“Topmost priority in COVID-19 immunisation to be given to frontline healthcare workers”

New Delhi: Dr. Harsh Vardhan, Union Minister of Health and Family Welfare responded to questions posed by his social media interactors on the fourth episode of Sunday Samvaad. The COVID Vaccine seems to have been a dominant theme in the mind of those who chose to submit questions for the episode. He also patiently explained related topics like the use of Plasma Therapy in COVID, the eradication of TB by 2025 in light of the COVID pandemic and the opening up of India’s schools.

On the questions of prioritising the distribution of vaccines, Dr. Harsh Vardhan answered that the Health Ministry is currently preparing a format in which States will submit lists of priority population groups to receive vaccine, especially health workers engaged in the management of COVID19. The list of frontline health workers will include both government as well as private sector doctors, nurses, paramedics, sanitary staff, ASHA workers, surveillance officers and many other occupational categories who are involved in tracing, testing and treatment of patients. This exercise is targeted to be completed by the end of this October and the States are being closely guided to also submit details about cold chain facilities and other related infrastructure which will be required down to the block level. The Centre is also working on plans for building capacities in HR, training, supervision etc on a massive scale and roughly estimates to receive and utilise 400-500 million doses covering approximately 20-25 crore people by July 2021. He further informed that the Government is also keeping an eye on immunity data with regard to COVID-19 disease while finalizing these plans.

He stated that there is a high level committee under the chairmanship of Niti Aayog Member (Health) Shri VK Paul which is drawing up the entire process. Vaccine procurement is being done centrally and each consignment will be tracked real time until delivery to ensure it reaches those who need it most. He added that these Committees are working on understanding the timelines of availability of various vaccines in the country, obtaining commitments from vaccine manufacturers to make available maximum number of doses for India inventory & supply chain management and also on prioritisation of high-risk groups. This is work in progress which will be completed by the time the vaccines are ready to ensure the swift roll-out of the immunisation program.

Clearing glaring misconceptions that seem to have captured the imagination of rumour mongers in pockets of Punjab, Dr. Harsh Vardhan strongly rebutted allegations that the COVID-19 pandemic was a government conspiracy to enable organ harvesting of healthy individuals. He stated that the Government is not tied to fiscal considerations from financing agencies for implementation of the COVID-19 emergency response in light of the recent loan from the World Bank- Asian Infrastructural Investment Bank and the Asian Development Bank to the tune of Rs 15,000 Crores for managing COVID.

The Minister assured another respondent that there would be no diversion or black-marketing, “Vaccines will be distributed as per pre-decided priority and in a programmed manner. To ensure transparency and accountability, details of the entire process will be shared in the coming months.” He stressed the need to prioritize health care workers and adults or those have underlying health conditions.

Answering similar questions, he said that it is not possible to comment on the superiority of one vaccine over the other although he would ensure “that even if we have multiple vaccines available, they will all be safe and will elicit the requisite immune response against novel coronavirus”. He said that all vaccines that have proven to be safe, immunogenic and efficacious in clinical trials outside India need to undergo bridging studies to prove their safety and immunogenicity in the Indian population as well although these studies can be conducted with much smaller sample size and end quickly.

While tackling a question on the level playing field for various clinical trials, Dr Harsh Vardhan shared that all proposed clinical trials in India are designed using set principles and are stringently reviewed by the Subject Expert Committee set up by the Drug Controller General of India. Recently, the DCGI has also formulated draft guidelines on regulatory requirements for licensure of COVID-19 vaccines in India. On a question regarding Phase 3 Clinical Trial of Russia’s “Sputnik-V” vaccine in India, Dr Harsh Vardhan clarified that the matter is still under consideration, and no decision has been taken as yet on the Phase 3 trials.

Stating that adverse events developing after vaccination are common, Dr Harsh Vardhan said that adverse events after vaccination include local reactions such as pain at the injection site, mild fever and redness, anxiety-related such as palpitations, syncope or fainting and that these events are transient, self-limiting and do not affect the protective response of the vaccine. In a related question, he detailed on the ethical concerns of Human Challenge Experiments, “India is not planning to venture into such trials until the method is proven to have an established benefit as per global experience. India has robust processes in place to ensure the vaccines that successfully complete the clinical trials are safe and effective against the novel coronavirus.” “When conducted, human challenge studies should be undertaken with abundant forethought, caution, and oversight. The value of the information to be gained should clearly justify the risks to human subjects,” he added.

Sharing his views on single-dose vs. double-dose vaccines, Dr Harsh Vardhan accepted that for quick control of a pandemic, it is desirable to have a single-dose vaccine. However, it is often difficult to achieve desired levels of immune protection using a single dose. He added, two-dose vaccines are suitable for attaining the desired immunogenicity as the first dose gives some immune protection, and the second dose augments it further.

On the opening up of schools, he mentioned the MHA Guidelines which states students may attend school only with the written consent of parents and that attendance will not be enforced upon the students. Schools that are allowed to open will have to mandatorily follow the SOPs set by government.

The Minister enumerated steps taken by the government to help senior citizens; All government and non-government hospitals have been given strict instructions to treat and test any potential corona-affected elderly on priority basis; The government’s call centers were asked to listen to the complaints of the elders seriously and to give them proper advice immediately; The Ministry of Health issued special guidelines for senior citizens detailing what to do and what not to do in the pandemic; All the Old Age Homes were instructed to take all measures to protect the elderly from Corona and deploy a Nodal Officer; CGHS beneficiaries 60 years or older were provided free medicines directly to their home.

Dr. Harsh Vardhan detailed steps taken to protect hard earned gains in TB from the COVID pandemic; Advance directives were issued by the Central TB Division, Ministry of Health & Family Welfare and reviewed with States/Districts to ensure continuity of TB services; Guidance for TB diagnostic labs was provided for them to remain functional during the Pandemic; Provisions were made for extended duration of drugs, door-step delivery and advisory issued on extra precaution for TB patients; New surveillance strategies were developed; TB Containment Facilities were leveraged and support provided for institutional-based screening; Awareness activities that concentrated on Infection, Prevention, and control activities were focused upon. The minister restated that notwithstanding the social determinants of TB like poverty, malnutrition, poor housing conditions, community hygiene and poor health-seeking behaviour, TB will be eliminated by 2025.

Answering a question related to the festival season, the Minister quoted the Hon. Prime Minister, and stated that “Jaan hai to Jahan hai”. We can enjoy festivals only when we are healthy, he said. It is a matter for the State governments to decide on allowing puja pandals in the upcoming festive season. Maharashtra has issued an advisory for the Navratri festival under which there shall be no garba and dandiya mahotsavs in the State. Gujarat has also disallowed the garba and dandiya mahotsav this year.

Dr. Harsh Vardhan used the medical parlance Prevention Fatigue to describe non-adherence to COVID appropriate behaviour, rather than complacency. “People tire out when they have to constantly take precautions. Some of them also give up taking precautions for various reasons. My message to everyone is that we must all diligently take precautions”. He urged all people to follow COVID appropriate behaviour during the festival season. He also appealed to be responsible citizens. He also urged “each and every one of you to take ownership at your own levels: personal, society, RWA, colony, and office”.