Just as Hamlet contemplated the choice between suffering “the slings and arrows of outrageous fortune” or accepting the uncertainty and irreversibility of death; so also, many individuals grapple with the choice of getting vaccinated or accepting the risk of a covid infection. Colourfully termed “vaccine hesitancy,” it is a direct consequence of inadequate communication, misinformation and even fake news. Vaccination was eagerly awaited expecting uncontrollable crowds at vaccination centres. Targets of 100 vaccinations per day were set up, with registration protocols and priority for healthcare workers. None of this happened; pre-vaccination surveys had already forewarned of hesitancy levels of 60-70%; translating into ground realities of wastage of doses because of inadequate demand. The multi-dose vials had to be used up within 4 hrs of the first dose being extracted. Vaccination centres reported attendance shortfalls as low as 25%, with figures like 13 out of 100 at JJ Hosp. So, what led to such distrust even among senior members of the medical faculty?
The pandemic has been the source of confusion from its very onset. Its very existence was denied; confusion followed over the most effective forms of treatment. Mundane preventive measures were (and still are) neglected. Vaccination was heralded as the salvation, with a mad scramble to develop the perfect vaccine and over 300 types in the pipeline. Allegations of short-circuiting research protocols, for financial interests should have been countered adequately, and most of the confusion could have certainly been avoided. Messenger RNA (mRNA) research has been ongoing for years and put to effective use for the first time with telescoping of the time scale. Pregnant women could not be vaccinated; now they can with the still later refinement that vaccination should be done in the early part of the second trimester of the pregnancy. Patients on blood thinners could not take the vaccine; now they can, with simple basic precautions. No alcohol could be consumed for 45 days after vaccination. This came from Russia without any scientific basis. I am by no means advocating the use of alcohol, but common sense indicates that excessive use of alcohol can certainly impair the body’s defensive mechanisms. Dosing errors in trials were initially hidden from the public.
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However other misconceptions could have been avoided by more vigorous public information programs before the campaign started. Some vaccines (Pfizer, Moderna) use mRNA or messenger RNA. Others use DNA. (Oxford) This raised the specter of altering the individual’s genetic makeup. The mRNA does not enter the nucleus of the cell. The DNA cannot replicate inside the cell. Hence neither can affect the genetic makeup of the patient’s cell. The fear was totally unfounded. The CDC does advise special precautions in patients with a history of allergies. Side effects like fever, muscle aches, headaches, fatigue, and diarrhea can occur but resolve in a few days. These may be more pronounced in patients with other pre-existing conditions. The mortality rate of Covid infection is only 1-2% hence the use of vaccination was allegedly unjustified. The main purpose of vaccination was to protect the more vulnerable sections of society and prevent the emergence of more dangerous variants. Bacteria and viruses can and do replicate by division. Exact replicas may or may not be produced. The emerging organism may be more, or less infective/transmissible. If less,it peters out in the normal process; if more it results in the emergence of a new variant as occurred in UK. Such developments are to be expected, and have to be dealt with adequately; without panic.
But experts like Dr Amit Dutt feel that not enough research is being done in this field. The adverse reaction rate in India is 0.18% with 0.002% requiring hospitalisation. Nevertheless, the 16 deaths in India and 29 post vaccination deaths in Norway should have been tackled in a more reassuring manner rather than the dismissive attitude of “not related to the vaccination”.
There is no doubt that the pandemic devastated humanity as never before. Jobs were lost as industries collapsed. The IMF estimates that 90 million people worldwide were pushed into extreme poverty; of which 40 million were in India. 100 million infections worldwide with 2 million deaths and counting; and both figures are probably underestimated. Interestingly Dr Laxminarayan, a noted epidemiologist, whom I quoted in an article in April 2020, had estimated three to five hundred million positive cases before the disease burns itself out, with 1-2 million fatalities.
Regardless of the political claims, India´s is merely a mass-producer and mass-consumer of antidotes developed elsewhere. In spite of available expertise, it is not an innovator. With $300 million risk funding, SII, a private company, took a massive financial risk in starting production even before approval. “The same engineers we train in India go abroad and do fantastic innovation,” said former RBI Governor Raghuram Rajan in answer to the question “Why is India not innovating?” It is often a simple matter of putting available technology to maximum use. Block chain technology would have tackled the problem of counterfeits. IoT (Internet of Things), and AI (Artificial Intelligence) could have been used to track supply chains. Losses estimated at $34.1 billion annually due to degradation in transport could have been avoided. (Integrated Air Transport Association for Independent Validation in Pharmaceutical Logistics). We should have pre-empted such issues well in advance.
Trust was undoubtedly eroded; helped in no small measure by the much touted 138% increase in the healthcare budget translating into 10.5% actual increase for H&FW ministry, once the figure was stripped of the ‘masala’. Mercifully the pandemic is in retreat with serro-survey results showing antibodies in 21% nationally and 56% of Delhi residents (fast approaching the herd immunity levels of over 60%). Nature may well be the best healer.
(The author is a founder member of VHAG)
