80,000 crore will be needed to procure and distribute the Covid-19 vaccine in India. Do you think this is a reasonably accurate figure? Does the Indian government have the required funds?
The figure is not unreasonable, it is Rs 650 per person. I assume the government has the funds, but we need to understand that vaccines are not the only tool that will require investment. We still need people, hospitals, tests, drugs, much, much more not just for Covid-19, but for all of the health sector.
(Ed—Government has said it does not agree with the calculation of Rs 80,000 crore. Health ministry secretary Rajesh Bhushan said the government has calculated the amount required and currently, that amount is available.)
7. Do you think there could be a trust deficit among the Indian population regarding Covid vaccines?
I do not know. I am worried that people think that once we have a vaccine, life will go back to normal — that is unlikely. On the other hand, when we had the last wide scale use of vaccine, with the measles-rubella campaign, we had many anti-vaccine messages emerging at the local level. That may happen again, so building trust is a key part of not just getting vaccines, but building trust in the government and its health systems.