Despite the excitement over the COVID vaccination drive on 16 January, hesitancy among healthcare workers, a lack of coordination and technical problems with the Co-WIN app meant government targets were not met.
Three days since the drive began, only about 50 people were given shots per session which is half of the expected 100, as per data by the Union Health Ministry.
Many health workers, who had volunteered and received an SMS verification with details on where and when to come for their dose, did not turn up. This reporter spoke to resident doctors and frontline workers in Mumbai from hospitals like Sion, KEM, Bhabha, JJ, Cooper and Nair who were unaware of the process and who are getting vaccinated.
429,209 people have been vaccinated in India till Monday, 18 January, reported Hindustan Times.
In Delhi, there were 4,319 healthcare workers who showed up on Saturday but this dropped to 3,593 on Monday. Worryingly, only eight people were vaccinated on Monday at the All India Institute of Medical Sciences (AIIMS).
It also must be noted that no vaccinations happened on Sunday, 17 January, which also does play a part in the low overall numbers.
Another factor could be the slow roll out. When reporting in Mumbai’s BKC Jumbo Facility, I noted that out of 15 active wards, only 5 were open for Day 1.
As of Monday, January 18, 580 Adverse Events Following Immunisation (AEFI) and seven hospitalisations were reported in the country since the launch of the coronavirus vaccine drive. This translates to just 0.014 percent of the total 381,305 inoculated.
AIIMS Director Dr Randeep Guleria told HT:
FIT has fact-checked some Whatsapp forwards, which told half the story about vaccinations but managed to spread like wildfire on social media.
Vaccine hesitancy in part stems from the lack of transparency and clarity regarding the approval process of the two vaccines approved for emergency use by the Drugs Controller General of India: Covishield and Covaxin.
FIT spoke to Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University, to understand the concerns over the Covaxin approval especially since Phase 3 clinical trials are still ongoing and no efficacy data has been published.
The Covaxin consent form, which beneficiaries have to sign before they get the vaccine, acknowledges that “clinical efficacy of Covaxin is yet to be established and is still being studied in phase three clinical trial.”
The Resident Doctors Association of the Ram Manohar Lohia (RML) Hospital in Delhi wrote to the medical superintendent on Saturday, 16 January, saying that the residents "are a bit apprehensive about the lack of complete trial in case of Covaxin and might not participate in huge numbers, thus defeating the purpose of vaccination."
"We request you to vaccinate us with Covishield which has completed all stages of the trial before its rollout," the letter read, coming on the day the vaccination drive against COVID-19 was launched across India.
However, senior staff members refuted the claim and, Dr Atul Krishna, General Secretary, RML Hospital, told The Quint there's no apprehension regarding Covaxin.
Still, hesitancy echoed across healthcare workers who were worried about the lack of transparency.
"Both vaccines are publicly funded and both have issues with lack of data. For Covaxin, Phase 3 trials are still ongoing and no raw data is available. For both Covishield and Covaxin, information around adverse events remains opaque. There is concern among doctor groups regarding the roll out, especially around adverse events involving neurological symptoms," says Dr Sumit Ray, Critical Care specialist at Delhi's Holy Family Hospital.
Dr Anant Bhan added that the first priority group – health workers – were also more informed and their concerns needed to be paid attention to.
Amidst reports of health workers threatened with salary cuts if they do not take the jab, Dr Bhan says such measures will only worsen public trust.
Dr Bhan added, “Vaccination only works when you have upkeep which requires you to work with communities to build trust in the process and to address any concerns. It’s important to deal with any concerns healthcare workers may be having.”
On 21 December 2020, Health Minister Dr Harsh Vardhan said that people cannot be forced to take the vaccine:
One of the issues is the lack of choice, and Dr Bhan adds that this is complicated when one vaccine (Covaxin) has not released efficacy data. “People can then opt out, but offering both vaccines at all centres is difficult and costly logistically and would involve a lot of waste of precious resources, especially when we have many more people waiting in the queue to get vaccinated.”
It’s important to remember that there is no choice anywhere in the world currently, but the situation in India is more complicated because of the approval to Covaxin.
Could this affect India’s overall trajectory in curbing the virus? What is the long-term effect of hesitancy?
Dr Bhan adds that we do need to fix the current problems and be “nimble” in identifying issues all while waiting on more data. “The UK looked at patterns on Day 1 and fixed it. We should also act fast.”
“These are early days, for now, we should wait before interpreting the data as concerning right away,” says Dr Bhan.
These healthcare workers are, in general, not hesitant about vaccines per say, but about these vaccines in particular. While we need to wait, in the larger picture, concerns about approvals, effectiveness and safety need to be addressed to counter hesitancy.
The dry runs could not identify the problems, and Dr Bhan said that the next few days and weeks will tell us if there are some patterns and give us some clarity on what problems we are seeing exactly – roll out issues, logistical problems or some patterns that indicate the vaccine uptake is not happening optimally.
The root cause of hesitancy is a lack of clear communication.
On the evening on 17 January, a ward boy, aged 46, who was vaccinated on 1 January, passed away. His family remains adamant that the death was linked to the vaccine although the post-mortem attributed the cause of death to cardiogenic shock / septicemic shock due to cardio-pulmonary disease.
This created fear about the adverse events, and raised concerns over the ethics of vaccine distribution: Should the man have been administered the vaccine at all as reports say he had a fever and cough.
“See, as we roll out in larger numbers, there will be more such incidents and issues which won’t be known via clinical trials. This happens when we trust on lakhs and crores and start picking up rare issues,” says Dr Bhan, “currently, we do not know if the death is linked to the vaccine. In the UK, for example, they found out people have allergies or in Norway, they are tracking 29 deaths mostly in the elderly.”
In public health practices, there are standard procedures like committees which monitor adverse events to ensure due process is followed.
“Covaxin has updated the list of those people who should avoid the vaccine,” said Dr Bhan adding that we have to be vigilant of serious adverse events.
For each vaccine, information pamphlets must be given and for Covaxin there is an additional consent form, but it remains to be seen if the information is being understood by all those taking the vaccine.
(The article was first published in FIT and has been republished with permission)
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