An Indian tale of vaccines!
A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body’s immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future.
Indeed, this was all our generation knew about vaccines in particular. We never saw a major outbreak. We were vaccinated against Polio in the early 2000s, but back then we were too young. All other vaccines we took as a child were merely preventive, there wasn’t a major outbreak of those viruses. So all I remember is seeing advertisements of “Pulse Polio - Do boond zindagi ki” where Shri Amitabh Bachchan used to come on Television and ask people to get vaccinated, yes much like how it is now. The vaccination drive for the poliovirus began in 1985. India was declared polio-free very recently in 2014. This means the last case of polio was found in 2004-05. To give a better perspective of numbers, that is a 30-year long fight. 20 years till the virus lasted after vaccination even began. Think how much time the first vaccine took to be available?
Development time for Vaccines
If you remember the early days of the pandemic, everyone was confused. Even doctors did not know what to do. This was once in a century event. Something of this scale was last witnessed in the Spanish Flu about 100 years back. I remember reading a world economic forum report on vaccines in general which mentioned a timeline of about 10 years for a vaccine to be ready. And I was shocked. See this image:
In general, vaccines are hard to make. According to Bill Gates, it’s harder than making a Jet Engine, and I agree. Polio vaccine development started in the 1930s. The first candidates were found in the 1950s. Vaccination Drive in India started as late as 1985. And it still took 20 years for India to eradicate polio. There are still many countries on this planet that haven’t eradicated polio yet. One of them is our not-so-friendly neighbor Pakistan.
The tremendous speed of vaccine development
All this proved wrong. The first vaccine candidate derived from MERS did its first clinical trial and this was just a few months after the virus outbreak was declared. India did not even have 5000 cases back then. India began its first trial in AIIMS in June-July same year. This was the first time the pace of vaccine development was so rapid. Part of the credit goes to institutions like Oxford University, ICMR, NIV Pune, and companies like BioNTech, AstraZeneca, Serum Institute of India, Bharat Biotech. Governments also streamlined this process and supported these institutes across the world.
We got our first vaccine candidate to publish its phase-3 trial results in November 2020. We also realized how VC-funded startups can also do miracles. Moderna, a VC-backed company also completed their phase-3 trial around that time and published stellar results. Both of these are mRNA-based vaccines. They don’t contain any inactivated virus / its spike protein or anything as such.
I don’t want to deep dive into how vaccines work and at the same time, I would not call myself to be completely competent to explain that. So here is an amazing video about how vaccines work.
A large part of the credit of this speed goes to the breakthroughs made in mRNA technologies. See this video to understand what they are. mRNA vaccines are easy to produce at scale because the process of culturing the virus is removed. They are also more effective, as the body is fed exact instructions of how to produce the anti-bodies instead of the body’s immune system learning to do it by looking at an inactivated virus. This is the reason why Pfizer-BioNTech and Moderna vaccines give immunity after 7 and 14 days of the second dose respectively.
But it’s not just that. Although late to the party, vaccines like Sputnik-V, Oxford-AstraZeneca, ICMR-Bharat Biotech, and others also joined the league in a matter of months. Each vaccine is different: some use inactivated virus, some use its spike proteins, etc. But everyone made it. Johnson & Johnson went as far as having a single shot vaccine, which in my opinion is a miracle!
Let us have a look at the major challenges faced by India in polio vaccination drive (Excerpt from this Wikipedia article.):
- Testing showed that three doses of vaccine were enough to protect children in developed countries, but it became obvious that this was not enough in some areas of India. The Ministry of Health and Family Welfare recommended eight to ten doses for each child. - Children in some areas of India are weaker and often had diarrhea, which reduced the efficiency of the vaccine. Open defecation, monsoon flooding, and a lack of water treatment made it easier for a child to swallow more poliovirus. As a result, children with too few doses of vaccine were not fully protected and sometimes got polio. - The eradication program, therefore, gave drops over and over again, to boost children's immunity higher and as a precaution against missed children. Few parents initially knew that the vaccination campaign was trying to eradicate the disease, so they did not understand the reasons for the increasing intensity of vaccination. The increasing frequency of the drops and cases of polio among partially vaccinated children caused rumors that the drops did not work. - On July 30, 2013, a nine-month-old boy from Navi Mumbai tested positive for vaccine-derived poliovirus (VDPV) type 2. This was the fourth such case recorded in the country in 2013. - Many parts of India are remote and hard to access. People in some areas had had poor and caste-discriminatory treatment by government health authorities, which made them less willing to assist in the vaccination program. The time demands of polio vaccination sometimes left health care workers with less time for other services. The absence of any free health services other than polio vaccination and contraception lead to rumors that the drops caused infertility. - Rumours about vaccinations varied by area, but were clustered, so that there was a greater risk of a cluster of unvaccinated children. Some believed that vaccinating newborns, children who are ill, or previously vaccinated children was not safe; the last polio case in India was a girl who had not been vaccinated because she was sickly. There were also rumors that the polio drops were made from the blood of pigs, dogs, or mice, or pig fat. - Poor participation of doctors and nurses, difficulty in maintaining and procuring vaccines, difficulty in procuring vehicles, and a lack of support from community members have caused problems in the program, as has fatigue at the length of the anti-polio campaign.
So, if you look at these points, the first one is a procurement issue, as in how to manage the procurement of so many doses? The second issue is rather a scientific one, efficacy was less because of poor infrastructure and poverty.
Now comes the major problem. Misinformation, fake news, and stuff. Yes, they existed back then also. What we see today is a much-amplified version of it.
The increasing frequency of the drops and cases of polio among partially vaccinated children, caused rumors that the drops did not work.
This line is just tragic at so many levels. After doing all this, kids started testing positive for vaccine-derived poliovirus (Inactivated Virus). Although this was very rare, to an extent that only 50 such cases are documented but news reports such as these spread this so as a person won’t take the vaccine after reading the article. This reminds me of my old article where I wrote about how Journalism is missing the “ethics” component.
Then all the other issues are logistical, misinformation, and operations.
Vaccine Logistics is hard!
Take into account the Pfizer-BioNTech and the Moderna Vaccine. Both require -50°C for storage. A supply chain of this temperature is nonexistent in developing countries. At the same time, penetrating villages and small towns and convincing people to take vaccines is also hard.
We often write a blank tweet saying “Government is inefficient” etc. What we have to think is who is running the government? Who is running such an operationally heave stuff? These are the IAS Officers, having no degree or experience in supply chains, logistics, or operations. The problem is deeply rooted, we just don’t notice.
It is important to reflect a bit here too. Think that you are a writer in a media company and are given a task to write articles about covid vaccines. What would you write to get maximum clicks? Think about what is the “Hot” article which people will open as soon as they see that?
Take some time…
Would you keep this in the heading?
Over 21,000 test positive for COVID-19 after the first dose of vaccine; 5,500 after the second dose
and keep the word “merely” in the subheading like this?
ICMR Director General Balram Bhargava said that merely 0.04 percent of 17,37,178 individuals, who received a second dose of Covaxin were tested positive for the coronavirus
This is a very basic question. WHY OVER 21,000 TEST POSITIVE INSTEAD OF JUST 21,000 ?
Think about how opinions would form just by reading this headline of this article?
And there are many such attempts to get clicks because hey, you wouldn’t click a positive article right? But you’d click this to know what the heck!
A proper headline for this news would be this article by India Today:
0.04% people tested Covid-19 positive after 2nd dose of Covaxin, 0.03% after Covishield: Govt
And that’s how it should be. That is what journalism means. And if not ever, this is the time when misinformation should not be spread to get few more clicks.
Issue of Health
Health is a state topic in India. This is the reason why you don’t see health and hospitals being talked about in the union election but the state elections.
This is much obvious but a lesser-known fact. The center can control the vaccine supply but not how those are being distributed. In the end, it boils down to the state and then to the local governing body.
Read this interesting article by The Print on how states failed the healthcare system. States are overly dependent on the center. Some elections had health in limelight, but when the pandemic hit, those were the states which suffered the most, or equally to other states.
No matter whose government is there in your state, the money is not being spent where it should be. India is a welfare state, we are socialist from the very beginning, and contrary to popular beliefs of BJP being the “Right” wing, BJP is also highly socialist when it comes to it. This means, almost every political party in India is socialist. We still don’t have proper public health infrastructure. At the same time, one should understand that no amount of preparation and no public health infrastructure can cope up with what COVID19 had to offer, but what we saw was terrible.
We need strong structural reforms. We need to increase the number of NIVs. Although this government has rapidly increased the number of AIIMS and MBBS seats, there is a need to increase research spends, figure out operations and stop corruption.
Sacrifices made along the way
When I was talking to my mother about vaccines in November when Pfizer published Trial-3 results, she said the following:
Given my experience with how it is in India, it would at least take 2 years for the vaccine to come to us if we are lucky.
As of today (After less than 5 months of having the conversation), she has taken the second jab (1.5 months after jab 1) of the Covishield already.
Something happened, while it may not seem all gloomy and shiny, we did something miraculous. This is the first time we did this as a nation.
And it’s not just the government who made it possible.
There are multiple heroes in this story. Scientists from ICMR, Oxford. People like Bill Gates subsidized the vaccine price to a mere $3-5. See this article to learn more about that. The pandemic showed why we need rich people in the world. But I have a better and a local example.
Adar Poonawalla, the owner of Serum Institute of India, went all in and started producing the Oxford-AstraZeneca vaccine (Covishield) even before the efficacy rates were out, even before it was approved. He invested a gigantic amount of $450 Million or ₹3370 Crore. It was a big risk. So big that I can’t even digest the fact. The vaccine could have failed, it could have not worked. More than 60-70% of vaccine projects end up in trash bins. Success rates are very low. We need to thank Adar for doing this. End of it, it’s not something he will make huge money from, but I hope he gets a good reward for the risk he took. Today 90ish % of all vaccines administered in India are because Adar took that risk. Think about it for a while. Be grateful.
And the end of it, the rollout has been highly structured, thanks to India’s recent experience with polio.
What can we as citizens do?
See, end of the day it will only be possible to tame the virus when both the stakeholders do what they are supposed to do.
We can do two things:
1) Get ourselves “Vaccinated” with whatever vaccine is available. Every vaccine works.
2) Practice social distancing.
And the cherry on top, normalize vaccines in your friend circle. This is the time to use social media and curb vaccine hesitancy and the spread of the virus. This article does not end here. I want to emphasize the global situation too. Here is a link to that article.
I know these times are tough. I appreciate you reading this. Please take utmost care of yourselves and your loved ones. If you want to talk about something, just rant out on stuff, have anything to share, need any help that I can do, tell your experience, drop me an email (firstname.lastname@example.org). I will be more than willing to talk. Expect a turnaround time of almost 10 mins in the daytime.