Is it our best shot?

Scepticism about Covid-19 vaccine amid reports of deaths keeps many away from inoculation but experts say it is the way to prevent the viral infection

Last year this time, India had not more than four cases of Covid-19 and the worldwide death toll had not crossed 3,000. In one year, the country’s positive cases have crossed 11 million and the virus has already claimed over 2.5 million lives around the world. But the year-long despair has given way to hope. There are vaccines now for the incurable viral infection and almost all countries have rolled out inoculation drive for priority groups, which include healthcare and frontline workers.

The vaccination drive in India started on January 16 and the first group was healthcare workers. In Meghalaya, the drive was launched at NEIGRIHMS in the city that is one of the 10 points where vaccine is being administered. “Today is a historic day,” Chief Minister Conrad Sangma had said.

However, the two vaccines, Covishield and Covaxin, which are currently being administered in the country are not reasons enough to steady the citizens’ nerves. Many people, including health workers and frontliners, still have misgivings about the vaccines, especially in the wake of news reports about deaths post vaccination. Even in Meghalaya, where the state government has procured Covishield, there is much apprehension about the inoculation and many citizens are questioning the efficacy of the vaccine.

A frontline worker in the state police told Sunday Chimes that he was still uncertain about getting the shot after hearing about the deaths in the country and around the world. “Many of my colleagues are also in two minds. Only 20% from among us enrolled for the vaccine. The news reports are disturbing,” said the cop in his thirties. When asked whether there is objection at home, his wife promptly replied, “No, it is up to him to decide. Either way, there is a risk.”

Though there has been no report of adverse effects of the vaccine in the state, one frontline worker in Manipur died recently after vaccination. In India, the first case occurred on January 18 when a 46-year-old attendant at a government hospital in north India died. He had complained of breathlessness and unease in the chest before he died within 24 hours of receiving a dose of Covishield, developed by Oxford University and AstraZeneca and manufactured by Serum Institute of India. Around 30 deaths have occurred in the country since then. There were similar cases in many western countries. But so far, experts worldwide have not found causal links between the vaccination and the deaths. Nonetheless, the fear factor remains.
Sampath Kumar, Principal Secretary of Health in the state, admitted that there was an “initial apprehension” among those enrolled for vaccinations but they overcame it. “More than fear it was hesitancy that people had. They wanted to wait and watch those who were being inoculated. When they were satisfied by the result, they too came forward for vaccination,” he explained.

For Covishield, the second dose comes 28 days after the first. As per data till February 26, 11.67% healthcare workers have been fully vaccinated and 40.2% partially vaccinated in East Khasi Hills. Among the 11 districts, South West Garo Hills has the highest percentage of fully vaccinated healthcare workers. As far as the frontline workers are concerned, North Garo Hills has the highest percentage of registration for the vaccination.

Fear of side effects

The Public Affairs Centre, a Bengaluru-based think tank, held a public policy dialogue last month on the Covid-19 vaccine rollout in Karnataka. The four panelists raised certain critical questions about the implementation of the immunisation plan, the herd mentality and immunity, legalities, participation of the private sector and pandemic-specific policies. According to one of the panelists, Dr Giridhar Babu, “vaccinating 60-70% of the population would be enough to interrupt the transmission and bend the curve of the pandemic”.

“As of now, only very mild side effects have been reported and that this is minor compared to the side effects to other vaccines,” minutes from the webinar quoted the expert as saying.

Dr Sapna Deb, ophthalmologist at Shillong Civil Hospital, said she had mild fever and pain after the first dose “but there was nothing after the second one”. The last date for enrolling healthcare workers for vaccination was February 25.

It was life as usual for Babat E Kharshiing after the first shot and “there was absolutely no side effect”, he said. The administrative officer at Woodland Hospital in the city will get his second jab on March 5.

About the vaccines’ side effect and its repercussions on the psychology of the public, Pritish Bhattacharya, the 64-year-old director of NEIGRIHMS and among the first in the state to get the vaccine, said mild reactions should not be a cause for concern as “it is natural”.

“The first time, I did not feel anything. The second time, I was a little feverish but that was immunological reaction. In fact, I would have been worried if no reaction had occurred,” he added.

More than 30% of the medical staff members at NEIGRIHMS have been inoculated. Bhattacharya said many employees came to him complaining about their families stopping them from getting the vaccine. “They were more scared of the repercussions at home than the effects of the vaccine. Many among them later took after I counselled them,” he added.

It is either the vaccine or the virus, said Dr Kyntiewlang Sanmiet, the nodal officer and spokesperson at Bethany Hospital, as he shared his experience of the dose. “Immediately post-vaccination, I was observed for half an hour and I was fine. I did experience a little soreness in my arm but it was bearable. It did not disturb my daily life at all. I experienced no fever or headache and no other side effect as such. I am working as usual ever since,” he added.

A healthcare worker in the city informed that some of her colleagues want to take Covishield as “it is developed by Oxford”.

“They are saying they want to take it now because you never know what the second batch of procurement would be. I have not taken the vaccine yet as I was not well,” she said.

Giridhar also observed that “one dose of the vaccine would not be able to effectively control the spread” and that two doses have to be taken. The two doses of Covishield are given 28 days apart. But a new research on Covishield suggests that the booster dose might be more effective if the gap between the two doses is between 6-12 weeks. In one of the interviews earlier this month, Giridhar had said there was no such data on Covaxin.

Talk it out

Fear, anxiety, hesitancy and reluctance are not common when it comes to take a decision on healthcare amid absolute uncertainty. A frontliner in his late fifties said he “read somewhere that the earlier vaccines for small pox and polio took years to be made and this one is done in a year. That is what makes me sceptical about the efficacy.” When asked whether he knew how the current vaccines have been prepared by using a more sophisticated technology, he answered in a negative but expressed curiosity to know.

For those who believe in facts, there are several reports and studies in the internet which can help understand the definitive qualities of the vaccines and the unpredictability.

According to Kumar, the government ran awareness programmes before the rollout and there were pre-vaccination counsellings. “There were designed interactive sessions between the inoculated and the non-inoculated candidates so that the inhibitions could be shared and mitigated,” he added.

A few private hospitals have their own way of tackling the situation. Sanmiet said, “Hesitancy was there in the beginning. We conducted a number of sensitisation sessions on Covid vaccination for all staff members after which a huge number of them voluntarily consented to give their names for vaccination. It was of critical importance to identify the staff who were vaccine-hesitant, to understand the reasons for their hesitancies and to develop tailored strategies to address them… we have addressed those accordingly.”

Transparency, Sanmiet pointed out, is important while informing vaccine-eligible candidates about the side effects. “Acknowledging the vaccines’ newness is important in addressing people’s concerns. Despite robust safety and efficacy data, some want to see more real-world proof first. Being transparent about any potential side effects, small and large, has also helped us engender trust. I strongly believe acceptance of the vaccine is likely to grow since many health care workers are not refusing the vaccine outright, and instead, planning to wait. That really provides some glimmer of hope,” he added.

Dr Sanjeev Sen Nongbri, the joint director of Health Services (MCH), had to counsel many healthcare workers. “The government website mentions everything. We are also here to answer the questions. Before the vaccination, the candidate’s medical history and current conditions are noted down followed by a quick medical check-up. Vaccination is delayed for people who have allergies or certain conditions. But one has to be honest about their health conditions and medications,” said Nongbri, whose vaccination was delayed owing to allergic conditions.

As notified by the Ministry of Health, to get the shot or not to depends on the candidate and there is no pressure on individuals from any quarter.

Work in tandem

PAC, while analysing the rollout of the vaccine in the southern state, raised the question of coordination among the stakeholders in ensuring efficient implementation of the vaccination plan. Jawaid Akhtar, the additional chief secretary of Health in Karnataka who was among the PAC panelists for the webinar, was quoted as saying that there were “daily meetings and discussions happening between the central and state governments in order to ensure efficiency in the vaccine rollout”. On wastage, Akhtar said only required number of vaccines “have been bought and therefore wastage of the procured doses is out of question”.

The coordination between the Government of Meghalaya and the Centre “has been very good”, said Kumar. “Inter-departmental coordination has been satisfactory so far but the next phases will require more coordination,” he informed.

At Bethany Hospital, the list of consented and registered beneficiaries for a particular day would be prepared and sent to district health office for approval in Co-Win App one day prior to vaccination schedule. “The approved list would be sent back to us. The following day, in the morning before vaccination, our cold chain in-charge would go and take the required number of vaccine vials from Rynjah Dispensary as it is a cold chain storage point for our hospital. At the end of a session, we send our report to the district health authority regarding the number of beneficiaries administered and the number of vials used and unused,” said Sanmiet.

On monitoring and tracking the individuals after the first dose, Nongbri said the state Covid management team has the data that is sent to the central database. “Besides, I try to personally monitor the post-vaccination conditions of the inoculated persons here,” he added.

Private sector

As the country prepares for the third phase of vaccination of people above 50 years of age and those with comorbidities from March 1, there is a debate over participation of private players in the vaccination drive for faster and more efficient implementation. A section of the population feels that allowing private players in the process would only raise the cost and make the vaccine unaffordable to the poor.
“I can get the shot for free as I am a frontline worker but my family too needs to take it at some point of time. I think if private companies are allowed to enter the vaccination drive, it will be bad news for people like us. Why do we even need private players? The Polio immunisation is run by the government. Why can’t this be,” asserted a police constable in the city who is yet to get his shot.

Others agree to the cost factor, but at the same time, try to make rational sense. A college goer in the city, whose mother is a frontline worker, pointed out that “millions of dollars were spent on developing the vaccine and millions more would be spent, so where do you think the money will come”? According to her, private players can help make up for the cost.

The mission director at Biocon Foundation, Dr Anupama Shetty, while speaking on the PAC forum, emphasised the need for involvement of corporate social responsibility (CSR) in the rollout of vaccines and suggested that CSR can be made more effective by streamlining efforts of the various organisations involved in it.
However, Kumar pointed out that the reach of private players to the remote pockets of Meghalaya, or for that matter any part of the country, would not be as good as the state and this may hinder effective immunisation process.

“We have been running immunisation programmes for years and have become expert in that. Meghalaya has 179 cold stores for vaccines. The necessary infrastructure is in place. So the government can take care of it,” he was confident.
But what about immunisation in the private sector? Many private companies in the state have employees who have comorbidities and/or are above 50 years of age. When asked whether the government is planning to issue any directive in this context, Kumar said, “Ideally, we will ask all private offices also to register their senior workers as and when the registration opens for vaccination.”

Way ahead

Researchers are still analysing data to find a correlation between the deaths occurred and the vaccination. While the jury is still out, one has to understand that vaccination is the only way of preventing a viral infection. There may be hiccups in the beginning and apprehensions among the public may prevail for some time, but as the scientific facts come to fore, there will be acceptance and the vaccination process would be without glitches. “People must have faith in the government,” said Bhattacharya.

At the same time, the government has to maintain maximum transparency in dissipating information about the procedure and the deaths. There are guidelines about the vaccination which the public need to be aware of. In case of queries, they can always fall back on government helplines or local experts for more information. Most importantly, one has to be careful about the source of information about the inoculation and should be wary of fake news.

“Many of my friends saw some WhatsApp messages about the vaccine and told me not to go for the second dose as ‘something bad may happen’. This is not right. My only message is that follow instructions, avoid fake information and have faith,” said Kharshiing.

~ NM