Pfizer’s vaccines were a non-starter in India because of their illogical legal waiver demands, their need for super-cold storage (-60 to -80 degrees C) and transportation infrastructure and prohibitive costs.
Covid-19, the dreadful pandemic, was a frontal attack on humanity, an unprecedented surge, devastating lives like never seen in our living memory. The deep impact of Covid-19 left the world in a suspended state of animation, frozen, surrounded with fear, grief and untold uncertainty, changing our lives, for many, forever. It’s been horrific, the global carnage, the world entered into an unknown, bizarre script. Yet India has done well, and we have risen as a nation. At the same time, a new type of reflection has set in, about how our collective experience during this pandemic will and should change our world in the future.
It’s certain that the Covid-19 crisis will significantly change the healthcare system itself, in particular—it will serve as a catalyst in developing more effective, efficient and, above all, more humane medicine.
The Indian government, which set correct formats first, based on data, facts, science, became a beacon on how to get the format right to combat this pandemic.
HOW INDIA SUCCEEDED
1. To initiate the early lockdown on 24 March 2020 was strategic but was not prolonged. This enabled India to develop community acquired immunity or herd immunity, which translated into hybrid immunity (past vaccination plus past exposure to infection). Worldwide data shows that hybrid immunity is far superior to even a triple vaccinated individual. Every exposure, however, subtle and even to other respiratory viral infections gives a boost of cross-reactive immunity. Every 10% increase in society’s immunization gives a similar corresponding increase in herd immunity.
2. Successful vaccination campaign with the protection of the elderly and the co-morbids first.
3. Used time tested platforms of cost effective and efficacious adeno vector vaccines of the inactivated type.
4. Early diagnosis, good testing, adequate isolation and community surveillance.
5. Good and accurate public healthcare messaging and media campaign pan India, which was scientifically data driven.
Why Indian vaccines have worked well: both Covishield and Covaxin are inactivated adeno vector based platforms with decades old and tested technology.
Pfizer is an mRNA vaccine and there is tremendous discussion on certain adverse reactions. The incidents of cardiac myocarditis post mRNA vaccine are 8-26/1 lakh (100,000) male population on day 21 post vaccination. Covid infection itself causes myocarditis at the rate of 60-64 per 1 lakh males mainly in the ages of 16-18 years and young adults. Whereas the general incidence of myocarditis is 10-22 per 1 lakh. Both Covaxin and Covishield vaccines used in India have an incidence of myocarditis 30-fold lower than the mRNA vaccines.
Covaxin and Covishield have a rare risk of blood clots (thrombo-embolism) of 0.38 per 1 lakh versus a general incidence of blood clots in population of 104-183 per 1 lakh and Covid infection itself carries a risk of blood clots of up to 20%. Therefore the vaccines used in India are safe and effective.
Meta-analysis and data review worldwide have shown decreasing vaccine efficacy and effectiveness across all vaccine platforms due to the emergence of new sub variants of omicron sub lineages. The new terrible strains of XBB, XBB1.5, BQ1.1, CH1.1, etc. have a higher vaccine escape and immune escape up to 3-4 fold, higher transmissibility with a growth advantage of over 150% convergent and recombinant in nature being completely antigenic distinct. The crossover breakpoint in XBB1.5 the most immune evasive strain is at mutation R486S amongst other synonymous mutations of more than 90.
The Indian vaccines have shown to decrease person to person transmission by 21-50%, decrease incidence of long Covid by 15%. Overall the Indian vaccines have decreased the incidence of getting infection by nine-fold and decreasing hospital admissions and death 11-17-fold.
Pfizer’s vaccines were a comprehensive non-starter in India because of their illogical legal waiver demands, super-cold storage and transportation infrastructure of commercial chillers of temperatures -60 to -80 degrees and prohibitive costs. All this made Pfizer vaccines, though useful internationally, logically and financially impractical in the Indian context.
Where did we stand in end 2019? India was a million plus deficient in doctors and nurses each, two million short in hospital beds, but we stood tall. And strong. Every initiative was taken to enhance the bed capacity of hospitals, created new diagnostic laboratories, newer centres for Covid-19 management, skill development and manpower to meet the crisis.
A multi-pronged plan and strategy was put into action in lightning speed, monitored and immaculately rolled out for our 138 crore population. India had 0.7 and 0.8 as doctors and nurses and beds per thousand population, in comparison with 2.5 and 2.8 apple to apple in the US. And the US is a mere 35 crore population. In ratio adjusted comparison, the US is 25-fold stronger in healthcare infrastructure, but we till date have about 300 per million case fatalities ratio and the US/western nations as over 1,800-2,000 per million.
INDIA UNFAIRLY TARGETED
There has been global under reporting and underestimating of Covid statistics. India was being unfairly painted with overt cognitive bias by the international press. The global press went on a personal agenda to tar our image. Not acceptable. They suffered more than us. Then why target one country? Many of us stood up against such inaccurate reporting.
When the world needed a leadership example and India provided that.
But unfortunately, we had half-baked opposition party politicians (a few of them), armchair debaters, chronic OCDs on Twitter, who left no opportunity to spit venom. But the Indian government stood steady. Many political leaders targeted our fight against Covid, created hurdles at every step and created huge vaccination hesitancy.
This crazy unscientific regurgitations spread vaccine hesitancy and misinformation; like vaccines cause infertility, contain pig or cow proteins. All fiction. They said it’s a BJP vaccine. Wrong. It’s a vaccine for humanity.
They challenged the Indian scientific community, saying the vaccine was not safe. Wrong. Vaccines have saved lives. Millions of lives. India stood tall through this barrage of irresponsible onslaught of opposition parties.
In fact all international data proves the vaccines are safe and save lives.
It’s indeed hurtful to see Opposition parties not focusing on Covid-19 but making discussions personal on the government and India.
India is bigger than the US or EU. Larger than many countries combined. Yet we have managed to keep the least case fatality ratios.
India is a fortunate country to be amongst only five globally to manufacture Covid-19 vaccines. Till early June 2022, we had completed more than 210 crore injections. Such a large vaccines campaign is the largest in planet earth. We have already done the maximum numbers, in least time and safely.
Well done, Indian scientists and doctors. In an era of huge global shortage of vaccines, when big five western countries stockpiled 54% of the global vaccines stock, when less than 1% of the world’s vaccines are available for entire Africa, India lent its gentle hand to support other countries.
CRITICAL STEPS TAKEN
Critical steps were taken to enhance infrastructure and public healthcare outreach.
The government put smart technology to highest clinical efficiency, operational efficiency, patient experience; human lives first.
Every move of India was to turn healthcare from 3As (affordable, accessible, accredited) to 6Ps (primary, preventive, precision, personal, predictive, proactive ) healthcare.
The Indian assault on Covid-19 was driven on data and facts, not anecdotal opinions or events. Nothing is truer than this at this timeline.
In this pandemic we are experiencing a renaissance of science as an indispensable advisor for politics and public.
In a crisis, this methodically logical, scientific situational analysis, weighing of options, and the methodological development of solutions proved to be the superior alternative to speculation, conjecture, and opinions. Science and technology form the basis for medicine.
Digitalization and smart innovative technology are the new norm; shedding the old fossilized inertia. Currently, telemedicine, remote control diagnostic systems and robots, diagnostic recommendations based on big data and artificial intelligence, and medical apps are revealing their enormous benefits—greater productivity, faster availability, less administrative work and, of course, the spatial separation of physician and patient. We are undergoing a paradigm shift. The rise of AI, VT, AT was made possible by this government.
Fair, equitable, accessible Covid vaccinations for all was India’s mantra. The poorest of the poor got vaccines free, the rollout strategy was scientifically accurate in accordance with global standards. But the Opposition never let go any opportunity to take potshots.
Vaccinations are the most vital and important public health intervention tool to save lives, more than 60m lives are projected to be saved by immunizations from 2000 to 2030, which is staggering. Then vaccine hesitancy is so absurd. Vaccinations are fair priced or indeed lowest cost in the pandemic, it is equitable for all, accessible to all; with public awareness being the key.
Medicine isn’t numbers or statistics; our approach was tempered with empathy and compassion. Patients aren’t numbers.
India shifted gears towards genomics, molecular engineering, and virology medicine. Centres were set up for these advanced tests. Easier said than done.
In the worst moments of pandemic waves, the government ensured adequate supplies of life saving drugs, anti virals, consumables and other essentials for hospitals. Worthy of acknowledgement indeed. No mean task this.
The government made us all realize, “mask up, vax up and namaste”. This will be our way of life. Now. For a while. For a long time. But that’s acceptable. Masks are much better than ICUs.
We largely have overcome this crisis. We will serve our nation as our inherent moral responsibility. No greater responsibility can fall on human shoulders than to be a physician, we love our role, rejoice in recovering of patients, stand with families in moments of grief.
The fight against Covid-19 is not over. But neither is the resolve of the doctors and nations. And the Indian government has stood by us and always will.
No country in this world has got the format right. India also made a few errors. We are also humans. But we built our foundations on science and scripted our journey better than many others.
We will look back in years to come.
History will write the script and we are and will realise the good India has done. He put lives as the central focus. We believed in science and facts and data. Never underestimate the torrential impact of this pandemic. Shudder to think what would have happened without the energy and resolve of India.
Jai Hind.
Prof Dr Sanjeev Bagai, Padmashri, is Senior Consultant Paediatrician and Neonatologist and Pead. Nephrologist, and Chairman Nephron Clinics.