Diverting resources and time to Covid to the exclusion of other health issues poor policy

India has a burgeoning middle class with rising aspirations. The economy, let us assume, is speeding. However, if roads are poorly maintained and traffic signals unreliable, fast cars can cause serious accidents. In the last seven decades the number of vehicles on Indian roads has risen by 11% every year. The road network on the other hand has grown by only 4% yearly – a gross mismatch.

Increased private transport on Indian roads has benefitted neither the rich nor the poor. Both suffer from air pollution, traffic snarls and road accidents, which kill over 400 people every day in India and maim 1200 more, mostly young adults.

The risk of a young person dying from road traffic accident in India is many times more than the probability of dying from Covid-19. If images of gory accidents and mangled bodies are shown daily on 24 x 7 news channels and on social media, one can imagine the panic it would cause.

Clearly, a permanent solution to traffic problems can only be achieved by increasing the quality of public transport in the country. Gustavo Petro, former Mayor of Bogota had remarked, “A developed country is not a place where the poor have cars. It is where the rich use public transport.”

The expanding middle class, while pursuing their dreams for a better life, tend to neglect their health. Most have little time for physical activity and home cooked healthy foods. Increased sedentary life and fast foods lead to lifestyle conditions like diabetes, hypertension, coronary heart disease and obesity. The current pandemic illustrates that these lifestyle diseases also make people more vulnerable to Covid-19.

Living in the fast lane increases the demand not only for new cars but also a pill for every ill and newer vaccines even if they are on trial mode, like new cars with temporary registration number.

Newer vaccines can definitely prevent diseases and deaths from a number of conditions depending on local epidemiology and public health problems. Vaccines in poor countries have had extraordinary successes as well as severe setbacks.

There is a fundamental difference between vaccines which are administered to healthy people and drugs which are given to diseased patients. Adverse effects due to vaccines in healthy, however rare, raises concerns of safety, ethics and public trust. Overlooking these aspects can erode trust leading to vaccine hesitancy. This can adversely impact vaccination programs.

Just as good roads and monitoring of traffic rules are essential to prevent road traffic accidents, good monitoring and surveillance systems should be in place to prevent vaccine related accidents and adverse events from an ever-increasing number of newer vaccines developed and introduced at warp speed.

With our existing limitations of public health infrastructure, this will be difficult. Fast tracking mass vaccination without proper infrastructure can be hazardous. It would be like running a superfast train on old rickety tracks.

Most vulnerable will be the marginalized and poor people in rural and remote regions, out of range of a surveillance system for reporting adverse events following immunization. Their vulnerability can be compared to pavement dwellers who are at risk of being run over by fast cars.

Introduction of a new vaccine can also impact the routine childhood immunization program and can overstretch the creaking public health system. Scant resources are likely to be diverted from care of other neglected diseases in our country which have higher morbidity and mortality.

Every day about 25, 000 people die in India from various causes. Tuberculosis takes a daily toll of 1200 persons in spite of having a vaccine for it which also claims to reduce severity and deaths; 2000 children die every day in our country from preventable diseases; typhoid is endemic in spite of an effective vaccine and treatment, to name just a few.

Compared to the burden of other communicable diseases in our country, Covid-19 with an infection fatality rate between 0.1 to 0.3% pales into insignificance, as between 99.9 to 99.7% of people infected with the novel c orona virus survive. Our endemic diseases with higher morbidity and mortality hardly get a fraction of the resources for their surveillance and control compared to Covid-19. Our priorities should be decided by our public health problems instead of Western models.

The latest round of serosurvey in our country revealed that 67% or 90 crores Indians have already encountered the novel coronavirus. Studies from all over show that people who have recovered from natural infection have long lasting and robust immunity even after waning of the antibody levels.

The government has allocated Rs 35, 000 crores for 150 crore doses of Covid-19 vaccine which can vaccinate 75 crore Indians. Going by the science and current evidence regarding the effectiveness and duration of natural immunity we can opt out of mass vaccination to avoid duplicating this population level immunity conferred by nature. It would be like giving a breast-fed baby top milk.

Instead, we can resort to smart vaccination by focused protection of people with comorbidities and elderly. This way we can save a huge amount from the Rs 35,000 crores allotted for the mass vaccination campaign and divert this for other pressing public health problems. For instance, water and sanitation has been allotted just Rs 21,158 crores. A large burden of disease in our country is related to water and sanitation.

We can sum up by saying that good health will be achieved not only by vaccines. It will be achieved by good public health infrastructure, safe water, nutrition, housing, and clean environment and judicious use of vaccines.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)