Getting access to the COVID-19 vaccine: What should be our approach?

Abstract

As the trials of vaccine development against COVID-19 progress, there is increasing hope of getting an efficacious vaccine soon. There is already a talk of equitable distribution of vaccine once developed. There was need for individual candidate vaccine development as chances of success are low as majority of the candidate vaccine fails in late phases of clinical trials.[1] However, once a safe and efficacious vaccine has been found and its effectiveness is ensured, all the resources should be used for rapid production and equitable distribution so that the pandemic is controlled. India will have an important role to play at this point as its manufacturing capabilities of Serum Institute of India (SII) to produce quality vaccine exceed any other facility worldwide. There is already collaboration between SII to manufacturing companies and international collaborators for equitable distribution of vaccine. One such collaboration is with COVAX, the ACT-accelerator vaccines pillar, which has pledged to donate 150 million dollars through Bill and Melinda Gates Foundation.[2] COVAX, which is co led by Gavi-the vaccine alliance, Coalition for Epidemic Preparedness Innovations and the WHO aims to pool the financial and scientific resources for easy and timely access of vaccine globally especially to countries which cannot afford. There are also pharmaceutical companies such as Astra Zeneca and Novavax which are leveraging on Serum Institute's existing infrastructure for mass production of vaccine for global supply. There is also a need for roadmap for countries to decide that who will get the vaccine first i.e. the distribution will be on the basis of priority or random. There is also question of whether it will be provided free by the government or can also be purchased individually in which case a priority distribution will be difficult. There has been talk in favor of priority distribution in population with increased risk, i.e., healthcare professionals and old age person or person with comorbidities.[3] However, such distribution carries the risk of getting infection from unimmunized population once immunity after vaccination declines. This is especially important if the immunity following vaccination is short lived. Probably, the best possible way of dealing such situation is to immunize a herd of people in and area at once or in short period of time. It will ensure that the virus is not transmitted and dies out in asymptomatic infective person. Thus, block-level immunization can also be a suitable option, especially in our country where other measures for the prevention of virus transmission have been difficult to achieve. This will not be an easy task looking at the sheer number of people which needs to be immunized. However, India already has infrastructure and experience to implement immunization programs according to a roster prepared following the planning process. Recently, an Intensified Mission Indradhanush 2.0 has been launched to ensure reaching the unreached with all available vaccines and accelerate the coverage of children and pregnant women in the identified districts and blocks.[4] This includes planning meetings at district and block levels, and oversight is provided by district task force for immunization. These programs have been the cornerstone of India's fight against infectious diseases. These well-built mechanisms can also be used to drive immunization against COVID-19. There are many options available for policymakers and the one with best scientific evidence and achievability should be opted. However, there should be definite transparent process to follow which should be made well in advance to prevent any confusion. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.