Correspondence Address:
Dr. Rahul Narang
Dean (Academics) and Professor and Head, Department of Microbiology, AIIMS Bibinagar, Telangana
India

Full Text

COVID-19 caused by SARS-CoV-2 spread to the entire world almost like a fire after it was first recognized as a threat to humanity in December 2019.[1] The year 2020 witnessed the disease becoming a pandemic and all the countries struggled to limit the spread of infection, treat those already infected, and prevent its further spread.

The Director-General of the World Health Organization (WHO) along with the President of France, the President of the European Commission, and the Bill and Melinda Gates Foundation launched “The Access to COVID-19 Tools (ACT) Accelerator,” a collaborative effort to develop, produce, and provide equitable access to COVID-19 diagnostics, treatments, and vaccines in April 2020.[2] The vaccine pillar of ACT recognized the need for early availability of vaccines to prevent deaths, getting the pandemic under control, and reviving the global economy. Global equitable access of vaccine to health-care workers and vulnerable populations was recognized as the way ahead to reduce the public health and economic impact of the pandemic. COVAX, a joint initiative between Gavi the vaccine alliance, the Coalition for Epidemic Preparedness Innovations, and the WHO, is tasked with ensuring that COVID-19 vaccines are distributed fairly and equitably and has secured more than 1 billion doses toward a 2-billion target for 2021 to vaccinate 20% of the most vulnerable groups from countries in need of help.[3]

Around 11 billion doses of coronavirus vaccine are needed globally to fully immunize 70% of the world's population. Till last month, orders for 8.6 billion doses have been placed by various countries with several agencies. However, about 6 billion of these will go to high- and upper-middle-income countries. Poorer nations accounting for two-fifth of the world's population so far have access to less than a third of the available vaccines. This is why around 100 countries, led by India and South Africa, are asking fellow World Trade Organization members to agree a time-limited lifting of COVID-19-related intellectual property (IP) rights, industrial designs, patents, and undisclosed information under the agreement of trade-related IP rights till there is equitable distribution and provision of vaccine globally.[4]

The multinational corporations involved in vaccine production need to have open licenses or transfer technical know-how legally to competent developers. This will ensure that more countries can start producing vaccines for their own populations and for the low-income nations. However, according to pharmaceutical industries, temporary relief from patents is not a solution till manufacturing is sped up or supply is ramped up. Currently, the scenario is very bleak, with developed countries moving toward 100% vaccination by including even the 12–18 years' age group for vaccination, whereas low- and middle-income countries are still struggling to procure vaccine doses for their health-care workers and vulnerable population.

Another issue related to COVID-19 vaccine is vaccine hesitancy. A systematic review published on December 25, 2020, which included 31 published studies, highlighted that the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%), and China (91.3%). The lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), the US (56.9%), and France (58.9%). Among the health-care workers, the vaccine acceptance rates varied between 27.7% (Democratic Republic of the Congo) to 78.1% (Israel). Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa, and several European countries.[5]

The sudden onslaught of the pandemic with a race to make and approve a vaccine, the political scenario, characterized by uncertainty and ambivalence about vaccination, etc., are responsible for vaccine hesitancy. Compared to earlier times, the confidence in the vaccine has increased in the general population, yet about 31% of Americans are cautious, and about 20% remain reluctant.[6] The common reasons for hesitancy are concerns about side effects, long-term effects on health, lack of trust in vaccines, durability of immunity, and the response of vaccines in view of the scenario of emerging newer variants of the virus. Because of the sheer nature of uncertainty during the pandemic, many people may accept these ambiguities, but yet for many, the perceived risk may apparently be more as compared to perceived benefits. The pandemic has thrown science and evidence-based practice out of the window and it has made it easier for not only people but even health-care workers to accept hearsay and anecdotal evidence/incidents.

Vaccine hesitancy seems to have waned, at least in India, after the second wave of pandemic and everyone is rushing to vaccine centers. Rather, now people are more confused than hesitant because of the fast-changing national, state, and local guidelines. The inequitable vaccine provision comes to light again as India does not seems to have enough doses at present to vaccinate its people. Till now, only 8%–9% of the total Indian population has been vaccinated with the first dose and only 2% has completed its vaccination. India produces about 75 million doses per day which is likely to boost up to 100 million doses per day soon.[7]

Due to the shortage of vaccines witnessed by the country since March 2021, and the rise in the number of COVID-19 cases, the government has halted vaccine exports and is investing millions of dollars to increase the supply of vaccines. It has also fast-tracked approval of the more expensive mRNA vaccines from Moderna and Pfizer-BioNTech, in addition to Sputnik V.[8]

To combat the shortage of vaccines, India can ramp up vaccine production in many ways. As this pandemic is a public health emergency, voluntary licenses should be given to various vaccine manufacturers as the government agencies hold the IP rights to Covaxin. This will increase our vaccine manufacturing capacity. As the first step, licenses have been given to Haffkine Institute in Mumbai, Indian Immunologicals Ltd. in Hyderabad, and Bharat Immunologicals and Biologicals Corporation Ltd. in Bulandshahr which would be able to support at least 30–35 million doses a month by September 2021.[9] So with increasing investment for vaccine production, provision of voluntary licenses to increase the production, and with global help in the provision of vaccines, India should be able to overcome this acute shortage to some extent.

But having said this, a country with a population of approximately 1.4 billion offers many roadblocks to the vaccination drive in India, production being just the tip of the iceberg. The recent stand by the government to allow states to purchase directly from producers and sell it at a price will widen the divide of inequitable distribution with rich citizens being vaccinated more as compared to poor. The Co-Win app comes with its own set of challenges to ensure mass vaccination. The road ahead for vaccination drive in India is still bumpy and the country will need a more holistic and inclusive policy to ascertain 100% vaccination in the near future.

References