Experience of past vaccinations can be of help

Senior Journalist

The sense of relief and euphoria felt by the people and the Modi government over the availability of Covid-19 vaccines at the beginning of the new year is understandable after the long lockdown of 2020 and the mental and physical stress it caused all round. The Central and state governments are now grappling with the gigantic task of administering the vaccines manufactured by Pune-based Serum Institute of India (SII) and Hyderabad-based Bharat Biotech. There are going to be hurdles and glitches as the operation unfolds, but the sense of helplessness is gone. With the vaccines at hand, the hospitals and the frontline health workers with auxiliary support from the administration at all levels can succeed in immunising a large section of the population during the year.

The flash of fierce rivalry between the two commercial manufacturers who have got the qualified nod from the Drugs Controller General of India (DCGI) was to be expected. But the invisible hand of the government seemed to have pushed them to make a joint statement that they will together make the vaccines available in larger public interest.

But questions remain, and it is good that many scientists and epidemiologists have raised some pertinent ones. The government, in its anxiety to deal with the pandemic, was naturally eager to make the vaccines available soonest, and there must have been pressure on the DCGI to give the clearances. The details will emerge much later. It would have been better if the different points of view, and even clashes between experts, between the government and the DCGI were in the open. It would have shown the inevitable difficulties and differences which would establish that vaccines did not come as a result of government directives. It was also natural for Prime Minister Narendra Modi and his colleagues in the government and in the BJP to trumpet the arrival of the vaccines as a policy triumph. It is par for the course. But we have heard dissenting voices from doctors, epidemiologists and scientists in the media, especially in the print, though the government, as is its wont, ignored them.

It is, however, necessary to get the facts right, though the facts might be a dampener for those elated by the turnaround in the battle against Covid-19. Covishield, the vaccine from the SII, is the result of virological research of the Oxford Institute at the University of Oxford, which has been at it for more than a decade ever since the outbreak of Severe Acute Respiratory Syndrome in 2002-04, also known as SARS1. It was a slight advantage for the Oxford Institute to work on SARS2 or Covid-19. SII is the manufacturer. In the case of Bharat Biotech, it was collaboration with Pune-based National Institute of Virology (NIV) that enabled the former to get to the vaccine. The lab-to-manufacturer path is not a simple one. The manufacturers need research and development of their own to move from the virus genome sequence to its large-scale production. At some point, there is a need for documentation of this part of the development of the vaccine. The question does arise whether as in the case of Oxford-AstraZeneca vaccine, Biotech’s Covaxin should be known as NIV-Bharat Biotech vaccine, where NIV gets its due share of credit in the collaboration. It is to be remembered that in the modern period, the vaccine principle is quite simple and well understood, from the time Edward Jenner discovered in the late 18th century that cowpox prevents smallpox, and what needed to be done was to inject cowpox. But the mechanism had to be refined over the years.

The story of vaccines in India is more than two centuries old, and it has carved major landmarks of its own before and after Independence. In a review article in the Indian Journal of Medical Research, submitted in 2012-end and published in 2014, public health expert Chandrakant Lahariya traces the story of vaccination in India from 1802, when smallpox vaccine was administered after it was discovered and developed by Jenner in 1798. The cholera vaccine trials were carried out in India in 1893 by Dr Haffkine, who developed it before he came to India, and the then colonial government allowed him to set up a research institute in Mumbai. He developed the plague vaccine at his laboratory in 1897, though it ran into trouble because a few persons died in Punjab. And the trials of the typhoid vaccine were conducted on British Army personnel stationed in India during 1904-08. Many vaccine research institutes were set up in the country, such as the Central Research Institute in Kasauli in 1904-05 and the Pasteur Institute of Southern India in Coonoor in 1907. Lahari says that the deaths caused by the plague vaccine were documented and it was the first instance of Adverse Event Following Immunisation (AEFI).

What India needs is a sense of history, to remember what has been done in the past which will give it confidence for what can be done now. Though the magnitude of the challenge of administering the Covid-19 vaccine is unprecedented, India has the policy and institutional framework — evolved over a century and a half from the Compulsory Vaccination Act passed in 1892 to the Universal Immunisation Programme of 1985 — to make it happen. It would be immature to believe that we are facing a pandemic crisis for the first time and we are dealing with the vaccination for the first time, or that vaccines have been made in India for the first time. A nod to the past is not a bad idea.