Within two months of commencing the country wide Covid-19 inoculation drive, India has managed to administer over 25 million doses and 4.36 million people have been fully vaccinated. However, despite the numbers, experts reiterate that India is nowhere close to achieving herd immunity. It is important to note that even as the vaccination drive is steadily gaining pace, the number of those fully vaccinated translates to a mere 0.34 percent of the population. It is therefore important that people continue to stay safe by wearing masks and practicing social distancing and hand hygiene

Evidence around various factors related to the efficacy of the vaccines is still weak. The duration of the immunity provided by the vaccines, the chances of infecting others after immunization, and protection against variants are few questions to which there are no clear answers yet. Experts suggest that one cannot lower their guard till at least 70 percent of the population gets immunized. This is going to be a long term affair. The possibility of another wave and the likely spread of overseas variants mean that the battle against Covid-19 is not over yet.

Even with seroprevalence studies showing high seropositivity in many parts of the country, Covid-19 cases have started to spike in the past month in select states, after over four months of a nationwide steady decline. Maharashtra, Kerala, Punjab, Karnataka, Gujarat and Tamil Nadu continue to report high number of Covid daily new cases. They cumulatively account for more than two thirds of all new cases reported in the past two weeks.  Partial lockdown has been announced in Nagpur in Maharashtra starting March 15, after an alarming spike in Covid-19 cases.

Moreover, new Covid-19 strains have been detected in India late last month. It is believed that the UK strain is highly transmissible. Renowned cardiologist Dr. Devi Shetty has been quoted as saying that there are indications of another wave hitting India shortly, especially with new, more contagious Covid strains.  The Council of Scientific and Industrial Research (CSIR) has also warned that the Covid-19 crisis was far from being over and allowing a “third wave” by lowering our guard is sure to have grave consequences.

As on March 11, India’s total confirmed cases are close to 11.3 million, with over 1.5 lakh new cases reported in the past week. The past fortnight saw a rise in cases by over 30 percent, causing fear that the country may have been hit by a second wave. 126 Covid-19 deaths were reported in the past 24 hours, taking the total to 158189 as on March 11.

Vaccinations Round Up

India has administered 24.3 million of the vaccine doses since January 16, making it the third highest country in terms of total doses administered. However, in terms of doses administered per 100 persons, India sits way below many countries at 1.9 per 100 persons. About 7.1 million healthcare workers have received the first dose so far, while 3.9 million healthcare workers have received the second dose, as on March 9. Similarly, 6.9 million frontline workers have received the first dose while 4.73 million frontline workers have received the second dose.

On March 1, India initiated the second phase of its vaccination drive to include people over 60 years of age and those of aged 45 and above with co-morbid conditions. As per the Ministry of Health and Family Welfare, 5.1 million people over the age of 60 and more than 830,000 people between 45-60 years with co-morbidities have been vaccinated with the first dose as on March 9. This phase is expected to cover more than 130 million of the 60+ population alone, who constitute the majority of the vulnerable population.

Recipients are now being able to self-register in advance by the Co-Win website and through other applications such as Aarogya Setu, which lists government and private hospitals serving as Covid-19 vaccination centres with the date and time of the available schedules.

Vaccination uptake rises post Covaxin’s efficacy results

The initial mistrust over its perceived controversial approval has reduced significantly after Bharat Biotech’s recent update regarding the 81 percent efficacy of its vaccine Covaxin on those without prior infection. This announcement, coupled with Prime Minister Narendra Modi taking his first Covaxin shot, is likely to have caused the recent surge in inoculations. India had approved the vaccine in January without late-stage efficacy data, raising questions about its effectiveness.

Bharat Biotech’s homegrown Covid-19 vaccine has shown an interim vaccine efficacy of 81 percent in late-stage clinical trials. The interim analysis was based on 43 recorded cases of Covid-19 in the trial of 25,800 participants, conducted in partnership with the Indian Council of Medical Research. Thirty-six of the 43 cases were recorded in participants who received a placebo, compared with seven cases in people who were given the Bharat Biotech vaccine, pointing to an efficacy rate of 80.6 percent, the company said.

The subject expert committee of the Central Drugs Standard Control Organization has now recommended removal of the ‘clinical trial mode’ condition attached to an earlier emergency licensure given to Covaxin. A decision on this will now be taken by the Drugs Controller General of India based on the SEC’s recommendations.

India’s vaccination drive, currently underway, includes Covaxin and Covishield, a vaccine developed by Oxford University and AstraZeneca, manufactured by Pune based Serum Institute of India. Also, of the total vaccine shots given in the country, only about 19 lakh shots have been that of Covaxin, while the majority of the jabs have included the administration of Covishield. 

Private sector participation in the vaccination drive

To ramp up the Covid vaccination capacity manifold, significantly a large number of private facilities are being involving in the process. Around 10,000 private hospitals empanelled under Ayushman Bharat PMJAY, more than 600 hospitals empanelled under CGHS and other private hospitals empanelled under State Govts. Health Insurance Schemes can participate as COVID Vaccination Centers (CVCs) as per the government directive.

States have been explained that the private hospitals functioning as CVCs can charge citizens up to Rs. 250 per person per dose along with the electronic and financial management mechanism in this regard.

Of the total 2.43 crore doses of Covid-19 vaccine administered in India so far, nearly 71 percent have been given out in government hospitals while the share of private hospitals has been the rest 29 percent. The public facilities include primary health centres, community health centres, sub-divisional hospitals, district hospitals, medical college hospitals and so on. While largely it is the empanelled private hospitals that have been roped in for Covid-19 vaccination drive, four states which include including Odisha, Telangana, Maharashtra, and Delhi have been exempted to involve private facilities other than those empanelled under specific schemes.

India’s Vaccine Diplomacy

As India’s domestic vaccination drives is gaining pace steadily, it continues to aid the world in the collective fight against Covid-19. External supplies of the Covid-19 vaccine have been made bilaterally through gifts and grants by the Government of India and commercial sales by the manufacturers. As of March 10, it has exported  a total of 58.3 million doses to a total of 69 countries. Of this, close to eight million doses have been exported as grants to 35 countries. Around 33.8 million doses have been exported on commercial basis to 23 countries while 16.4 milllion doses have been exported under the COVAX initiative to 29 countries.  As a member of COVAX facility, India is both a recipient of vaccines from the facility as well as a supplier of vaccines. COVAX is the initiative for equitable vaccine distribution created by the Global Alliance for Vaccines & Immunization (Gavi), Coalition for Epidemic Preparedness Innovations (CEPI) and WHO.

Many questions around the science of the available vaccines remain unanswered

Globally, nine vaccines have proved effective at protecting people from developing symptoms of Covid-19. And yet, evidence around various factors related to the efficacy of the vaccines is still weak. A recent study suggests that most people who recover from a SARS-CoV-2 infection retain the immune memory they would need to prevent a severe reinfection, for eight months. The protection provided by vaccination may be similar in duration. However, this hasn’t been established so far. Similarly, it is not yet known as to how well does vaccination prevent people from getting an asymptomatic infection or passing the virus on to others. The other question that remains is around the efficacy of the vaccines against the Covid-19 variants. The ICMR on recently said that the results of the ongoing clinical trials have indicated that the indigenous Covid-19 vaccines would be effective against the mutated virus strains reported from the United Kingdom, South Africa and Brazil.

The efficacy of the two Indian vaccines currently is likely to be tested against the Brazil and South Africa variants soon. Pune-based National Institute of Virology was in the process of isolating and culturing the South African variant in its lab. The NIV has already readied a culture of the Brazilian variant for testing. The results are awaited.

References:

https://www.mea.gov.in/vaccine-supply.htm

https://health.economictimes.indiatimes.com/news/pharma/bharat-biotech-says-covid-19-vaccine-shows-81-interim-efficacy/81311876

https://health.economictimes.indiatimes.com/news/diagnostics/covid-19-vaccination-should-you-take-or-should-you-wait/80879993

https://www.orfonline.org/expert-speak/58-million-vaccine-doses-exported-23-million-domestic-use-this-week-may-see-drastic-changes-india/

https://www.bloomberg.com/news/articles/2021-02-18/can-a-vaccinated-person-still-spread-the-coronavirus-quicktake

https://www.livemint.com/news/india/explainer-the-effect-of-covaxin-authorisation-on-vaccination-drive-11615455594106.html

https://www.newindianexpress.com/nation/2021/mar/11/govt-hospitals-administered-71-of-covid-19-vaccine-dosesso-far-centre-2275314.html

https://www.pib.gov.in/PressReleasePage.aspx?PRID=1701407

https://www.medicalnewstoday.com/articles/immunity-against-sars-cov-2-may-last-at-least-8-months

https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html

https://www.ndtv.com/coronavirus/fullcoverage

https://www.mohfw.gov.in/ https://www.pib.gov.in/PressReleasePage.aspx?PRID=1703442