A dozen health activists, mostly associated with Jan Swasthya Abhiyan (People's Health Movement), Rajasthan, have questioned the scientific rationale and soundness of the Central government's plan for universal vaccination of Indian citizens against COVID-19.
In an open letter to Prime Minister Narendra Modi on November 24, the civil society representatives said the current incidence, prevalence, and fatality status of COVID-19 disease in India, do not call for such an approach. They also cautioned that the move could be a logistical nightmare and financially catastrophic.
"SARS-COV-2 is an acute infection caused by species of Coronavirus and should fade away after a time span as the epidemics of SARS in 2002-03 and of MERS (2012-13) caused by the viruses of the same species faded away", the activists said.
According to them, both SARS and MERS washed out without any vaccine, specific medicine, and any herd immunity. "A small fraction of the population who is at the highest risk could be vaccinated when a fully safe and effective vaccine becomes available. For the majority of the population, only non-pharmacological measures to protect themselves from the disease should go on more stringently along with prompt and quality treatment of those who require hospitalisation because of the intensity of symptoms", they suggest.
The open letter points to the importance of adequate medical care as they feel the majority of deaths owing to coronavirus happened due to inadequate medical care. "The money saved by not procuring vaccines for the entire population should be used for strengthening the public health system - state of the art medical colleges with hospitals in every district with minimum 700 beds with all specialties and possibly super-specialties. The primary health system was brought up to the standard as enshrined in the new Health Policy 2017. This strengthening will not only mitigate the attack of COVID-19 disease but would serve as an active guard for several years to come to deal with all other diseases, many of which take an even higher toll than COVID-19 in India", they argue.
The group called for publicly funded initiatives to find new medicines for COVID-19 while cautioning against the use of mRNA technology to develop a vaccine as it is yet to be tested on humans and its long-term side effects are unknown.
The letter criticised the practice of announcing test results of different vaccine candidates and claims of more than 90% efficacy on the basis of a very small number of positive persons out of the large number of volunteers being put on trial.
"Efficacy data has not been presented through peer-reviewed article in any medical journal of repute, but through press releases. The released data does not provide any differentiation between age, sex, geographies, co-morbidities, body mass index, and antibodies status prior to trial and after testing positive. Therefore, the efficacy of these vaccine candidates for the entire range of human beings is still to be established", the health activists said.
The letter also reminded the Prime Minister that it is still unclear how many doses of the vaccine would be needed and how long the immunity would last. This could be extremely unaffordable if the vaccine would be required at short intervals. "Vaccines to be given intramuscular would pose a serious threat of other medical problems as maintaining aseptic conditions could be a huge challenge. If abscess developed at the injection site among older and diabetic people it may take a long time to cure and call for additional medical attention," the activists said, adding that their strong suggestion for India would be to go for a very selective immunisation against COVID-19.
The signatories to the open letter are Chhaya Pachauli, Gautam Khandelwal, Dr. Gopal Dabade, Jagannath Chatterjee, Kavita Srivastava, Dr. Meeta Singh, Dr. Narendra Gupta, Dr. Pavitra Mohan, Dr. Prabir Chatterjee, Dr. R. Srivatsan, Rosamma Thomas, S. Srinivasan, and Sudhir Katiyar.
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