We have the resources and the experience to run this gigantic vaccination drive

India

oi-Vicky Nanjappa

By Dr V M Katoch

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Vaccines go a long way in managing, controlling, eliminating deadly, sometimes debilitating infectious diseases. Smallpox was the first example e of a dreaded disease, with mortality rate as high as 30 percent, being eradicated by a vaccine. But it was a long journey from the development of the vaccine to the elimination of the disease. Edward Jenner, an English physician, was the first to demonstrate the effect of vaccine for this deadly disease in 1796.

The World Health Organization (WHO) initiated a campaign to eradicate smallpox in 1959, but despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks in multiple countries. Then in 1967, efforts were intensified, scientists came up with a higher quality freeze-dried vaccine, bifurcated needle, stringent surveillance system. India achieved the target of eradication of smallpox in 1975 after a very intense vaccination and containment campaign.So, it took almost 200 years, when on May 8, 1980, the 33rd World Health Assembly officially declared the world free of the disease.

Well, smallpox is not the only example. Over the years, vaccines emerged as a powerful tool to protect populations against various disease-causing organisms. Our scientists have developed vaccines that provide complete or partial protection against diseases such as plague, cholera, rabies, polio, measles, rotavirus, influenza, among others.

When Covid-19 hit the world last year, scientists across the globe came together to develop an effective vaccine against it. Interestingly, within 10 months of decoding the viruss genome sequence, many vaccines were not only developed but tested for their safety and efficacy. With vaccines we have achieved an important milestone in our fight against Covid. It is a matter of pride that two vaccines have become available in India one totally developed in India, other in partnership and manufactured in India.

So far, India has done exceptionally well in managing the deadly virus. The per million cases of Covid in India are far less as compared to several other countries. We have been able to slow the spread of disease and control the number of cases without vaccines by conventional and known tools/ approaches of using masks, physical/ social distancing, hand hygiene, detection of cases and their isolation.

Progress in medical management by modern as well as traditional medicine systems are also contributing to prevention and improved treatment outcomes. While all these methods will remain relevant, building the immune capacity of individuals and population by vaccination can prove another highly effective shield against Covid. We are at an important juncture in our fight against Covid 19. On January 16, the government is planning to roll out the vaccines across the country. Its plan to inoculate 30 crore people in the first phase of vaccination drive is an ambitious plan, especially when the vaccine has to be given in two doses, at an interval of 4-6 weeks. To execute it we would be requiring an army of vaccinators, on-ground staff, experts to keep a watch on any adverse events, specialists to address these adverse events in shortest possible time, data specialists to analyse the large amount of data the nationwide vaccine drive would generate, and also the physical infrastructure for the storage and transportation of the vaccine.

This may sound like expecting too much in too short a time. But times have changed and viruses are becoming smarter. With humans travelling across the world, viruses too are travelling to all nooks and corners of the globe. As a result, an endemic turn into an epidemic and an epidemic may turn into a pandemic in a blink. So, the fight this time is not only against the virus, but also against time. So far we have fared well. India has managed to tame the virus, by and large. But we cannot afford to become complacent as it is not going to disappear suddenly. A new strain with potential to spread faster has appeared in the UK, and several other countries, including India. There are many pockets in the country which are still not exposed to the virus. We dont know how the virus is going to behave in the coming months. It can come back in small waves, then spread to newer areas and we may also see another severe wave.

We need to put in practice all the lessons we have learnt during the past vaccination drives.

From redesigning a vaccine campaign, to recalibrating it to address various issues that may arise after its launch, to the redevelopment of a vaccine itself to address the mutation in the virus, a vaccination process may need to be changed according to the demand of the time.

For example, the first polio vaccine-Salk vaccine-developed in the early 1950s, was an injectable vaccine, which contained the killed virus. It brought a significant drop in the number of cases of polio. Later in the 1960s oral poliovirus vaccine was developed. It had live attenuated virus.

Apart from aspects related to science, for a vaccine campaign to achieve its target, it may have to overcome various social and political challenges as well.

Every time, we introduce a new vaccine there is vaccine hesitancy. People have a lot of concerns-some genuine, some arise out of rumours and misconceptions about how the vaccine can affect their health.

There are many historical examples of such lack of communication or miscommunication becoming barriers in India which could be overcome by establishing good connection with people and their leaders. Peoples concerns should be identified, addressed as fast as possible by sharing scientific facts with them and in the language, they can understand. Providing complete information in an effective way, maintaining the confidence of people in information from authorized government sources as well as mainstream media will be as important as the logistics of providing vaccines with highest standards of quality. We should be confident that this will be done in current situation as done effectively in the past.

Second, the adverse event surveillance after the vaccination has to be strong. We need to identify, report, address any emergency-small or big-in the shortest possible time. Besides, real-time analysis of the reports as well as data generating from the various vaccine sites across the country will be important to further ensure the safety and efficacy of the vaccine.

Whether it is smallpox or polio, we were able to eradicate the disease with a targeted approach. First, implement it at a wider scale. Slowly, identify the problematic areas. There could be places where the disease prevalence could be higher than the rest of the country, target that area. Then there could be pockets where people would be more hesitant to vaccines, target that area with clear communication strategies. Communicate with the community, the local leaders, address their concern. After some time, the country could face yet another wave of Covid, or issues of mutant variant(s) may emerge. We need a robust disease surveillance mechanism to handle any such situation and contain the outbreak before it spreads.

Pandemics can be contained only when people become resistant to the disease-causing pathogen. There are two ways to acquire herd immunity-one, on exposure to the pathogen people develop antibodies/ immune response in the body and second, the body develops antibodies/ immune response when we give the vaccine. Allowing the natural spread of disease to generate herd immunity is not desirable as this comes at the cost of avoidable morbidity and mortality. With mass use of vaccination against Covid 19, government is determined to protect the people from illness and save lives.

We are a big country, and rolling out vaccines to 1.3 billion people is not going to be an easy task. But we are a very determined country. We successfully eradicated Smallpox and Polio. We are managing many vaccine-preventable diseases through our routine immunisation program. We have the resources and the experience. With hard work of persons leading and implementing the campaign and with the support of people, we are bound to succeed in our gigantic vaccination drive against Covid-19.Together with proven public health measures ( masks, hygiene, distancing, detection and isolation) being practiced at present, mass coverage with vaccines will help us achieve victory over Covid 19 much faster than before. Let us all contribute by hard work and partnership as a cohesive determined society as India always does when faced with challenges.

(Former Director-General, Indian Council of Medical Research (ICMR) and Secretary, Department of Health Research, Ministry of Health & Family Welfare, Govt of India)

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