2022, Here We Go Again; the Games India Plays With COVID-19 Vaccines

Precisely when we should be gearing up against the next crisis is exactly when we choose to let our guard down.

Bill Murray thought he had problems in the movie Groundhog Day. The coronavirus has put 7 billion people in leading roles in this dystopian sequel, and the end is nowhere in sight.

Back in 2020, we didn’t know much about COVID and we did what we do well – honking away and yelling at no one in particular while stuck in a traffic jam. In January 2021, we got some good news: vaccines were now available. We got out of that traffic jam, turned up the radio and began cruising on the expressway.

To start with, only frontline workers, healthcare professionals and people over the age of sixty were eligible, but that seemed both fair and fine.

Fair for self-explanatory reasons, and fine because in January, the crisis seemed to have abated. There were underlying problems: clinical trial data was still pending for one of the vaccines and a clear plan about the logistics was not available.

But all seemed fine – there was no traffic jam and the music was classic rock, there was enough beer and chakna to go around – and that was enough. One of us wrote in the summer of 2021 that given India’s successful universal vaccination track record and vaccine manufacturing prowess, Indians should be in a safe place. The government told us that we were safe with Fabipiravir, HCQS, remdesivir, steroids, Ayush-64, “immunity boosters” and vaccines.

Then came the second wave, the disaster that was the misguided procurement and distribution programme of vaccines, with frantic course corrections regarding both in May and June, and the second wave eventually abated.

Vaccines soon became available more widely, cases began to drop, and life lurched back towards something approaching normalcy. All seemed fine, there was no traffic jam and the music was classic pop and there was still fizzy drinks and crisps, and that was enough.

Then came Diwali and vaccination rates dropped, the sense of urgency went away, and we are now inching forward with our vaccination rates. About 43 percent of all Indians are twice vaccinated, about 60 percent of the population is vaccinated at least once, but there wasn’t a major crisis looming upon us, and all seemed fine, and that was enough. It didn’t bother us that the rest of the world was talking about booster doses, testing for variants and planning measures to protect their people.

Another Traffic Jam — Why?

And when we say all seemed fine to us, we include the government, policymakers, public intellectuals and the public at large.

As it turns out, we worry about vaccination rates, availability of vaccines, logistics of procurement and distribution, availability of boosters (or precautionary doses) and everything else only when the crisis is already upon us. And the latest crisis is that of the rapidly spreading Omicron variant.

Another traffic jam, no food or water in the car and the FM radio station is playing power ballads, all the liquid that we have imbibed is not helping, but we are even now, only honking away again.

We would like to ask a simple question: why?

Let us deal with the India specific questions first. Why do we not have data about the efficacy of our vaccines against the Delta variant, let alone Omicron?

Why do we not have data about the efficacy of our vaccines when used as booster doses?

Why are adolescents to be administered Covaxin only, given the history of uncertain supplies? On what basis are they being denied the other vaccines approved for adults in India?

Why have we approved vaccines like ZyCoV-D and Sputnik, which have been manufactured but not widely available? What then was the point of approval and announcement that India has more vaccines than any other country?

Why do we not yet know how and when the government is planning to use Corbevax (we don’t have data for its efficacy as a booster), the 200 million doses of Covavax, Sputnik Lite, and ZyCoV-D as boosters?

Why is it that experts and scientists are asking these questions and don’t get any answers?

Now about us, the public: why, when vaccines are now available in plentiful supply, are vaccination rates so pitifully slow?

Why are we, the public, so very callous about masking up when in the public?

Why is social distancing absent – in political rallies, yes, but also in a million other places?

Is it because the government is constantly telling us to not panic and behave as if all is well with the world?

And what applies to India applies with just as much force to the rest of the world too. We aren’t, in this regard, any better than the rest of the world despite the leaders telling us that we are the best at fighting the pandemic. Nor, it should be said, are we any worse.

We’re all culpable, and the charge against us is that of complacency when the crisis ebbs. Precisely when we should be gearing up against the next crisis that the virus throws at us – and the most important lesson of the last two years is that there will always be a next episode and a next season – is exactly when we choose to let our guard down and relax.

There will be a lot that will go wrong with the build-up to the crest of the Omicron wave.

There may be, we hope, some introspection come the inevitable trough. There will be hand-wringing, there will be recriminations, “expert” committees even, and there will be robust defences offered on all sides. How many more sequels of the dystopian movie can we suffer before we see the insanity of poor decision making at all levels?

It’s the same set of announcements from the government, along with a continuing lack of data and uncertainty about the scientific basis for decision making. INTAGI, for example, didn’t approve the “precautionary shots”.

There is also continuing uncertainty about vaccine supplies and the apparent lack of demand for vaccines: the “antibody cocktail” aka the “Trump cocktail” seems unlikely to work anymore, and itolizumab, plasma, Remdesivir, and Fabipiravir definitely don’t work as well as was advertised and we still don’t have the Pfizer or Moderna vaccines, which are effective as boosters.

Additionally, keep in mind that there is limited clinical trial data in India for Molnupiravir, which was recently approved as an antiviral pill.

And finally, the same theme when it comes to communication from the government: “there is no reason the vaccine wont work against variants” instead of “here is the data that tells us that vaccines work against variants”.

What Next?

It is the same lack of care when it comes to vaccination upticks, lack of social distancing and lax attitudes towards masking up when it comes to us, the public.

All seems fine. Sounds familiar?

One can hope that the crisis will abate, and that the virus will finally recede or perhaps become endemic as Dr Swaminathan, the chief scientist at the WHO assures us. Hope is good.

What one shouldn’t do is plan on the basis of hope. That is what we did in 2020 and 2021 and we now know that it is bad – bad for the families of the 4.5 lakh dead Indians and many, many more who have suffered immensely.

And that, we think, should be our most important learning from the year that was 2021. We have got to do better. 2022 looks more and more like 2021and more of 2021 isn’t just good enough.

(Murali Neelakantan, is a lawyer specializing in healthcare issues. He was formerly global general counsel at Cipla and Executive Director and Global General Counsel at Glenmark.)