Dr Gagandeep Kang, one of India's eminent virologists, is skeptical about the government’s claim that it will get over 2 billion doses of vaccine from August to December, as the production capacity of vaccine makers such as Serum Institute and Bharat Biotech is yet to ramp up.
“I take the projections with a grain of salt. If you remember, last year, we were told that, by December, Serum Institute would produce 100 million doses of vaccine and Bharat Biotech in tens of millions of doses. There was going to be a large stockpile that was available with them. As we have found, that is not case,” Dr. Kang told Moneycontrol in an interview.
“So when we say there is going to be 2 billion doses of vaccine in the last five months of this year, I am a bit skeptical because we haven't seen the previous predictions play out well," she said.
Kang, one of the country’s leading experts on vaccines, is a Professor at the Department of Gastrointestinal Sciences at Christian Medical College, Vellore. She was roped in by the Karnataka government last week to advise on vaccination strategy. She is also a member of the advisory committee of the World Health Organisation on research and use of vaccines.
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
As the second wave of Coronavirus ravages India, with a third wave expected later this year, experts have urged the government to accelerate the pace of inoculation.
While India has administered over 18 crore (180 million) doses so far, the government is confident of vaccinating the country’s entire adult population of 95 crore (950 million) by the end of the year.
Union Health Minister Harsh Vardhan said that the number of vaccine doses administered in India will touch 51.6 crores by the end of July. “Sputnik has been approved. This, along with the slated approval of Zydus Cadila's vaccine, Serum Institute-Novavax vaccine, Bharat Biotech's nasal vaccine, and Genova mRNA vaccine will push the availability of COVID vaccines to 216 crore (2.16 billion) doses in the August-December period,” he told journalists last week.
Nasal vaccines don’t work very well
But Dr Kang has raised questions on the vaccines that made it to the government's list as they have no data for now.
“In general, nasal vaccines don't work very well against many respiratory infections. While it sounds like a brilliant solution, and I hope it works, I would like to see the data.. And DNA vaccine (Zydus Cadila's ZyCoV-D), we have never had a licensed DNA vaccine for humans. I'd be very supportive but I would like to see the phase 3 data before thinking this is a valuable addition," she said.
"So I think the projections are optimistic, I hope very much that I am completely wrong and the government is completely right but we have to wait and see," she said.
Dr Kang had also questioned the hurried approval of Bharat Biotech's Covaxin in clinical trial mode in January this year but has since said in recent interviews that Astra Zeneca's Covishield and Covaxin are both effective vaccines.
Bharat Biotech announced its Phase 3 results in March, where it said Covaxin demonstrated an interim clinical efficacy of 81 percent in preventing COVID-19 in those without prior infection after the second dose. Its second interim results, announced in April, demonstrated overall clinical efficacy of 78 percent and 100 percent efficacy against severe COVID-19 diseases.
Vaccination licensing, procurement
“What I said then, and I stand by it, is that I don't think we should be licensing vaccines where we have no indication of whether they work or not. Once the clinical efficacy data becomes available, even if as an interim analysis, I am willing to accept the vaccine. But if you want credibility in your regulatory process, if you lay out a pathway for the vaccine, stick to that pathway", she said.
Dr Kang, who is advising states such as Punjab, Andhra Pradesh, and now Karnataka, backed a central procurement of vaccines at the best price available instead of letting states and the private sector compete.
"It has always been that any vaccine being bought for the national immunisation programme are bought by the Centre and distributed to states. Last August, the government told states there is no need to go for their own procurement, which changes overnight in April (last month). Now, states which could have done this months ago are in the back of the queue," she said.
"You are creating a market that is free for all. If you have a vaccine manufacturer in Maharashtra or Telengana, are they going to provide to other states first or their states? It is unnecessary, this level of complication. Ultimately, if vaccines are free for everybody, it is good for all of us,” she said.In an interview with Moneycontrol last week, Narayana Health founder and chairman Devi Shetty, too, called a centralised approach to vaccine procurement, stating that India should buy as one, buy in bulk and rope in private hospitals to hasten the pace of inoculation.