COVID vaccines: Pertinent Points Discussed by Prof. Dr. Shubhashish Sircar

Subhas Chandra Pattanayak

[Presently Associate Professor and Head of the Department of Community Medicine, (PSM), in Sheikh Bhikari Medical College, Hazaribagh, Dr. Sircar is evaluated as one of the best SMO (Surveillance Medical Officer) in the Polio eradication project of WHO. He is well trained on technical skills pertaining to Surveillance, Epidemiology, Data analysis, Field monitoring and Supervision, monitoring and supervision of NIDs and SNIDs (Pulse Polio), Routine Immunization, AEFI (Adverse Events Following Immunization), EPPR (Epidemic and Pandemic Preparedness and Control) along with Finance, Logistics and Administration for 9 years by technical officials, researchers, officials and consultants of WHO (Geneva Headquarters, Regional Office for South East Asia and India Country Office), by officials of Ministry of Health, Govt. of India, CDC (Centers for Disease Control) officials, Atlanta, USA, researchers of John Hopkins Bloomberg School of Public Health, Baltimore, USA, USAID (India), DFID and Unicef officials and consultants.
In this exclusive sharing, he has focused on the unseen horizon centering the vaccine.

A vaccine/a few vaccines may arrive in India by March or April next year. SII (Serum Institute of India) has said that their vaccine will hit the market in four months. Most vaccine manufacturers have said that it’ll be available “off the shelf” by end of 2021.

I doubt even that, because 1/2 of the vaccines have already been booked by the affluent countries. That’s 9.5 billion doses!!!

Another thing, to vaccinate all in India will take a whooping four YEARS!!!

And the 3rd wave has hit Europe now (along with H1N1 spilling over to swans in Belgium from migratory birds), and will hit India within a few months, probably once again in Maharashtra, Gujarat, Kerala and Delhi.

Meanwhile, let the Kanpur-walas (in UP), be happy being “guinea pigs” and undertake the 3rd trial of the Sputnik-3 vaccine. SII is conducting the 2nd and 3rd trial and Bharat Biotech, its 3rd trial in India. These could well be more reliable.

I’ve worked in WHO and with officials from GAVI (Global Alliance for Vaccine and Immunologicals) in their immunization projects for nine years and here’s my take on the upcoming COVID 19 vaccine maintenance and delivery.

A new vaccine – the question is, which one and how many?

Pfizer with probably 90% efficacy is in Phase 3 trial. The only issue, in my opinion is that, it was conducted on only 94 patients. Isn’t that a small sample size? It works on the ‘Spike proteins’ of Novel Corona virus. FDA has said that it’s not for emergency use due to certain non-compliance issues (6 weeks is the minimum study period for studying side effects). Recently it has been approved by FDA for Vaccine approval. BioNTech may get approval by mid December, 2020. Their data will first be reviewed by Review Boards. Astra Zeneca vaccine is very expensive and the Pfizer vaccine in addition requires to be stored at minus (-) 70 deg. Celsius. The Astra Zeneca and the Bharat Biotech vaccine are also undergoing Phase 3 trials. Cadila is in Phase 2 trial.

The Astra Zeneca will cost $ 18.34 per dose. Pfizer will cost $ 19.5. The Oxford vaccine in India will cost Rs. 1000/= per dose. We will probably have to wait for other vaccines, keeping in mind our resources and our monstrous population, most of whom are poor, hungry, downtrodden and marginalized.

How-many extra syringes will we need? 120 crore? Or 30 crore or twice that? Is UNICEF (United Nations Children’s Fund) giving us 50 crore? Will prices rise like PPE (Personal Protective Equipment) prices in the Corona pandemic? Injection needles likewise. How many will be needed? These questions need to be answered by the logistics and procurement experts.

Then there’s the issue of “Injection Safety” training of health delivery staff. That may take a month or two.

We can get ‘jet’ injectors as used in 1971. Its procurement and training is another issue.

Regarding “Cold chain” – a vaccine carrier will be needed for every 100 doses given on a single day. Should we alternate it with routine sessions??? Will that put a strain on staff???? Can one SHC (Subsidiary Health Centre) do 5000 doses in a year???? What will be the vaccine delivery cost????

Regarding electric Cold Chain – Do we double the number of ILRs (Ice Lined Refrigerator) ???? Where will we get/purchase them from???? What’ll be the cost??? …. And special minus (-) 70 cold chain???? That’s another issue. Or should we use ‘Dry Ice’???? Will it be affordable?

See the prices mentioned above. Will it be equitably distributed??? The lucky Biharis (of the state of Bihar) may get it for free if the politicians adhere to their promise. What about we, the other poor Indians ???

The initial low supply will mean that the vaccine will be first given to doctors, nurses, lab technicians, other health personnel. Then those above 65 years of age. Then those with Co-morbidity conditions. Others will have to wait in the line.

Bio-waste management – Bury-space, Incinerate, Autoclave, Transport.

Recording Cards or Android???? Training and logistics will be a serious issue.

The issues like “access” in far flung areas ……. in HRAs (Hard to Reach Areas). Special microplans need to be drawn up. Monitoring of these is a tough call. I know that, as I have done it a decade ago.
How will the adverse events due to the vaccine be monitored????

A proper AEFI (Adverse Events Following Immunization) system and ADR will be needed. This however, has improved vastly since 2005.

It’ll surely be a tough battle for an exhausted army of health professionals, nursing staff, ANMs and health workers including supervisors.

Let’s hope for the best.

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