Will Vaccinating Everyone Help Curb the COVID Wave?
Instead of restrictions and a lockdown, can vaccinations alone help? “We need both,” say experts.
For the past week, it’s been the same headline: India sees the highest surge in COVID numbers. Today, 7 April, is another ‘biggest-ever daily surge’ with 115,736 Covid-19 cases in the last 24 hours as per the MoHFW.
There’s no denying we’re hurtling towards a huge spike. Now, we’ve established before that vaccines alone are not a cure, but everyone wants to know: will opening up vaccination to everyone above 18 help curb the spread?
On Monday, 5 April, the Chief ministers of Delhi, Maharashtra and Rajasthan, appealed to the Centre to relax the age limit for vaccination, reported India Today.
To get some answers, we go to the public health experts: virologist Dr Shahid Jameel, Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University.
Universal Vaccination: Yay or Nay?
On Tuesday, the Centre said that the vaccine discourse needs to be looked at ‘scientifically,’ and COVID-19 task force head, Dr V K Paul said that the vaccines are available “for those who need it, not those who want it.”
1. Should We Start Vaccinating People Above 18?
“The vaccine is one tool to control the pandemic. It’s an important tool, but needs to be deployed intelligently. It’s good to think about opening up the vaccination process above 18, but the approach needs to be more nuanced - for example, specific state-wise protocols in states experiencing a surge.”Dr Shahid Jameel
Dr Jameel explains that a blanket India-wide vaccination policy makes little sense as “Maharashtra and Nagaland, with different case rates, for example, cannot be treated the same.”
He adds, “Vaccination should be opened in states where there is a surge and where models show there will be a surge - such as election states. We can pre-empt the rising numbers and plan for that.”
Speaking about a targeted vaccination approach Dr Anant Bhan adds that, “the government’s rollout policy has to look at the situation on the ground and look state-wise.”
The WHO recommended a staggered approach to vaccination, with the elderly and those with comorbidities getting priority in an effort to reduce death and disease burden. And in a pandemic - which we are still in - this is the priority.
“We know these vaccines reduce mortality and severe disease. They protect lives. Keeping this in mind, we have done the prioritisation,” says Dr V K Paul.
But as younger folk are affected in India this time around, should we change our stance?
2. Will it Help Stop the Surge? Will We Still Need a Lockdown?
“It does make sense to vaccinate more people,” says Dr Jameel. But before opening up, Dr Anant Bhan says we need to ask more detailed, scientific questions about vaccine availability, reducing the disease burden and more.
“The idea of relaxing the age limit for vaccination should be brought to the table. But is must be clear that this will not affect the current wave as the effects will be more medium-to-long term (about 6-8 weeks from the vaccination date). So for now, we would need to follow restrictions as well.”Dr Anant Bhan
Dr Bhan agrees that states with a surge and a predicted surge should consider opening up, but this is for longer-term protection in the pandemic.
“We cannot vaccinate everyone overnight,” asserts Dr Jameel.
“Besides, it is not this (vaccination) or that (lockdown), it must be a combination.”Dr Shahid Jameel
He explains that lockdowns have an immediate effect, unlike vaccines. “Limited lockdowns are inevitable, although night and weekend curfews are of little help and more for optics,” says Dr Jameel.
In the current surge, experts suggest we follow restrictions and plan to increase vaccination simultaneously.
As for lockdowns? It may be inevitable but Dr Jameel and Dr Bhan both agree we need a more nuanced, scientific approach. “We can do a lockdown in certain areas of affected cities,” says Dr Jameel, while Dr Bhan adds that since we know the problems from last time, “we can plan better for other healthcare services to continue, the elderly to be protected” and daily wagers to stay afloat.
3. How to Ensure Equitable Vaccine Distribution
Currently, younger healthcare workers are the priority again and “from a risk-based approach, we need to ensure they have enough vaccine coverage,” says Dr Bhan. At the same time, many people above 60 are still waiting on their second dose so we need to ensure this priority group is covered too.
As World Health Day, with its theme of fair and equitable healthcare dawns on April 7, Dr Bhan urges us to consider equal distribution of the vaccine to smaller, rural areas and tier 2, 3 cities - especially when we open up to those above 18. “Since there are issues of uptake, we need to look at current demand and supply too,” he adds.
4. Do We Have Enough Vaccine Supply?
Our vaccination policy cannot go over our supply. The lack of vaccines in centres in Mumbai and Delhi have been surfacing and ANI reported that Maharashtra Health Minister Rajesh Tope said that, “We do not have enough vaccine doses at various vaccination centres, and people have to be sent back due to a shortage of doses.”
While the health ministry denies any shortage, can we not increase the existing supply?
“Why can’t supply be increased?” asks Dr Jameel. “We have a good manufacturing capacity. In fact, the Serum Institute of India has gone on record saying they have the capacity to manufacture 10 million vaccines a month. Earlier, Bharat Biotech had said they can make 3, and ramp up production to 5 million a month.”
This means we can have at least 10-15 million doses a month.
Dr Jameel adds that these are just from the 2 approved vaccines, but there are 2 more in the pipeline namely the US’ Johnson&Johnson vaccine, and Russia’s Sputnik V.
“Why is the regulator demanding bridge trials for these, especially in a surge and time of crisis? Covaxin was approved without any efficacy data. Even Covishield did not have bridge trials done before being approved,” says Dr Jameel. “On this, the government is being unscientific.”
5. Dealing with Vaccine Myths and Hesitancy
“It’s a myth that vaccines prevent infection, they prevent disease. This means vaccines protect against severe disease and death but you can still be infected and transmit the virus to others. So you MUST wear a mask even after being vaccinated.”Dr Shahid Jameel
He continues, “Even with 1 dose there are studies that say you are offered limited protection against severe disease.”
There needs to be clear public health communication on three points:
- Vaccines are not a magic bullet - they are one tool to fight the pandemic, along with masking, hand washing and distancing
- Vaccines are safe and protect against severe disease and death
- You need to mask and observe COVID protocols post-vaccination
Dr Bhan says that we should be leveraging our expertise from the polio campaigns, and using national and local networks to spread correct information.
Over-eager, sensationalist reporting on adverse events, lack of transparency during the regulatory approval process and a general lack of public health awareness culminate in hesitancy. “It’s important to understand the hesitancy, and work with communities, hear their concerns and answer them,” says Dr Bhan.
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