Before the cure

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Before the cure

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• Dejection and optimism: In the middle of a raging global pandemic, news of new Covid vaccines is sparking hope. High success rate (95%) was reported in Phase 3 trials for both BioNTech-Pfizer and Moderna vaccines. The Sputnik-V vaccines of Russia reported 92% success but was not credible as only 20 infections were counted. (Other two are based on 170 and 95 infections)
• Oxford-AstraZeneca vaccine: Phase 2 trials showed strong anti-viral immunity, even for the elderly. Phase 3 trials showed 90% efficacy for lower dose, and 62% for higher dose, crossing over 70% efficacy. These are good results for all other vaccines under development.
• The Spike Protein: So vaccines are now being based on a small part of the virus - the spike protein - and can effectively save human lives. It can be done via -

1. a piece of the RNA delivered to human cells can convert into the Spike Protein (BioNTech-Pfizer and Moderna) OR 
2. a viral vector delivers the DNA for this protein into human cells (Oxford-AstraZeneca and Russian).

• Time taken: While before 2020, it would take 10-20 yrs to develop vaccines, now it is considerably faster due to genetic technology, better coordination, and more investments.
• Caution needed: When "high efficacy and safety" are mentioned, it must be remembered it's based on short-term analyses, without any long-term study or a peer review. It's known that when launched in the real world, vaccine efficacy reduces (usually due to poor cold chains). So the Bio-NTech-Pfizer vaccines needed minus 70-80 degree Celsius is a non-starter in many countries! Moderna's vaccine can remain stable at 2-8 degree C in a fridge, but long-term storage needs minus 20 degree C (tough for many countries). One more unknown is the longevity of the protection.
• Access and equity: How much of any vaccine can be made, and what costs, are the obvious questions. The vaccine companies are promising several crore doses per year, have received huge funding from US govt's 'Operation Warp Speed', and many countries like the UK and Australia have pre-booked vaccines many times their population size. What will India do?
• The Indian case: The good news is that India has huge local vaccine manufacturing capabilities. It makes 300 crore, of which 200 cr are exported. India is testing three vaccine candidates today - the local inactivated vaccine Covaxin (ICMR + Bharat Biotech), the ZyCov-D (Zydus Cadila) and the Oxford-AstraZeneca (Serum Institute of India SII, Pune). The govt. wants to vaccinate 25 cr in 2021, so 50 cr doses needed. 
• Prioritisation: It must be on three aims - (a) protect frontline workers, (b) reduce mortality, and (c) control by herd immunity. Hence, first will come the healthcare workers, security and sanitation workers, the elderly and those with co-morbidities. For 60% coverage of herd immunity, India needs 2 doses for 80 crore people, which is 160 crore doses. The SII Pune can make 80 cr doses, of which 50% is committed to COVAX (international alliance that gives to low income countries). Another 30 cr will come from Bharat Biotech and 10 cr from Zydus Cadila. So that is enough for 60% population in two years.
• Whom not to vaccinate: Those naturally infected (and hence protected) do not need any vaccine. Sero-surveys show India may have 13.5 to 15 cr infections already. Most are asymptomatic. So antibody testing before vaccination is needed, and that cost adds to cost of vaccination. 
• Costing: Total cost will be anywhere between Rs.22500 cr to Rs.72000 cr to vaccinate 25 cr to 80 cr people. It is clear that extremely detailed planning alone will save the day for India, else even vaccines won't help.

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