Counter vaccine hesitancy to rein in Covid

Jagat Ram and Rakesh Kochhar

Jagat Ram Director, PGI and Rakesh Kochhar Prof, Gastro Dept

More than a year after the first case of Covid-19 was detected in the Chinese city of Wuhan, the world continues to grapple with the pandemic. With there being primarily only supportive treatment of the disease, the medical community had pinned hopes on an effective vaccine. Both the Pfizer and Moderna vaccines reported more than 90 per cent efficacy. To these were added vaccines developed by Oxford-AstraZeneca, Bharat Biotech, Gamaleya centre (Russia) and a couple of Chinese vaccines. Covishield (Oxford-AstraZeneca) and Covaxin (Bharat Biotech) are available in India.

Vaccines have helped mankind prevent many diseases, starting with smallpox. Of the 20 commonly used vaccines today, 13 are against viruses that cause diseases such as polio, Hepatitis B and chicken pox. While a majority of these are given to children, some are used to prevent diseases in adults as well. The basic premise of using a vaccine is to prevent a disease altogether or to mitigate it. The WHO had reported that 21 million deaths were prevented between 2000 and 2017, thanks to the measles vaccine alone. Yet, hesitancy against the use of vaccines is not uncommon.

The WHO describes vaccine hesitancy as the refusal of or delayed acceptance of being vaccinated despite the availability of vaccines. It is estimated that vaccine hesitancy is one of the 10 major health threats worldwide. Already, efforts towards the eradication of polio and measles have suffered because of vaccine hesitancy. The same phenomenon is now being seen for Covid-19 vaccines. In January, India launched an ambitious programme to vaccinate three crore healthcare workers and other frontline warriors in the first phase, but vaccine hesitancy is coming in the way.

The WHO recognises three key reasons for vaccine hesitancy: lack of confidence (safety and efficacy concerns, lack of trust in health services), complacency and inconvenience of getting the jab. While scientists admit that a vaccine gets introduced once phase 3 trials are over and the surveillance phase (lasting months to years) reports no adverse fallout, Covid vaccines received emergency use certification because the data had proved their safety and the benefits far outweighed adverse events. There have been negligible side effects (0.08 per cent) from the two vaccines used, with occasional hospitalisation. Covishield is already widely used in Europe, and data on Covaxin has shown over 90 per cent protective antibodies.

Snags in the Co-Win portal have also accounted for poor acceptability of the vaccine at many centres.

In India, complacency is a major factor for vaccine hesitancy. With the lifting of restrictions, most people feel the worst is over. They, however, do not take into account that the Spanish flu had ravaged the world for more than two years in three waves. Covid-19 has waxed and waned in the US, Europe and the Middle East in multiple waves. The Indian Council of Medical Research (ICMR) has warned that India may face more waves in the coming months. Recent sero-prevalence data shows that close to 80 per cent of India’s population is still vulnerable. A number of variants of the virus have emerged. The B.1.1.7 or the British variant is roughly 50 per cent more infectious. It has been detected in over 70 countries. The B.1.351 lineage, which emerged in South Africa in December, reduces the effectiveness of some vaccines. It accounts for 90 per cent of the cases there. The continuing occurrence of a high number of new cases in Kerala, Karnataka and Maharashtra is being investigated for possible import of variants from other countries.

Going by the current rate of vaccination, it will take another two to three years for the whole world to get vaccinated. An exit from the pandemic is possible only if the world develops herd immunity either by natural infection or by vaccination. Leaving behind pockets of infection will remain a threat to the rest of the world. Countries have tried lockdowns and restricted trans-border movement in an attempt to curb transmission of the virus — with limited success so far. If the virus continues to mutate with the emergence of vaccine resistance or more contagious or virulent strains, we may end up in a vicious circle unless we stop the spread of the virus globally.

Tedros Ghebreyesus, WHO head, has pointed to the disparity between the rich and poor countries, with the former cornering 75 per cent of the available vaccines. India is in an enviable position with enough vaccines available for the frontline workers and more ordered for the rest. India is exporting vaccines to over 25 countries, with new ones being added every day. One can imagine the plight of those nations which do not yet have access to any vaccine.

To break the chain of Covid-19 transmission and eliminate the pandemic, mass vaccination is the only solution. Also, we have to keep following Covid-appropriate behaviour — wearing of masks, social distancing and washing of hands.

The ongoing vaccination drive must be strengthened. This can be done at multiple levels. To start with, each vaccinated individual should be given a badge mentioning ‘I am protected’ to highlight his or her status. Frontline warriors getting vaccinated should be given freebies, as was done for months in the US and UK. We could follow the example of Brazilian rap star MC Fioti, who has recorded a song titled ‘Vacina Butantan’, which has swept the country as the vaccine anthem. Corona survivors could be roped in to emphasise the importance of protection. Print, electronic media and social media should be involved to drive home the need for converting vaccine hesitancy into vaccine envy. 

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