CME INDIA Presentation by Admin.
“No other disease has attracted more public attention than this pandemic, probably a result of the way the lives and jobs were affected. Even the cremation of dead family members caused so much stress that media has been full of news that was so far restricted to scientific journals. With the number of cases rising every day, there was severe panic. Added to that was the loss of jobs, salary cut, people not able to attend their parents’ funerals. OMG, they wanted to know what was happening in the field of medicine to bring back normalcy. At that stage, they thought that the only savior was vaccine. That is why so much public interest. By the time the vaccines came, the Indian numbers were dipping, so the hesitancy. Vaccination hesitancy comes naturally to us. So, let us not expect the people to rush to vaccination centers. By restricting vaccination to specific groups, we are slowing down the process.” – Dr H D Sharan, Ranchi.
CME INDIA Inputs
Dr Urman Dhurv, Ahmedabad shares:
FDA says COVID Vaccines Must Work Against Old and New Strains, so why are people hesitant to take Vaccine?
- COVID-19 vaccines modified to work against circulating virus variants should have clinical immunogenicity studies supporting their effectiveness, and ensure they work not only against the variant strain, but the initial strain, the FDA said in modified guidance.
- The agency already issued a warning that variants may cause false negatives with certain diagnostic tests, though officials at the briefing emphasized that so far, the impact on testing does not appear to be significant.
Dr Rajeev Jayadevan, Gastroenterologist from Kochi tweets:
- Vaccination for older people, finally. This is good news. Vaccination of the vulnerable age groups is the quickest way to bring down COVID death rate.
Ministry of Information
“From March 1, people above 60 years of age and those above 45 years of age with comorbidities will be vaccinated at 10,000 govt & over 20,000 private vaccination centers. The vaccine will be given free of cost at govt centers”
Dr Nandini Rastogi, Sr Diabetologist, Kanpur feels happy after taking 2nd dose:
- COVID-19 vaccine distribution plans are being drawn up in India. But, mistrust and hesitancy could compromise the efficacy of coronavirus immunisation programmes.
Dr H D Sharan, Sr Cardiologist, Ranchi analyses the scenario:
|24th Feb 2021||25th Feb 2021|
Is this the warning bell?
India registered 3000 more new cases yesterday as compared to previous 24 hrs.
Of these 3000 cases, 2500 cases came from Maharashtra.
Need to contain the infection in the districts which are showing the surge and Mumbai too which registered more than 1100 new cases after 4 months.
- Some people think the pandemic is over in their areas. The pandemic comes in multiple waves, and no region is exempt yet. Being prepared with vaccination is wiser than being dismissive of this virus.
- 91 districts in the country are showing a surge in COVID-19 cases. Of these 36 are in Maharashtra, 16 in Karnataka 4 each in Punjab, Haryana, Gujrat, Bihar, Bengal and Chhattisgarh and 2 in Kerala.
- We must have plan B in place for vaccination. Extensive vaccination programs should be conducted in these districts. The vaccine can be made available for these districts by delaying the second dose of Covishield to 12 wks after the first.
- Public and private sector companies have shown their willingness to actively participate in the vaccination program. Each organization should be given charge of one district depending upon their presence in the district. Apart from the present preference list, we should also cover the College Hostels which have the capability of becoming super spreaders.
I strongly feel that India should also invest in the single dose J&J vaccine.
- This is also an adenovirus viral vector vaccine. For the huge population of India, a single dose vaccine can be very useful. It has 72 percent efficacy in US and 66 percent efficacy in Europe to prevent mild infection. What is really good about this vaccine is the fact that it totally prevented COVID-19 related hospitalization and deaths in phase 3 trial. This can be very useful in controlling a surge while the other vaccines can be given to those who are at greater risk.
- The need of the hour is to vaccinate the maximum number of our citizens in the minimum time. Let us strive to achieve more than what remarkable we have already achieved so far. It is painful to see that people are not turning up for vaccination while millions who need and are eager to receive the vaccine wait for their turn indefinitely.
- Data shows that the Johnson & Johnson Covid-19 vaccine was 100% effective in preventing Covid-related hospitalizations and deaths. The one-dose vaccine is pending emergency use authorization.
How many people in rural India can get themselves registered for vaccination?
- We will have to do away with the prior registration and invitation through SMS system before vaccination for senior citizen starts in March or April.
- We will have to include old age homes in our plan for senior citizens and ensure that vaccinators reach them instead of expecting them to reach the center. Current system is based on principles of high demand which we have not seen so far.
- Take the example of second dose. Every person has a 14-digit id number. Why should he or she be not allowed to go to any center of his choice, show the same id as for the first dose and receive the second dose? I have a center now in my hospital but I will have to go to the Sadar Hospital for the second dose. The process needs to become as convenient and as easy as possible to remove vaccine hesitancy.
- We must always remember that the longest experience any group of scientists has had with any vaccine is 7 to 8 months. Anything beyond that is pure conjecture based on our experience with T cell long term immunity. It may or may not turn out to be what we expect it to be. But we can be assured of one fact that for the next 9 to 12 months, we will definitely have significant protection against COVID-19 related hospitalization and death. Irrespective of which vaccine we take. This is the message that has to go out to the public.
- Vaccination may or may not become an annual affair. This will depend on whether the Virus decides to live on through its mutation ballet or decides to rest in peace
We as a community have never been known to accept vaccination without hesitation.
- We have not been able to convince a large chunk of our population to immunize all children against diseases like Tetanus, MMR, diphtheria, Hep B etc. This hesitation to accept vaccination is seen more in areas and communities with low levels of education.
- When the cases of COVID-19 were rising and COVID-19 related deaths crossed one Lakh, there was a panic in the society. With no treatment available everyone was eagerly awaiting the arrival of a vaccine.
- According to an article published in the JAMA, around 56 percent people said that they were likely or very likely to get vaccinated against COVID-19.
- But what was more worrying or puzzling was the fact that 29 percent of health workers said that they were most likely to avoid or definitely avoid the vaccine even if scientists call them safe.
The vaccination strategy at this moment is based on assumption that people were in panic
- We assume that people are in panic and will come running for vaccination and there will be a chaos and those who need it most will be left out.
- If at the peak of the pandemic, around 30 percent people were not willing, the numbers must have gone up with the pandemic receding.
- Industrialists like Premji and Atul Mahindra have offered to help and we must take their help.
- We need a big PR exercise in line with, ” दो बूंद जिंदगी की” to boost the drive.
- Bill Gates Foundation took the initiative for the Pulse Polio. We should also involve the NGOs like Rotary. Rotary played a big role in Pulse Polio program. I remember when the Hepatitis B vaccine came to the market, We in the Rotary vaccinated 13000 people against Hep B in Ranchi.
- We need a course correction immediately. We need a strategy where the vaccination reaches the houses of the people and not expecting them to stand in a queue to get the vaccine.
- Anything that is free comes with the suspicion of vested interest. Give it free only to the poor. Let others pay a small amount.
- Must appreciate the move by the government to involve the religious leaders as the hesitancy has its roots in religious beliefs too.
- Let us not forget that NO ONE IS SAFE UNLESS EVERYONE IS SAFE.
CME INDIA Tail Piece
 The YAKSHAPRASHNAM is YET to be answered by ALL of us.
Dr Pramod Mathur, Alwar:
- IF the conclusion of the results of intensive experimentation and research published in The LANCET dated 27th Oct 2020, is authentic, regarding the interval of 12 weeks in between the doses hold true??
- Then what is the use of such AUGUST and ESTEEMED organizations such as ICMR, API, RSSDI, and other state level organizations prevail upon the WHO to issue NEW INSTRUCTIONS for the Appropriate preventive measures against CORONA in the FUTURE ??We can at least PROTEST with appropriate scientific research-based reasons
 Covaxin is unfairly criticized
Dr Rajeev Jayadevan, Kochi:
- In fact, a whole virus inactivated vaccine that generates the right kind of T cell response (and antibodies) is the need of the hour – for the long term. This type of vaccine is exactly what China chose for its citizens, and has been giving to people in several other nations now.
- Broadly speaking, it is these T cells that protect us from severe disease, not antibodies. Among all the immune players, T cells “do the heavy lifting”.
- The very objective of COVID vaccination is to prevent severe disease (not to prevent virus infection).
- T cells come in two flavors CD4 and CD8, a small section of which are also made into memory cells, which protect us in the long term.
- Unfortunately, people mix their personal prejudice, ignorance of the immune system and their own political agenda into criticism of vaccines.
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Informative & impressive
This is for Dr Rajiv Jayadevan.
I do not think that anyone has criticized Covaxin.
It is the process that has come for severe criticism.
Infact it has done a great disservice to Covaxin.
The medical community will wholeheartedly accept it the day the phase 3 trial on its efficacy and safety is published
Within 2 weeks phase 3 data coming, so far all well with Covaxin
Let not perfect become the enemy of good.
Dr Sharan, I appreciate your frank comment. You are right that we all want the perfect evidence presented before we do anything. Hope you are aware of my Twitter handle where I summarised hundreds of scientific papers everyday on this topic as a service.
(Of course for many treatments that are blindly accepted by society, there is absolutely no evidence base, but let’s leave that aside for now)
In a pandemic, where people are dying everyday, we can’t let PERFECT become the enemy of GOOD.
None of the trials even in frontline vaccines are perfect. None of the results are guaranteed to occur in field conditions. The methods of measuring efficacy are far from perfect.
The evidence so far is all in varying shades of grey. Depends what is your comfort level of grey is, it varies between people. It can range from blind trust to extreme skepticism to a point of refusal.
There will be plenty of uncertainty about the true efficacy of vaccines for some time to come. This is not the fault of science – this is just the way the disease is.
But let not perfect become the enemy of good. (The phrase means that sometimes we lose valuable time “chasing (or waiting for) the perfect solution”, we forget what is truly practical and good for the society as a whole. As a result we delay using something that was actually available and beneficial)
Vaccines are here now, and deserve our trust. There are no better alternatives at this time, as obtaining immunity by natural infection (instead of vaccination) is fraught with risk of severe disease and death.
The question here is not just about evidence, it is about decision making.
Vaccination, when done even a day early, will save many lives.
Will write in detail on this topic.
Dr Rajeev Jayadevan
Waiting anxiously because theoretically it should be effective against all strains as all types of proteins in the virus are there in the vaccine in form of a killed whole virus.