‘India Must Vaccinate Vulnerable Sections On Priority’

Prof Jimmy Whitworth, a  member of the Scientific Advisory Committee for WHO’s R&D Blueprint for Action to Prevent Epidemics, has been at the helm of several global initiatives on public health research in low- and middle-income countries. An academic staff member at the Liverpool School of Tropical Medicine and the London School of Hygiene & Tropical Medicine, he has rich experience in devising strategy and policy on population health. In an emailed interview, Prof Whitworth spoke with LokMarg about the pandemic situation in India, what to expect in the foreseeable future and how India can tackle the situation.

India has witnessed a deadly second wave of the COVID pandemic that has left in its wake millions of people dying and many more battling with the infection. Although there has been a decline in cases, are there still risks of another wave?

The deadly second wave of COVID-19 in India is now thankfully receding. From a peak of 400,000 new cases a day in early May, there are now around 100,000 new cases per day. However, unless there are concerted efforts to control the epidemic, there are likely to be large waves in the future. These reported numbers of cases are likely to be severe underestimates of the true burden due to a backlog in reporting test results, poor access to testing and many people not being tested because of fear or stigma.

Do you think the Indian government’s decision or recommendation to increase the interval between the first and second doses will have an impact on its efficacy? Or is it, as many believe, an attempt to solve the demand and supply gap for vaccines?

The gap between first and second doses is of minor importance right now, getting vaccines in Indian arms as quickly as possible is the priority. Early on in the pandemic India provided vaccines and medicines for other countries. But now there is a shortage of vaccine supplies in India that is expected to last until July 2021.

The important actions now are to give priority to vaccinations for vulnerable populations, support state level estimates of demand, ensure a coordinated strategy between states and make sure there is an effective supply chain. This means national and state level negotiations are needed to procure vaccines urgently.  There also needs to be a negotiation of patent waivers and clearances for production of a broad set of vaccines with incentives and support for local manufacturers.

One of the variants of the virus in India is believed to be a mutation that is resistant to antidotes. How effective are the vaccines available now? Is there reason to believe that they are not effective against new variants of the COVID virus?

The current vaccines appear to be effective at preventing infection and disease of all of the new variants described so far, although there is some drop-off in effectiveness in protection against some of the strains. The vaccines are still valuable and one of the most important tools that we have to combat this terrible epidemic. Everyone should be encouraged to come forward for vaccination.

How do you think India can best handle the situation there in the context of lack of healthcare infrastructure and the sheer size of the population?

Despite the vast population and fragmented health system, India can control this epidemic. This needs political leadership, with good quality data for decision making. Transparency, public communication and engagement to ensure collective responsibility and action will be important. We need to enhance the ability of health services to respond by expanding the pool of trained, well-protected staff, establish dedicated well-equipped and safe COVID-19 facilities, use primary care for home care, and ensure sufficient medical supplies and oxygen. As well as the need for mass vaccination mentioned above, we need to scale up SARS-CoV-2 testing and expand decentralised contact tracing and isolation. International and domestic travel need to be reduced and made safe through testing and quarantine. Effective bans of gatherings of more than 12 people, closing venues and indoor public spaces and ensuring physical distancing, hand hygiene and mask-wearing will be important to prevent transmission of infection.

What does the future scenario look like? Would most of the world’s population have to live with the reality that the virus and its mutants will continue to be a threat in varying degrees for the foreseeable future?

The measures mentioned above will be sufficient to bring the epidemic under control, however it is likely that this virus will remain in the human population and cause outbreaks for years to come. We will need to adapt to become faster and more effective at controlling these waves of infection. This may need the development of new vaccines to combat variants that occur in the future.

Watch – ‘Vaccination Was Smooth, Very Well Managed’

As India moves on from one milestone to another in its vaccination drive against Covid-19, LokMarg spoke to several senior citizens in Delhi-NCR about their experiences of getting the jab. Most of members interviewed said the entire process was well managed and orderly.

While some of them felt that a doctor’s presence at the vaccination point would have emboldened the beneficiaries, there was unanimity that the inoculation was organized in most professional way hitherto unseen at medical facilities.

Watch full video here

‘I Had Zero Side-Effect After Second Covid Vaccine Shot’

Dr Amiya Kumar Verma, deputy medical superintendent at Max Hospital Patparganj, Delhi, got his 2nd shot of vaccine on Feb 13.  Having seen the battle against Covid from the frontline, he is relieved to see the vaccination moving in right direction

I got my first dose of Covishield vaccine on January 16, 2021, the day when the nationwide Covid-19 vaccine drive was started. I had volunteered to take the shot on the very first day itself as I wanted to remove the fears of some of the doubting Thomases in my team.

And it worked. Of the 100 health-workers slotted to be vaccinated on day one, 70 came forward; this was the best percentage score from Delhi centres. It was natural for them to have anxiety about the vaccine, but when they saw the seniors taking the jab, they felt encouraged.

I must also appreciate the government’s efforts and planning for the vaccination at the designated unit in our hospital (Max Patparganj). The drive was monitored by health officials who informed the beneficiaries of possible side-effects and managed it smoothly.

Of the 70 who were vaccinated that day, almost everyone experienced a mild fever and weakness for a few days. I too had similar experience but the effects tapered off in three to four days.

ALSO READ: ‘Mild Fever Overnight Was The Only Side-Effect’

After the first vaccination shot, there was a survey carried by the government through a toll-free number for feedback about the procedure followed, hygiene maintained at the centre, and if the beneficiaries were attended to for the designated period post-vaccination.

The second shot after 28 days, that is on Feb 13. This time, there were no side-effects. Not even mild fever; I even went for my routine evening walk. As the experience was shared, it has raised hope and confidence among others about the vaccination programme.

I have been telling the heads of each department in our hospital to lead from the front so that the rest of the staff gains confidence. Of the 2,200 to be vaccinated, about 1,600 have got the jab. The ones left include those who adopt a wait and watch policy. They want the others to take the second dose and wait for their side effects.

In our battle against the pandemic, other than basic precautions, we simply do not have any other alternative except the two vaccines available. So why should I not take it!

Dr Verma considers vaccine a blessing amid pandemic

It is a blessing for the healthcare workers and their families as well as for those who have lost their loved ones during this pandemic. This pandemic made people so helpless that they couldn’t be at the side of their loved ones in the hospital or bid them a final goodbye. I have seen deaths where relatives prayed us to let them visit their patients one last time. And then, there were some people who did not come to see their family members for the fear of contagion. Such has been the stigma and the hopelessness that the pandemic caused.

ALSO READ: A Vaccine Of Hope

It is disappointing to hear some people say, that if others have taken the vaccine, we don’t need it. The idea for taking the vaccine is that the antibodies are developed in our body; it doesn’t mean that we won’t get the infection. What it means is by chance even if we get it, we will not have a serious effect like it did in the past after having taken the shot.

I want to tell people that if I have taken the vaccine then I can face and fight coronavirus while the one who is not vaccinated is neither safe from contraction nor capable of battling the virus. So this mentality that let others take it and we will be safe is not the right one.

If the government puts a price on the vaccination, I am sure people will stand in queue to get it but because the government is doing it free of cost, people are taking it for granted. Also the social media spreads a lot of misinformation. People keep forwarding a message that can do more harm than good without reading or understanding it.

As told to Mamta Sharma

India’s Vaccine Victory Carries A Parsi Punch

Smarting at China for long over several issues – border tensions that have compelled, among other things, minimizing of economic ties, boosting of “all-weather friend” Pakistan, being opposed at diplomatic forums and being surrounded in the region south of the Himalayas – India has found a sure and significant counter in the shape of vaccine against Coronavirus.

Even if small and short-term, it is smart, and has the world taking note – a world that is suffering from the pandemic. The Narendra Modi Government deserves full marks for launching “vaccine diplomacy” when confronted by a myriad issues. That includes being among the top five nations among the Corona-hit.

Its aspirations to become vishwa guru – teacher to the world – may seem tall and are contentious, even at home. But this one, emerging as vishwa chikitsak – doctor to the world, at least a good part of it, and partly, is eminently achievable and is already underway.

Beginning January 16, countries far and near are benefitting on something they direly need. That brings goodwill – hopefully, also blessings from individuals and families those who get cured. A vaccine is tika or teeka. It also carries several other connotations. The one that fits in here is tilak, the mark on Indian forehead to depict success, with humility. And why not, when India has already been the wold’s largest vaccine-maker?

Five million doses of Oxford University-invented Astra Zeneca vaccine, produced by Serum Institute of India (SII) are being gifted to Bangladesh, Nepal, Bhutan, Maldives, Myanmar, Afghanistan, Sri Lanka, Mauritius, Cambodia and Seychelles. Each of them is in dire need of the vaccine due to high incidence, and each one is hit economically by the pandemic. Inoculation began within three days of the vaccine being flown by special flights.

This has been India’s traditional area of regional influence where China, with its deep pockets and offers of huge projects has grabbed in the recent years.

Predictably, given perennially adversarial relations, India has ignored Pakistan that has yet to get a firm Chinese commitment of Sinovac. It is in queue for free doses while awaiting Astra Zeneca and Russia’s Sputnik for “emergency use.”

ALSO READ: A Vaccine Of Hope

India has raced ahead when China has yet to begin because of the uncertainties attached to its vaccine trials. Indeed, there is also the psychological factor about China being accused – real or propaganda – of causing Covid-19 at Wuhan and as it spread, not informing the world.

This is India’s defining moment. Besides goodwill and prestige, it is good business also, coming when its economy is struggling to recover from the lows experienced long before Covid-19 struck last year. Seven Indian companies are racing to produce vaccines and Covaxin of the state sector Bharat Biotech is already being administered.

Thanks to the virus, the Indian pharmaceutical sector, slated to export worth USD 25 billion by end-March, can expect to export much more.

To some of the neighbours, including Bangladesh that is to get three million doses for free as a goodwill gesture, commercial exports are scheduled to let the SII recover its investment and effort.  

India has contracted to sell SII-made Covishield to Brazil, Morocco, South Africa, and Saudi Arabia. Flights carrying the precious cargo took off to these countries on January 22. Order books are full to conduct exports to more nations.

India plans to export vaccines to the other poor and middle-income countries of Africa, Latin America and Southeast Asia as part of an arrangement with GAVI, the vaccine alliance. This should boost its and soft-power on even a larger scale than yoga.

It has not been easy, however. A major pharma producer, despite its growing strength, India has faced an undercurrent of propaganda in the global market about the reliability of its medicines after the US Food and Drugs regulator sent out adverse notices.

Emerging as the pharmaceutical powerhouse of the region has increased the reliability of India’s healthcare sector on which its neighbours are heavily dependent. This could further bolster medical tourism.

ALSO READ: ‘We Moved 1.1cr Vaccines In 24 Hours’

The least-talked part of this vaccine story is the role of the tiny Parsi community of fire-worshipping Zoroastrians, to which SII’s owner, Cyrus Poonawala and his CEO son Adar belong.

A story on social media that remains unconfirmed is that of Cyrus offering the Bombay Parsi Panchayat to reserve over 60,000 doses of Covishield for the community. Ratan Tata, head of the house of Tata, politely declined: “we are Indian first, then Parsis. We will wait our turn in line.”

This is the modesty for which the Parsis are well-known. But there is no escaping some details, even allowing for an element of exaggeration.

+ SII’s Covishield is stored in glass vials produced by a Parsi firm Schott Kaisha, owned by Rishad Dadachanji.

+ They are transported with dry ice manufactured by another Parsi, Farokh Dadabhoy.

+ They are delivered by Tata Motors Trucks.

+ Vaccine batches transported by GoAir of Jeh Wadia and stored in refrigerators made by Godrej, both renowned Parsi family enterprises.

Despite being a miniscule fraction of the 1.3 billion Indian population, the Parsis have never asked for Minority benefits. They have always punched above their class and the numbers.

Literate, industrious and not averse to leaving shores unlike the traditional Hindus, they became indispensable to Britain’s global reach. One of their tasks was carrying opium to China. But they also fought the British: Dadabhai Naoroji, Dinshaw Mehta, Bhicaiji Cama were among them.

They responded to overtures from the Mughal kings and later to the early British settlers, taking up shipping, banking, construction and brokerage. They were the pioneers who built a half of Mumbai.

It would take several pages to list only the names of Parsis who have made an outstanding contribution to independent India’s economy, defence, atomic energy, music, literature, science, sports and cinema. Their reach is now global.

Way back in 2012, a top community official told the Mumbai High Court that its definition of a poor Parsi was one who earned less than Rs 90,000 per month. This is many times more than India’s per capita annual income of $1,876.53 or Rupees 136,794.

Is the community India’s richest? It does have poor members. But then think of India’s Tata, Godrej, Pallonji, Wadia, Avari and Bhandara of Pakistan, Lord Karan Bilimoria of Britain – to name only the industrialists and businessmen.

Almost all of them have institutionalised philanthropy giving billions away. Although all faiths preach piety and charity, the Parsis (“thy name is charity”) lead. It is riches well earned, well spent. It will be tragic if their population dwindles to almost zero by the end of this century.

The writer can be reached at mahendraved07@gmail.com

‘We Moved 1.1 Cr Vaccine Doses In A Day, It Feels Great’

Kunal Subhash Agarwal, co-founder of Kool-ex, the first logistics company assigned to transport Covid-19 vaccines, talks about the proud consignment and the challenges it entails

In the last 30 hours, we have transported 1.1 crore Covid-19 vaccine vials to their destinations. The last three days, since we were assigned the task of transporting the vaccines, have been super busy. But it feels great to be a vital cog in the national vaccination machine.

We have been in business as a pharma distribution company for a decade or so and transporting similar cargo across the country. So, while in terms of work this is business as usual, several facts make this moment unique.

First, we have not seen a pandemic of this volume in our lifetime. India has been one of the worst hit countries but also one of the first few to fight back with an indigenous immunization programme. The scale and geographical diversity of our country makes it even more challenging and special. Therefore as a service to the nation, to our countrymen, this is both an emotional and proud moment for us at Kool-ex.

Today, when the first batch of trucks was getting flagged off, we did a small ceremony of sorts to cherish it as a memory in future. The national Tricolour was placed on the trucks and having secured the permission from the police to film the event, we shot some videos to share it on social media too.

Kunal Subhash Agarwal (extreme left) has given Kool-ex fleet (right) a new ‘Make in India’ look

ALSO READ: A Vaccine Of Hope

Here, I would like people to know how a pharma distribution company operates in contrast to a non-pharma cargo service. First, we are part of a cold chain logistics, which essentially means moving goods in a temperature-controlled set-up, unlike carriers in the movers & packers category. Then in the cold chain, there are two segments: pharma and non-pharma. The non-pharma segment comprises supplies such as dairy products, perishable food items, yeast, even blood.

The pharma segment is mainly restricted to medicines or vaccines that also require a temperature-module during transportation. As it involves saving lives, the quality-control measurement in the pharma supply are much more stringent than other cold chain carriers, even though the vehicles used are similar.

For example, all our trucks are fitted with sensors that tell you live temperature across India. We have a monitoring cell that screens each and every truck, their temperature and movements through GPS devices. We also have door-open sensors linked to the monitoring unit, so that we know if a door has been opened, and for how long. So basically, it is a tech-enabled fleet.

ALSO READ: ‘Proud To Be A Part Of Vaccination Process’

To maintain such operations is not an easy task. A pharmaceutical company will never work with a company that is dealing with anything non-pharma for the risk of contamination. So even if someone has used a truck for food and it comes in for loading it will get rejected.

Incidentally, I have realised that keeping such strictly-monitored operations is an easier task than managing the media in our country. Ever since the news hounds got the wind of our work, we were flooded with calls from all corners. And I knew not how to manage their queries.

As told to Mamta Sharma

‘Proud To Be A Part Of Vaccination Programme’

Savita Paliwal, 52, a senior vaccinator in Moradabad (UP), is happy to see India among the first few countries to launch vaccination programme early. She explains how the monumental process will unfold

I have been in the medical profession for nearly three decades now and have been involved with quite a few vaccination and immunisation programmes. As a government employee at the Community Health Centre at Thakurdwara, Moradabad, I have been actively involved in building a healthy society. However, this time it is quite different.

Dealing with the Covid-19 is something that we have never seen before in our entire career. Healthcare professionals have been on their toes for nearly a year now. And with new strains coming up at different parts of the world, the challenge is only getting tougher.

It was therefore both a moment of relief and pride when we were informed that India is one of the first few countries to start vaccination programme. We have compiled the beneficiary list in our zone and have had two dry runs, on January 5 and 8.

We have been divided into two teams of three members each. Both teams have one vaccinator, one helper and a data expert (someone who keeps track of the beneficiaries who get vaccination). Healthcare professionals, especially the pharmacists and paramedical staff will be given the vaccine on priority basis.

ALSO READ: A Vaccine Of Hope

The phase 1 of the programme begins on January 16. Each team is supposed to vaccinate 25 people in a day, so in our locality you can say that the Community Health Centre employees will be vaccinating around 50 people daily. The process will be spread across five rooms with standard operating procedure in place like regular sanitization, temperature screening etc.

Savita Paliwal (middle) with her colleagues at Moradabad community health centre

The DM (district magistrate) was very involved in how the dry runs were conducted and there was total cooperation from the Chief Minster’s office as well. I feel happy that we are all functioning as one smooth machinery.

Of course, many people are scared of taking vaccines but as someone with an extensive experience in this field I know how to soothe people. Asha workers are also involved in the vaccination programme, and spreading awareness about it.

Moradabad was declared a hotspot last year and I would say we expect most people to be co-operative. No query of the beneficiaries will be considered insignificant and we will take care to also inform them of the minor side-effects they might encounter after the vaccination.

ALSO READ: Nursing Our Healthcare System

I feel lucky to be a part of this monumental process. I have been keeping myself updated with all the news about vaccines developed in India as well as other countries and I would say so far we have handled the Covid-19 situation really well. But it is not over yet and the pandemic needs the cooperation of every single citizen of the country. I make it a point to carry extra masks in my bag and hand them free to anyone I see not wearing a mask.

I feel proud that India developed and mass-produce a vaccine in good time and now we aren’t dependent on any foreign country for the immunity programme. I wonder how the scientists who developed the vaccines must have raced against time to save as many lives as possible. I hope the process goes smoothly. We have managed and eradicated polio and now we are confident we shall put corona virus behind us too.