Who should receive the COVID vaccine first in India

The discussion and debate around who should receive the vaccine first once it is out is perplexed. In its truest sense, it is a question of logic rather than science but then again what form of logic should be entertained? Is it the medical officers and other health workers including volunteers as well as police personal that should get the priority no matter the age (not as a note of thanks for their efforts but because of their direct contact with infected patients) or is it the elderly who have been the victim of the virus in the worst way, that is, often leading to deaths should be at the top of the list. Again, should there be sub-categorisation on the basis of what disease or medical condition someone is suffering from amounting to more or less risk of the virus or on the basis of social classifications of gender, caste and even class. Yes. the priority set on the basis of caste and class will not be a complete surprise for a country like India, where finally the decision will be politically motivated rather than scientifically provoked.

Yet, assuming that a vaccine actually prevents transmission of the virus, then the priority should go to those who transmit the disease most often – younger adults, or as psychologist Erik Erikson describes as a person who is between the ages of 19 and 40, a group sandwiched between the adolescent, teenage youth and middle adulthood stage. The reason is quite simple and logical – getting protected with a vaccine is a way of protecting others, since you can’t give someone the disease if you never get it and the age group of 20-40 is the most susceptible and most likely to get the virus, they being the pillar of the working class population in India and hence more involved in the day to day economic activities. Moreover, they are more likely to physically sustain themselves without showing the symptoms or without getting medically deranged than the other ‘weaker’ age group of 50-60 or above, hence increasing the chances of spreading the virus unknowingly.

But why give the vaccine to people most likely to spread the disease rather than to people most likely to die from it? Virologist David Sanders of Purdue explains that it’s likely that Covid-19 vaccines won’t work in people with poor immune systems – those most vulnerable to the disease. But those people can still be protected to a great extent if healthy people get vaccinated on time to stop the spread. “Immunization is not about protecting the individual – it’s about protecting the society,’ he says.

According to Integrated Disease Surveillance Programme, a Health Ministry body, about half of the infections in India are in the age group of 20-40 as of August, a figure that is evident enough to show the group’s priority in receiving the vaccine.

Another set of data from the Health Ministry shows the percentage shared in the death count by different age groups –

Data sourced from here

These stats are alarming (because of the disproportionate share in cases and deaths) and also prove the point that the young adults need to be looked out, for them to not spread the disease to the older age groups to reduce the fatal count.

But here’s the catch: if young, healthy people unlikely to die from the virus are to be vaccinated first, the odds of any serious side effects, both short term and long, have to be extremely low. The whole process of vaccination and its efficacy will only truly make sense thereafter. And that’s one of the reasons why field testing or clinical trials is important.

There are different Phases of this testing method. Phase 1 will determine the optimal dose for a vaccine. Phase 2 enrolling hundreds of people can reveal common side effects and determine whether the vaccine prompts the body’s immune system to produce antibodies that are capable of disabling the virus (some of the milder, short run side effects can and should be tolerated keeping in mind the number of people dying on a daily basis).

Phase 3 is the time-consuming part and according to many, the most vital phase. Here, the vaccine will be compared to a placebo in the real world. At least a few hundred people in the placebo group need to get infected to demonstrate efficacy, which takes time and rigorous data collection and analysing methods for success. It is in this phase that the researchers can tell if the people who got vaccinated can still get back the virus, even silently or mildly and transmit to others. But many argue that even enrolling hundreds or even thousands of people for this phase will never be enough to reveal any rare showcase of side effects (the live polio vaccine caused a few children to get polio – about 1 in 2.8 million in India). It is thus in Phase 4, mostly a data-gathering phase, a sort of post licensure surveillance, that a vaccine’s efficiency and efficacy can be judged and verified. It will help prevent problems that might get in the way of widespread adoption of any COVID-19 vaccine. It is a step in the right direction but also something that many countries and institutions are going to skip keeping in mind the urgency of the pandemic.

But skipping Phase 3 altogether citing the urgency might backfire rather than serving the purpose of pre-emptive action (of defeating the virus). It is this Phase that countries like Russia most likely to skip to make the vaccine available at the earliest. With plans of already making a deal with India and India on its own developing the vaccines ZYCOD-D (by ZYDUS) and COVAXIN (by BHARAT BIOTECH) that are to be made available sooner between September and December, a move that may have come amidst the political pressure to ICMR are worrisome to some extent (quick trials may lead to mismanagement and faulty results). With one of its two indigenous vaccines already in Phase 3 trials, India will have both the vaccines ready by next year, that is 2021 (if the emergency approval of an earlier availability is not granted), which is not to worry about as the Oxford vaccine is to be made available to Indians before that.

What will finally matter is the right people receiving the vaccine first and that too in a planned manner without the influence of money, power or any social stigmas.Those not following it should be held accountable under legal grounds. Cost of the vaccines and accessibility will also play a crucial role. After all, it’s about the vaccination more than the vaccine.