COVID-19 vaccine shot for all Indians unrealistic; better health services, masks crucial, say experts

Does India’s entire population need to be vaccinated against COVID-19? Not necessarily, or so the government seems to have suggested in a recent press conference. Union health secretary  Rajesh Bhushan  clarified on Tuesday that the Central government never spoke about vaccinating the entire country against the coronavirus. Further, Balram Bhargava, the head of the Indian Council of Medical Research (ICMR), was  reported to have said, “…Our purpose is to break the chain of virus transmission. If we are able to vaccinate a critical mass of people and break the transmission, we might not have to vaccinate the entire population.” Much of the public commentary on COVID-19 vaccination in India, however, has envisaged a rather different scenario (see  here, for example). The presumption seems to be that most, if not all the people in the country, will eventually be administered a vaccine—in a gargantuan but phase-wise exercise. Experts who spoke to Firstpost on the issue, however, emphasised the distinction between vaccine shots being administered to individuals with the aim of specifically protecting them against COVID-19, and a public immunisation programme designed to achieve population-level immunity. Based on their perspectives, here is an overview of the role that vaccines could play in immunising India’s population against the novel coronavirus. Is vaccinating the whole population feasible? In general, a vaccine coverage rate between 65 percent and 70 percent would be enough to reach population immunity, thereby breaking the chain of transmission, experts from the  World Health Organisation have estimated. However, in India, reaching out to 65-70 percent of a population of about 1.3 billion is also an enormous challenge. Speaking to Firstpost, T Jacob John, a virologist and former professor at the Christian Medical College, Vellore, said, “Nobody expects that the entire population of the country can be vaccinated against COVID-19. However, merely saying that everyone may not be vaccinated holds little meaning. If the government had specifically mentioned the sections of society that will be given the vaccine shots, then that would have been more meaningful.” John further said, “A vaccine can be used for a public health purpose — which is to achieve immunity against the disease among the population at large; or it can have a healthcare application—which means protecting the individuals who get the dose. The government has to take a decision on whether it will administer the vaccine to selected individuals, or whether it will try to control the infection in the community by means of a vaccination programme.” That brings us to the issue of what the government has announced with respect to vaccination against the novel coronavirus. Union health minister  Harsh Vardhan has announced that India hopes to receive by July 2021 up to 500 million doses of the vaccines against COVID-19, which can be used to inoculate about 250 million people. While this will be a massive task, one reason for optimism that has been  expressed by many  is that India has considerable experience with distributing vaccines through the universal immunisation programme. However, vaccination against COVID-19 will be a different scenario, points out Mathew George, professor at the Centre for Public Health, Tata Institute of Social Sciences. Speaking to Firstpost, he said, “Other vaccinations that have been a part of the country’s immunisation efforts deal only with children. On the other hand, the COVID-19 vaccine will have to be administered to the adult population as well. This will pose several operational difficulties. Earlier immunisation programmes focussed on anganwadis and schools and hospitals as sites of distribution. An immunisation programme against COVID-19 would have to involve going from house to house.” He added, “One indication of the time that may be needed is our experience with polio. The immunisation programme to eradicate polio took about 13 years, even though it was only targeted at children between 0 and 6 years of age.” Mathew says, “Individuals who can afford the vaccine against COVID-19 will, of course, avail of it for their personal protection—that is a separate issue. However, personally, I am sceptical about achieving population-based immunity against COVID-19 through an immunisation programme.” In an  article in The Hindu, he also wrote, “In the midst of a pandemic, the popular perception for vaccination is that which safeguards oneself from the disease. It is this individualistic need that generates a huge demand for vaccines in the market, which, in the absence of government intervention, will be affordable only for those who can pay for them.” If India does decide not to vaccinate its entire population against COVID-19, it won’t be the only one to do so. In September, China announced that not everyone in the country will need to get vaccinated against COVID-19 after it succeeded in significantly containing the virus. The country’s top medical official was  quoted by CNN as saying that while there was no need for mass vaccination at that time, that could change if another serious outbreak takes place. The United Kingdom , which has become the first Western country to allow mass inoculations against COVID-19, has been unclear on whether the entire population will be vaccinated. In April, the country’s health secretary Matt Hancock had said that given the positive impact a vaccine could have, he was hoping that ’everybody would have the vaccine." However, in October, Kate Bingham, the chair of the UK vaccine task force, reportedly said that less than half of the country’s population could expect to get a jab. She said that if a successful vaccine was found, inoculating everyone in the country was “not going to happen” and that “we just need to vaccinate everyone at risk”. Wearing masks, strengthening health systems crucial The above discussion raises a pertinent question—if mass vaccination programmes won’t adequately combat COVID-19 in India, then what will? Universal mask-wearing is a non-pharmaceutical intervention that can help reduce the lethality of COVID-19 in the absence of a vaccine. In fact, some researchers have even said that the effect of mask-wearing may be similar to that of a  crude ‘vaccine’ against the coronavirus. A study published in the  New England Journal of Medicine has hypothesised that universal masking might help reduce the severity of disease and ensure that a greater proportion of new infections are asymptomatic. According to the study, masks can prevent people from getting sick by reducing the amount of virus they inhale. Also, if a small number of pathogens do slip through, they may prompt the body to produce an immune response against the virus. Commenting on the study, John said, “The comparison of a mask to a crude form of vaccine is of symbolic value, and is meant to help people understand the importance of mask-wearing. It is indeed an important intervention. If one wears a mask in a public place where other people may have the COVID-19 infection, the risk of the infection spread is reduced by about 75 percent. That, of course, is provided that everyone else is wearing masks too.” Speaking about other public health interventions needed to combat the coronavirus outbreak, Mathew said, “There is a need to strengthen existing health services. For example, community health centres can temporarily be converted into nodal centres for COVID-19 treatment. Ideally, each of these centres can serve a population of 1 lakh each. Such a strengthened system will remain helpful even after the COVID-19 pandemic subsides. Also, there needs to be a systematic analysis of the total cases of coronavirus, to see what proportion need hospital care, ventilators, etc.”