TO VACCINE OR NOT TO VACCINE!

The dilemma continues in Goa…

Vaccine programs underway in Goa… frontline health workers first! A few doctors have got vaccinated including oncologist Dr Shekhar Salkar!

By Pankajbala R Patel

THE vaccine story gets more and more curious. Seriously the Covid-19 vaccines chai pe chercha or mann ki baat is endlessly ongoing and it has gone on long enough without too many being convinced enough to rush and get the vaccine jab which may be once or twice depending on the vaccine of choice. In the government vaccine program you don’t have a choice in vaccines of course. From the sound and looks of it many Goans still can’t made up their mind about whether to go get vaccinated or not, even if they have done the expensive RTPCR testing (costing as much as Rs4,500 per person at private hospitals) just to satisfy themselves that the virus is not lurking in their blood, lungs, stomach or anywhere else.
Reportedly even many frontline health workers are not turning up to take the vaccine available freely to them, although at private hospitals like the Manipal Hospital not only testing but vaccinating is going on for all those who fear getting the contagion or have to move out of Goa and are in need of Covid-19 vaccine certification.
This even as the Indian Medical Association is on the warpath over the promotion of Baba Ramdev’s Patanjali Coronil’ with the apparent blessings of the AYUSH department at State and Central Level. Albeit Patanjali’sCoronil’ is not a vaccine but gives Baba Ramdev’s huge number of fans the impression that it is a “vaccine” for super improvement of immunity (maybe something on the lines of chaywanprash). The question being asked and pertinently: Why promote `Coronil’ when the government is spending Rs35,000 crore on the mainstream Covid-19 vaccination program? IMA critics say the funds may as well go to AYUSH for “free” distribution of Coronil!

TO VACCINE OR NOT TO VACCINE!

NOT 100% SOLUTION
AT ground level most medical people know that there is no 100 % effective solution. And that a vaccine is only for protection for a given period although nobody is confirming for how long. Vaccines will not protect you forever or will they once you acquire the antibodies? All this is cold comfort naturally for those trapped between whether to go get the vaccine quickly or to wait and watch till they are convinced that they should take it. A vaccine may not be a permanent solution but then again we hear accounts of the grimmer variant strains of the coronavirus taking an even worse toll in some countries and some of the strains are in India now — perhaps with this in mine many will change their mind and rush for the vaccine, especially if in Goa the prediction of a second wave comes true and cases start rising again. Even doubting Thomases will rush to get a vaccine for fear of losing life!

VACCINE PROGRAMS
In the meantime the picture the country over is that the vaccine program is rolling along successfully. But now we hear of the second surge of cases in Maharashtra and this is raising concern among public and health workers anew, will this second wave prove to be more deadly? The Maharashtra government has rushed to take fresh measures to re-impose closure of schools and colleges, impose limited movement at night time as also restrict wedding or any large celebrations for a month. There are of course those who will carry on life as if to say that more people die out on the roads of India and more babies are aborted than people dying of Covid-19!
In Mumbai cases have increased from 18,200 cases to 21,300 cases and the areas of concern are the Mumbai suburban areas where weekly cases are up by 19%. In Nagpur, Amravatri, Nashik, Akola and Yavatmal we hear the weekly cases have increased by 33%, 47%, 23%, 55% and 48%, respectively.

GOAN SITUATION
SEEING the close relationship Goa enjoys with Maharashtra, Goa’s Chief Minister Pramod Sawant and Health Minister Vishwajit Rane are contemplating on new SOPs to prevent the dreaded infection from sweeping into Goa again. In Goa at last count the death toll remained at 787 and recovery count risen by 44, with number of people discharged at 53, 287 – leaving the state leaving with only 488 active cases plus or minus as to be seen in the coming days and weeks.
The second phase of the government-sponsored vaccine drive started on February 9 when reportedly 7,000 healthcare workers from public and private sectors received their first dose out of the vaccine, that is out of 19,000 odd healthcare works and Central government employees who registered on the Covid-19 website. According to oncologist Dr Shekar Salker (of the Manipal Hospital and Dr Vinayak Buvaji (president, Indian Medical Association, Goa)the what is important in vaccination programs is speed and coverage,“If we can achieve at least 60% of population vaccinated this will definitely reduce the incidence of new cases and confirm successful vaccination.”
This is not happening as of now. There is need to streamline effective delivery of the vaccine. The present approach of mandatory pre-registration of health care workers has limitations and it is observed that not all healthcare professions and ancillary frontline workers are registered for the vaccine due to multiple practical reasons. Resulting in denial in uploading the beneficiaries name on the Cowin portal.
With the public programs of vaccination under way people are urged to get themselves vaccinated but obviously there are practical hitches which still have to be ironed out. The IMA has made some suggestions which it hopes the government powers that be will take seriously in the larger interests of successful vaccination in Goa. The government machinery may be overloaded but where is the public even in this case? IMA fears that the end result would be wastage of vaccine with only a very small percentage of the Goan population vaccinated successfully!
A suggestion because time of the essence is that the government authorize local medical associations to approve beneficiaries and direct them for administration of vaccine at nearest Covid vaccine booth with authenticated ID proof. Currently, the Covid-19 vaccine booths set up in enlisted private sector have appointed dedicated manpower for delivery of the vaccine but for all kinds of reasons vaccination is not happening as expected or desirable.
Perhaps the real issue here is that nobody is sure whether the vaccine is available freely or even under the DDSSY medical insurance scheme (which operates in biased ways between Goans and non-Goans) or even which vaccine is freely available and where – at government centers or at listed private hospitals? While the government vaccination program is only dispensing the Covishield vaccine, it is anyone’s guess which is the better vaccine (many seniors are wary about vaccines safe and not so safe for patients with comorbidities and the costs entailed of availing of the better vaccine). The flip side is also that many well-read educated young people think that if one’s risk of dying of Covid-19 is only 3% why take chances with any of the vaccines in the market place, or the one offered in government programs which the government has invested in so heavily for reasons best known to it. Health is not something you want to play in the absence of conviction or trust.

VACCINES GALORE TO CONFUSE!

IT is mindboggling the number of covid-19 vaccines which are available now in the vaccines market. At least a dozen vaccines have been officially authorized by RAPs or Regulatory Affairs Professionals Society and a dozen more are still under development around the world. Vaccines are of several kinds and the ones we hear currently in India are usually either Covaxin (which is called an inactivated vaccine put out by the Hyderabad-based Bharat Biotech, ICMR, India) or Covishield developed by the Pune-based Serum Institute of India. We also hear of Moderna, AstraZeneca, Pfizer-BioNTech, Johnson & Johnson vaccines and some of them are not given in two installment dosest but as one time vaccines which many prefer. AstraZeneca is also the Covishield and an adenovirus vaccine.
Vaccines may be mRNA-based (like Comirnaty and Moderna), adenovirus, inactivated (like the CoronaVac where base adjuvants are formalin with alum, developed in China); there is also EpiVacCorona which is a peptide vaccine from Russia. There are also recombinant, peptide and plant based adjuvant vaccines, also nano particles vaccine, DNA and DNA (plasmid) vaccines, life-attenuated vaccines. The general concern usually is about the adjuvants or based materials used to fix the vaccine. A dozen more vaccines are under development. The world of vaccines has become macabrely fascinating for many students of immunology!
Needless to say it usually takes anything from ten to 15 years to develop a new vaccine, but due to unprecedented circumstances or so to speak the current lot of covid-19 vaccines we hear about have been developed in less than a year. In India there are only two key players and these are the Serum Institute and Bharat Biotech of Covishield (adenovirus vaccine) and Covaxin (inactivated vaccine) fame respectively.

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