Ramping up vaccination

The immunization drive against COVID-19 is poised for a big push in India with the Central government deciding to include people aged 45 years and above from April 1. The move is timely as several states are grappling with the second wave of infection. Six States – Maharashtra, Punjab, Kerala, Tamil Nadu, Karnataka, and Chhattisgarh account for 79 per cent of the new deaths and upscaling the preventive measures are crucial to prevent spread of the second wave to other states. The immunization drive, launched on January 16, so far allows healthcare workers, frontline workers, all persons aged 60 years and above and persons with one of the specified comorbidities in the age group 45-59 to register for vaccination.The age-specific vaccination is in line with the global practice as objective is to protect the most vulnerable sections. According to Ministry of Health and Family Welfare COVID-19 affects all age groups; however, morbidity and mortality is several times higher in adults particularly in those above the age of 50 years. Children have either asymptomatic or mild infection. The general practice is to first evaluate any new vaccine in older population and then age reduction is done to assess the safety and effectiveness in paediatric population, according to information on vaccination disseminated by the ministry among public. It is heartening to know that adequate quantities of vaccine doses are available. Two vaccines that have been granted emergency use authorization by the Central Drugs Standard Control Organization in India are Covishield and Covaxin. Vaccine hesitancy prevalent among many across the country has slowed down the immunization drive. More public messaging by scientific communities on importance of vaccination in the fight against COVID-19 is required to allay apprehensions and encourage everyone aged 45 years and above to register. The scientific community has been cautioning against dropping the face mask and stopping other safety protocols in public places. Even those given the first shot of vaccine may be infected by the virus as it takes time for immunity to develop. Indian Council of Medical Research has recommended that the second dose of Covaxin should be administered in the interval of 4 to 6 weeks from administration of the first dose and the Covishield in the interval of 4 to 8 weeks. So far over 5.5 crore vaccine doses administered in the country. Eight states accounting for 60 per cent of cumulative doses given so far says a lot about poor pace of vaccination in most states. Lowering the age bar is expected to increase the figure from April onwards. Since March 1 private health facilities have also been permitted to function as COVID-19 Vaccination Centres and charge a maximum amount of Rs 250. Apart from hesitancy resulting from circulation of rumours and unscientific information about the vaccines, logistic challenges of vaccinating in a vast country with over 121 crore (2011 Census) population is enormous. For the fist phase of polling in 47 constituencies in Assam, the Election Commission has made elaborate arrangement for COVID-safe voting. This includes wearing of facemask, maintaining the physical distance while standing in the que, temperature checking. While political parties and candidates were seen flouting all COVID guidelines issued by the Election Commission for electioneering, the arrangement at the polling stations will remind the voters about the importance of adhering to the safety protocols in public places to prevent spread of infection. The second wave in several states is a practical lesson even for the lay person about how ignoring the safety protocols can lead to exponential rise in infection no time. Complacency over low number of active cases when a low percentage of population have been given both the doses of vaccines may prove costly and push the state into a crisis situation. So far, only 1.36 lakh persons in the state with 3.12 Crore population have been given the second dose of vaccine. This shows the vulnerability of the state to a second wave gripping due to exponential rise in active cases. Ramping up testing is one way of ruling out spread of fresh infection in the communities which are yet to be protected with the vaccine shield. Ironically, instructions issued by the state government to enforce wearing of mask in public places and imposition of penalty on violators have remained on paper. A second wave will disrupt the normal life and will have cascading affect on education, agriculture, industry, economy, cultural practices, and overall development activities. There is no need to press the panic button, but lessons must be learnt how multiple waves of floods during the peak of pandemic last year affected healthcare deliveries in flood-hit areas. Till the state's population is well protected through immunization, there is no alternative to the most important piece of advice from health experts that masks are as important as vaccines.