Vaccines won’t be a magic potion to protect against COVID-19, say experts

With just a month left for 2020 to end, many people are pinning their hopes on a vaccine to get back their pre-COVID-19 lives back. However, vaccines won’t be a magical potion, say scientists. They will be one of the many steps necessary to reduce the spread and severity of the SARSCov2.

Of the many vaccines under trial across the world, five have so far showed promise – Pfizer and BioNTech, Moderna, Oxford/AstraZeneca, Sputnik and Covaxin. Even so, all of them are only in trial stages, with data as yet inconclusive.

“Vaccines have been a challenge. The data and the efficacy of these vaccines will change. But, it looks like some vaccines we have never had before are working. There are also worries about the speed at which work is being done and whether there are corners being cut while looking at the safety of these vaccines,” said Dr Gagandeep Kang, vaccine scientist and professor at the vellore-based Christian Medical College. She was speaking at the eighth national bioethics conference.

“The interim results show that all of these vaccines are likely to provide a reasonable level of protection, but exactly how much protection we cannot say for sure now. There are results from just a few weeks into trial. We do not know just how long the vaccine will protect us against the virus either,” said Dr Satyajit Rath, a scientist at the National Institute of Immunology.

For now, it looks like the vaccines being developed by Pfizer and Moderna are the best bet as their efficacy is more than 90% in the initial results. “Moderna is actually better than Pfizer for India because we won’t need to keep it at -70 degree C. Moderna requires temperatures of -20 degree C and that is seemingly possible in India. I say this based on the strength of the data they have put out. Even though it is new technology, it seems safe. However, the vaccines are not available for India. Whatever they make will be used up in the United States, in addition to being expensive,” added Dr T Jacob John, virologist and former professor at Vellore-based Christian Medical College.

Dr John, however, believed that the hope for developing a vaccine in a short time is dim right now and there is nothing visible on the horizon. “We have to wait. Bharat Biotech’s Covaxin is still undergoing Phase III trials, so the trials will be over only next year,” said John.

The Oxford vaccine trials, which gave mixed results, have not inspired much confidence. Initially, they said it showed more than 90% efficacy, but later reports said they dispensed two kinds of doses. Then, the efficacy dropped to 62%. “We will have to wait to hear about Oxford vaccine as we are not sure about its safety and efficacy. The only benefit for India is that this vaccine doesn’t require low temperatures to store it. According to WHO guidelines, any vaccine which has more than 50% efficacy is acceptable to fight the pandemic,” said Dr Sunit Singh, professor of molecular immunology at Varanasi-based Banaras Hindu University.

John added that AstraZeneca is saying many things, but no one outside the company is endorsing what they are stating.

Sputnik is likely to be the first vaccine registered in India, pointed out John. “Transparency and credibility have been issues with the Russian vaccine, but Russian research is usually reliable. So, we can hope that Sputnik may be better than the Oxford vaccine,” said John. The Russian vaccine has more potential to reach the remote areas of the country, underscored Singh.

China has already given its vaccine to more than a million people to protect them from infection. “China has never been transparent on this issue. Nobody has any idea about it. They are saying it is safe, but we will never know. Even if the vaccine is effective, but not safe, they will still use it. That is a problem. This means it would protect against Coronavirus, but it will have severe reactions in some people. That is why all vaccines must be both efficacious and safe,” said John.

There is widespread anxiety and expectation around the vaccine. “There is a difference between being careful about how much protection the prospective vaccines offer and if the vaccines come quickly, they are going to be harmful. Vaccines are unlikely to be harmful to anyone who takes them. Should we be measured and careful? Yes. That means we must think of vaccines as an additional instrument in our cycle of response to the pandemic. There has to be societal support systems, personal responsibility such as maintaining physical distancing and wearing masks. The vaccine is no magic bullet that is going to turn off the pandemic,” asserted Rath.

What is of concern is also the fact that India currently does not have a plan in place for administration of a vaccine. India has only announced that it would give a vaccine first to healthcare workers, then to people above 65, followed by people with co-morbidities.

“This is not a plan. The government has announced its desire, but desire is different from plan. This is prioritisation. I have not seen a plan of action. India needs to make a policy for the dissemination of the vaccine; then there has to be an action plan, let everyone know what the policy and action plan is,” said John.

Policy consists of several things, highlighted John, such as the decision on whether the vaccine would be available in the public and private sector. “If it is in the public sector, will the government give the vaccine to people free of cost or will they charge a user fee? The point is that the government only announced in Bihar that the vaccine would be free of cost. This implies that in other states it would not be free of cost. This is only an implication, but what is the policy?” John wondered.

India’s Universal Immunisation Programme (UIP) was devised, as policy, by the Centre but implemented by the states. “What is the government policy in this case? What freedoms do the states have? Pondicherry has announced that it would give free vaccine to people and the union territory’s budget would take care of it,” said John.

The vaccine has to be given to a wide group and not only to under-five children like the UIP or to antenatal women who are in hospital for vaccination. “The government has to decide if it will it be administered under a doctor’s supervision or will the ANMs (Auxiliary Nurse Midwife) give it. Will the vaccine be given in heath care centres or ration shops or pharmacies? Who will monitor adverse events if it happens and who will be charged if an adverse event happens? If someone has a problem with the vaccine, where will they go supposing the vaccination in done in a general execution? So many issues are pending to be addressed,” underscored John.

Kang added to John’s concerns. “We have never had a vaccination programme where the goal was to immunise the bulk of the population. We have to wait to see how this is going to play out in terms of the product and the delivery. In all of this, I cannot emphasise enough the role of the regulator, which is to ensure the population of the country they are in receive high quality, safe and efficacious vaccine. There are no shortcuts to use the vaccine even if we go for an emergency use.”