Editorial

Vaccination: Evidence And Data Analytics Important

In the COVID vaccine roll out, there is no clear data for either of the two vaccines proposed for use in the programme. We do not know if they provide protection for life, for a year or six months, its efficacy among the elderly or the very sick or in stopping new infections. Getting such data requires at least three years and cannot be obtained in a few months. India also does not have any advance purchase agreements for vaccines that have some of this data due to the completion of Phase 3 trials. The two vaccines to be used in India, have not completed the Phase 3 that confirm safety and efficacy when tried out on a large sample. Given these limitations, the government has drawn up strategic guidelines for implementing an ambitious vaccine programme covering 30 crore people by July. With meticulous attention to detail, the guidelines draw upon the knowledge of running national campaigns acquired over three decades of implementing the Universal Immunisation Programme that resulted in eradicating polio and protecting 75 per cent children against 14 vaccine preventable diseases. These guidelines detail the skills, roles and responsibilities of the required human resources, logistics for delivering vaccines at point of use, physical infrastructure, monitoring systems based on digital platforms and feedback systems for reporting adverse events. The approach involves 19 departments, donor organisations and NGOs at the national, state, district and block level. The guidelines also mention the priority criteria — caregivers, front line workers of the departments of health, defence, municipalities and transportation; persons above the age of 50 and those below 50 having diabetes, hypertension, cancers and lung diseases. In other words, the guidelines are a reference manual for what is to be done, by whom, when and how. The non-availability of efficacy data could also impact the procurement and supply of vaccines, result in huge wastage, and can introduce scope for errors and duplication. Instead of rolling out the programme throughout the country in one go and given the complexity of the line listing of priority groups, it may be useful to consider other options such as covering all at one time in an area, instead of sequencing them into different groups. The areas could be ranked on the basis of a vulnerability index built by triangulating data sets from disease burden, caseload of COVID infections, demographic profile, health-seeking behaviour and availability of infrastructure etc, block, district and state wise. Such an approach could enable having differential strategies to suit the health system capacities to organise, deliver and monitor. But central to the success of the roll out will be the confidence of the people in the vaccines. Non transparency of data, needless haste and opacity with which the licenses were given, worsened by caveats and conditions, strident defence by the ruling party in its attempt to stifle healthy conversation that could result in allaying doubts and fears, clumsy attempts to politicise the discourse by media channels have only deepened suspicions. The worst outcome is the denting of our international reputation and respect built over years of adherence to scientific rigour. Coming out of this messy situation is necessary and one option — as adopted for the polio eradication programme — is to establish an independent team of experts under the aegis of the WHO to ensure adherence to recruitment standards, consent conditions, adverse event record management, compensation standards, conditionalities required in emergency authorisation and trial conditions. This will create confidence in the community and international authorities as well. Finally, it is important to understand that vaccination is an incomplete solution to ending the epidemic, since the virus is mutating. Adopting safe behaviour is. Launching a nuanced communication strategy will be fundamental. The government can use its experience of controlling the HIV/AIDS epidemic. Science, evidence and data analytics needs to be the bedrock of the roll out policy, not politics and scoring brownie points for electoral advantages. The need of the hour is winning this battle that has drained us economically, socially and psychologically. That said, the decision to roll out the vaccine is a good start. Let’s keep our fingers crossed

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