‘Don’t Go By Efficacy, Oxford Vaccine is the Best News for India’

"Just because a vaccine costs $35, it doesn't mean its a better vaccine than one that costs $3."


"If a vaccine is 70 percent efficacious but offers 90 percent coverage, compared to a vaccine that is 90 percent efficacious, but offers only 50 percent coverage, I'll any day go for better coverage," said virologist Dr Shahid Jameel while decoding the various efficacy figures thrown up by top three COVID-19 vaccines. He calls Oxford vaccine data very good news for India, and for the developing world.

Oxford AstraZeneca vaccine's preliminary data from stage 3 trials indicated that it has 70.4 percent efficacy. What does it mean in real terms? How does it compare with Pfizer and Moderna vaccines that show a 95 percent efficacy? And do Bharat Biotech's claims on the indigenous Covaxin being at least 60 percent efficacious hold up? Is that good enough for you and I?

I put all these questions to Dr Jameel, director at Trivedi School of Biosciences at Ashoka University.

“Just because a vaccine costs $35, it doesn’t mean its a better vaccine than one that costs $3.”

Decoding Oxford Vaccine Efficacy: 62%, 70.4%, 90% - Which is it?

Dr Jameel says that while Oxford vaccine data is promising, it's still not as exciting as Pfizer and Moderna's efficacy of nearly 95%. However, there's a lot of science that indicates it still is very good news.

Oxford vaccine was given in two different dosages: One set received a 'low' shot as the first dose and a 'high' shot as the second dose. The second set received 'high' doses both times. He says it's surprising that the low dose produced better efficacy of 90% than a high dose that received an efficacy of 62%. The Oxford team will be examining the data that gave better efficacy, and we'll know more shortly.

Efficacy Matters, Coverage Matters More

"90% is great, but I would any day take a vaccine that offers better coverage," said Dr Jameel. Expanding on it, he said, if there is a vaccine that offers 70% efficacy but a 90% coverage, it's a better bet for a country. Reasonable efficacy but a good coverage is very important, he adds.

Despite Low Efficacy, it's the Best Bet for India

“First of all, Pfizer and Moderna vaccines will not be available in India. Let’s be very clear about it.”

Dr Jameel, stating a simple fact there. These vaccines require very cold storage. Pfizer needs to be stored at -70 degree celsius, requires specialised containers, transport, training, distribution. Moderna vaccine can be stored at -20 degree celsius and can be kept in freezers of normal refrigerators, but again, those are not available everywhere.

Secondly, and this is the painful truth, these vaccines are just too expensive and have been pre-booked very heavily by first-world countries. For example in the UK, for a population size of 67 million, they have already pre-booked 325 million doses - 5 times their population size. Similarly in Australia, for a 25 million population, 34 million doses have already been booked.

Oxford vaccine on the other had has phase 3 trials going on in India. Serum Institute of India is already manufacturing these vaccines here. They have a capacity of 800 million doses a year, of which 400 million will be available to India. We have a lot of stake in that vaccine.

Haves and Have-Nots: Do I Get a Raw Deal Because I live in a Developing Country?

Dr Jameel says just because Moderna and Pfizer vaccines have 95% efficacy, it doesn't automatically mean they are better vaccines. Efficacy during a trial, in a controlled environment, is a different ball game than efficacy in real-world situation. "If cold chain breaks down, we can't train enough people, if distribution is limited, it is of little value. I would not pay too much attention to this 70 vs 90 vs 95% efficacy."

“On the other hand, we know we live in an unequal world.”

Look at the cost differential, he adds. Pfizer and Moderna are selling in those countries that have pre-booked the orders at $25-35 per dose, Oxford vaccine is available at $3-4.

If I have a Choice Between Moderna, Pfizer and Oxford Vaccine, Which One Should I Pick?

Dr Jameel repeated what he has been emphasising on, better coverage, affordable cost, and availability should determine what vaccine you choose. Getting a vaccine at a higher cost should not be a status symbol.

On a hopeful note, what these first 2-3 vaccines have proven is that all vaccines will work, because they essentially follow the same principle. All vaccine news is good news right now.

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