Vaccination for COVID-19: It will be a mistake to have a simplistic plan in a complex scenario

People who are most at risk should get a Covid-19 vaccine before those who are running a lower risk of the contagion. This is the principle of priority – seemingly very simple, but very difficult to implement.

India, undergoing the process, is now faced with several impediments in the way, including the danger of falling in the trap created by error of application of mind due to several reasons. The tasks at hand are not only ensuring distribution of Covid-19 vaccines on priority and equitable basis, but also ascertain that the vaccines are safe, effective and affordable.

In the midst of the Covid-19 pandemic, several countries including India have been racing to develop and deploy safe and effective vaccines. There are currently over 50 vaccine candidates in trial, and several manufacturers have applied for emergency use approval for their vaccines, which they claimed were effective. India was the top country to have ordered the largest number, with 1.6 billion doses, followed by European Union with 1.58 billion and US with 1.1 billion doses as on November 30.

However, India had to reduce the number of ordered doses to 1.5 billion as on December 11, indicating the difficulties the county is facing in acquiring sufficient number of doses for its 1.38 billion people. Since every person requires several dozes of the vaccine, there is a great shortfall. It is here India needs prioritization of deployment of the vaccines.

Presently, the five manufacturers of Covid-19 vaccines are Oxford-Astrazeneca, Pfizer-BioNTech, Moderna, Novavax, and Gamaleya (Sputnik).

Though India is almost ready with its vaccination plan, only about 30 crore people could be vaccinated in phase one which is only 21.7 per cent of the population. The population to receive the vaccine in the first phase include one crore health care workers, two crore frontline workers, and 26 crore persons above the age of 50 years. People below the age of 50 years who are suffering from chronic critical illness, which is about one crore, will be provided vaccines after completion of the first phase.

It goes without saying that the plan of distribution of vaccine on priority basis is simplistic while the situation is complex. It is an error similar to that which India committed in its order of complete lockdown on March 24, followed by several ad hoc orders on containment measures. The mistake was realized only after a great damage was done to the economy and thousands of lives lost both on account of diseases and several other reasons such as chaos among migrant labours. We had locked even those areas and regions where there were no infections. Only with Unlock-1 on June 1 could we come to terms with our own error, and started giving relaxation to the areas without any infection.

The lockdown orders were simplistic and lacked careful application of mind. Lockdown and containment measures were required only for those areas where there were infections, not for those areas where there were no infection.

Similarly, while ascertaining priority, government should not adopt simplistic logic that people above 50 years of age are most vulnerable to Covid-19. After careful application of mind, one can easily find error in this attitude. There are many areas in the country where there is no corona infection, and subsequently no risk of the contagion. Why should we then insist on giving vaccine to them when they are not at all at risk? If government implements its present plan, several states with lower risk of contagion and less population would receive more doses of vaccine than the states running higher risks on the ground with higher population. It would be due to demographical differences. To avoid this we must assess the actual risks on the ground, not the age.

Since records for all the states are not available, the country needs to collect them first to assess the real situation in each of the state. We do have 50+ population records for all the states but do not have records for high blood sugar or on medication for high blood sugar, and also high blood pressure or on medication for blood pressure population for 11 major states - Uttar Pradesh, Tamil Nadu, Madhya Pradesh, Rajasthan, Odisha, Punjab, Jharkhand, Haryana, Chhattisgarh, Delhi, and Uttarakhand. Additionally, this fact should also be taken into consideration as there could be millions in the country suffering from high blood sugar and high blood pressure who are yet undetected for several reasons ranging from carelessness to lack of medical facilities available to them. In due course of time number of newly detected persons with these ailments could sharply increase.

If we look at statewise demography of the country with 50+ population, and the population with high blood sugar and high blood pressure below and above 50 may alter the present priority of the government. It would be a wrong decision only to go on 50+ population basis and ignore the cases of co-morbidity in the first phase. People with actual higher risks must get the vaccine first irrespective of their age.

The records of the patients with high blood sugar and high blood pressure are available only for 11 major states – many of them have very high level of corona infection. These states are Maharashtra, West Bengal, Bihar, Karnataka, Gujarat, Andhra Pradesh, Kerala, Telangana, Assam, Jammu and Kashmir, and Himachal Pradesh. Maharashtra and West Bengal have the highest number of people with hypertension and diabetes respectively, while almost one third of Kerala’s population is 50+ with high prevalence of these diseases. Uttar Pradesh has the

highest 50+ population followed by Maharashtra, West Bengal, Tamil Nadu, and Bihar. It’s a very sorry state of affair that the present strategy of prioritization ignores even 6.5 per cent of adults below 50 years of age having diabetes and hence running the risks more than others without such ailment.

This is only an example to show the error in the present strategy that need more thought to reach the people actually running highest risks.

Acquiring the safest vaccine at an affordable price along with its deployment within the shortest possible time is also a challenging task due to maladministration breeding corruption and lack of infrastructure and medical personnel. Vaccination at the rate of only 100 people per session at each site per day needs to be substantially increased. The fact that the government has declared increasing the number to 200 if logistics allow, indicates how tough the task is going to be.