[Editorial] Protective Vaccination against COVID

What did the government announce recently?

  • On December 25th, the PM announced that groups that are at risk of contracting COVID-19 would be eligible for a ‘protective’ 3rd shot of vaccine from January 10, 2022 onwards.
  • This group includes elderly individuals suffering from age-related severe diseases and those who face repetitive occupational exposure to the virus.
  • From January 3, 2022 onwards, the vaccination drive is to cover the 15-18 year age group too.

What is the significance of this announcement?

  • Restricting the eligibility for the protective shots is a wise decision as:
    • The vaccine supply chain isn’t wide enough to immediately cover all the adults and children.
    • Even though India is increasing its production volumes, it has international obligations to fulfil.
    • The vaccination teams can’t be expected to focus only on COVID-19 vaccination. Other routine immunization programs also require their service.
  • The use of the terminology ‘protective’ (as opposed to ‘booster’) serves 2 purposes:
    • The scientifically accurate way of describing the 1st dose of a vaccine is ‘primer’. The 2nd dose is referred to as the ‘booster’. All the subsequent doses are for immunity enhancement and they help augment the protection.
    • Indicates that the previously administered doses still offer some protection to the recipients. It is a reassurance for those who have been categorized in the low risk group and won’t be receiving the 3rd.
  • The decision to vaccinate the older children would help comfort the parents and the teachers.
  • Also, though it has been seen that children generally experience milder illness when affected by COVID-19, they are a highly mobile age group and a high incidence of infection may lead to long term complications.
  • The decision coincides with the regulators’ approval of Covaxin administration for the 12-18 years age group. This vaccine from Bharat Biotech, now joins Zycov-D (a DNA vaccine from Zydus Cadila) as COVID-19 vaccines available for paediatric use.
  • This announcement is a relief for the at-risk population who have been anxious about the rapid spread of the Omicron variant. There is a concern that the protection acquired in early 2021 would be insufficient against this new variant or even against the still circulating Delta variant.
  • Available data on breakthrough infections and re-infections suggest that Omicron has high immune escape capacity. However, global data also suggest that a 3rd dose will help restrict such infections to milder illnesses and prevent hospitalization.

Most probable and repeated topics of upsc prelims

What is the way ahead?

  • The December 25th announcements have been widely welcomed. However, several aspects are still awaiting clarification.
  • There are questions regarding:
    • The method of determining eligibility for the elderly
    • Choice of vaccine for the ‘protective’ dose
    • Procedure for registration and certification
  • The eligibility of frontline workers can be ascertained as was done in early 2021.
  • Eligibility for the elderly was earlier based solely on the age criterion i.e. 60 years old and above for vaccination. It now comes with the qualifier that a doctor must advise it on grounds of a comorbidity.
  • If documentary proof are required for registering the elderly for protective vaccination, it may create a disadvantage for the poorer senior citizens, already having only limited access to doctors.
  • In such a case, presumption of comorbidity in all elderly would help with regards to deciding eligibility for the protective shot. This is justified by the fact that the 60+ age group has a high prevalence of comorbidies.
  • The immune-compromised persons are another vulnerable group who needs to be prioritized in the upcoming vaccination drive. 2 doses aren’t sufficient to ensure long-lasting immune response in such persons as they are either afflicted by diseases that render them immune-deficient or are being subject to therapies that suppress their immune system.
  • Additional vaccine doses could help such persons keep their immunity at sufficiently highly levels to escape severe COVID-19. The government will have to revise guidelines to list out the eligibility criteria for this group.
  • In addition to the eligibility criteria, the government will have to upgrade the COWIN app to facilitate the upcoming immunization drive.
  • Also, the Indian vaccination program currently has only 2 vaccines. The government could consider including other vaccines especially as experience suggest that heterologous boosters are better than homologous boosters.
  • The decision on the adoption of heterologous booster vaccines is to be taken by the government. However, even if its left to the doctors’ judgement, the supply chain situation in India may dictate the selection of the 3rd
  • If more choices of vaccines are available, the decisions will be easier. Some eagerly awaited arrivals include the subunit protein vaccines and the mucosal vaccines that could be administered nasally.
  • After covering a significant portion of the at-risk population, when the domestic supply of vaccines increases, the attention can be shifted to providing protective shots to other adults and younger children.
  • While this COVID-19 vaccination drive is taking place, focus on routine immunization of children and pregnant women mustn’t be lost. This suffered neglect in the initial stages of the pandemic- something that mustn’t be repeated.

Conclusion:

As the pandemic, being fuelled by the new Omicron variant, stands ready to enter 2022, the recent announcements regarding 3rd protective shots and expanding coverage to older children are welcome. India is right in not blindly following other countries and should determine its vaccination policy based mainly on local evidence and conditions.

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