FIT IN CONSULTANTS

Consider this: the Lancet Infectious Disease has said that Covid vaccines saved an estimated 20 million lives a year. This estimate was via a mathematical modelling that said that Covid-19 vaccines prevented over 42 lakh potential deaths in India in 2021.

Then why are booster doses not being rolled out with the force they should be? Why are then children below the age of 12 not getting the benefits of the vaccine against Covid-19? And why is the government not considering cocktail of Covid-19 vaccines? And is it time to revisit India’s vaccination policy?

India Today spoke to experts to analyse the challenges in the current vaccination policy and the way forward regarding the same.

FACTS FIRST

Corbevax, vaccine developed by India’s Biological E, supported by the government, is yet to be used as a booster. The vaccine received an approval from the drugs controller general of India in the first week of June. This, in fact, is the first vaccine to get the approval for heterologous (mix and match) use in India for a booster shot.

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But the clearance for a roll out is awaited. The National Technical Advisory Group on Immunization is yet to give a green signal. Speaking to India Today, a highly placed source said the discussions have not been initiated yet.

Speaking to India Today, the developers of Corbevax, said that the vaccine was extremely safe and generated significant immune response (in the 5 to 17 year age group) also making a pitch for a quicker roll out amongst younger kids.

“SARS-CoV-2 infections and resulting hospitalizations are increasing globally, including young kids and to certain extent in India too. Corbevax vaccination provides significant protection against symptomatic infection and severe disease based on long-term monitoring of subjects in BioE clinical trials and it is imperative to provide this option to young kids in India, especially due to unknown sequelae of Covid-19 in kids” Dr. Vikram Paradkar, Executive Vice President (Manufacturing & Technical Operations), Biological E, said

PRECAUTION DOSE PROGRAMME IN NEED OF A BOOSTER

Boosters in India have seen a poor uptake. A survey done by LocalCircles, a community social media platform, said 57 per cent eligible adults will not take the precaution dose in the next 3 months.

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Interestingly, 14 per cent of them are willing to take it if it is made free. Meanwhile, 42 per cent of those who have taken it are not confident about the benefits of a second dose. The survey was done across 351 districts of India, 15263 responses were received.

Professor Giridhara Babu, a well-known epidemiologist associated with the Public Health Foundation of India, said, “The problem is two-fold, concerning both the demand and supply. The awareness and priority of the public regarding the importance of boosters are also poor. At the same time, the availability of boosters is limited in all areas. This is more problematic in the districts compared to metros. The government needs to address both these issues.”

“Every adult should be allowed to get a booster. Prioritization of the vulnerable and elderly is essential.” Giridhara Babu said.

In the age group between 18 to 59, only 61.8 lakh (61,76,328) precaution doses have been given. The total population of this age group is approximately 80 crore (801389000). So, only 0.77 per cent of this population has received booster dose so far. April 10, 2022 is when the government opened up administration of booster doses to those above 18 years of age. (Input from Piyush Goyal, India Today’s Data Intelligence Unit)

“The government should do more to increase booster uptake among vulnerable populations, including those above 60, those above 45 with co-morbidities and the immunocompromised,” said Gautam Menon, a professor at Ashoka University.

He, however, adds that India’s policy on boosters for the young and healthy may need to be revisited in the light of recent work that suggests that contracting the Omicron variant after two standard vaccines doses may provide more lasting protection than a booster dose.

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“I would think, based on what we understand currently, that vaccines and boosters for the young, under-18, population can be delayed further, since there is no clear understanding of costs and benefits in that segment and many of them have already been exposed to earlier and current variants. We need a clearer and more nuanced understanding overall of the benefits of boosters following the emergence of the Omicron variant and its sub-variants, which we can only do with better and more extensive data”, Gautam Menon said.

WHY IS MIXING OF VACCINE NOT BEING CONSIDERED?

A study done by CMC Vellore shows that using Covishield as a booster after primary vaccination with Covaxin gives six to 10 times higher antibody levels.

“It is time to have great access to this compared to existing policy of preference to covaxin,” said Professor Giridhar Babu.

But it is worth noting that this study has not been peer reviewed.

Experts also say that the long term efficacy of vaccines cannot be dependent only upon neutralising antibodies, as they have the tendency to wane over time, and has been demonstrated in several publications about different Covid vaccines. Also, one cannot ignore the fact that worldwide, many countries have stopped viral vector vaccines, like in Canada and EU countries, these vaccines presented an increased risk for thrombocytopenia, blood clots, guillen Barr syndrome etc.

ARE BOOSTERS EVEN EFFECTIVE WITH ONSET OF OMICRON VARIANT?

In the wake of the rapid spread of BA.2.75, the second generation subtype of Omicron, are boosters even effective is the question many are asking. Double and triple reinfections during the Omicron wave and the astounding number of breakthrough infections it has caused and is still causing begs an answer to this question.

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Dr Rajeev Jayadevan, vice Chairman of Research Cell, IMA, Kochi, said booster use must be looked at very carefully given their limited efficacy now, owing to the surge of Omicron and its subtypes.

“Omicron has changed the immunity playing field. Described as weakly immunogenic, Omicron is able to infect people and leave them with a weak immune response against itself, allowing frequent reinfections at shorter intervals. Omicron is also able to leap past vaccine-generated immunity – which appears short-lived.” Jayadevan says.

WHERE ARE VACCINES FOR KIDS UNDER 12?

In spite of much publicised approvals, vaccines for kids under 12 have not been rolled out. Serum Institute’s Covovax has been approved by the regulator for kids above the age of 7. Covaxin has been approved for children above the age of 6. Biological E’s Corbevax has been approved for those between the age of 5 to 17.

However, none of these vaccines have been rolled out. The government has been given the recommendations on roll out of vaccines for children below the age of 12, a source within the NTAGI told India Today, but with a rider.

“We are in favour of improving the poor uptake of vaccines in the age group of 12-17 which stands at about (40 percent ) before the roll out of vaccines for kids under 12,” the source said.

“This group is more vulnerable than the age group of below 12,” he added.

Sources also say that booster uptake in 18 to 59 age group must be the focus and then rollout of vaccines in age group of below 12. That is the recommendation to the Union Health Ministry by the NTAGI.

WHY TAKE A CHANCE THOUGH, EXPERTS ASK

“Compared to adults, the severity of the illness is not a major problem in children. Despite multiple waves, children are relatively spared. However, we are unsure how long Covid will affect children. It is better to vaccinate children following the precautionary principle,” said Professor Giridhara Babu.