Everyone seems delighted, but what’s the good news?

AstraZeneca and Oxford experimented with two different dosing regimens. One regimen demonstrated an efficacy of 90% when AZD1222 was administered as a half dose followed by a full dose a month later. The second regimen showed 62% efficacy when two full doses were given a month apart. The average efficacy was 70%.

So, what now?

While the trials continue and reseachers search for an explanation on why the lower dosage works better, the results allow AstraZeneca and SII to approach drug regulators for an emergency licence. However, how long the immunity would last after the vaccine is administered is yet to be answered.

Why does the AstraZeneca-Oxford vaccine matter more than the other candidates?

In short, AstraZeneca’s vaccine is being developed using a 50-year old platform (a chimpanzee adenovirus vector-based antigen) that has been used in clinical trials for other vaccines.

On the other hand, vaccine developers Pfizer and Moderna are using the messenger RNA (mRNA) platform, a new technology with no approved vaccine before. There is more confidence in the safety profile of the AstraZeneca vaccine.

Also, it is a poor man’s vaccine—the storage requirement is 2-8 degree Celsius. India has enough capability to store and distribute the vaccine at this temperature range compared to Pfizer’s and Moderna’s vaccines, which would need deep freezers at -70 degree Celsius and -20 degree Celsius respectively.

Does the vaccine have any side-effects?

AstraZeneca said that no serious safety events related to the vaccine have been confirmed. The most common side-effects observed are temporary injection site pain and tenderness, mild-to-moderate headache, fatigue, chills, feverishness, malaise and muscle ache. These occurred less frequently after a second dose and more often after the first dose, and could be treated with paracetamol and painkillers if needed.

So, when can India start the mass vaccination drive?

SII will produce 1 billion doses, but not all of this capacity will be for Indians. The company’s CEO, Adar Poonawalla, has committed to reserve half of the doses for use in India. The emergency use authorization, a licence for limited and monitored use of the vaccine, is expected by December-end. The vaccine may be launched in January under the ‘Covishield’ brand. However, due to the challenges of distribution and limited production, the immunization drive in India could stretch up to 2024, Poonawalla said.

Who would receive the vaccine first?

The government has prepared a priority group list. Healthcare workers, including doctors, nurses and paramedics, will be the first to get the vaccine, followed by other frontline workers such as essential service providers. This will be followed by groups at the highest risk of mortality, like the elderly and those with co-morbidities.

Poonawalla expects the rest of the population to be vaccinated only after March or April 2021.

What complications could arise in the administration of the vaccine?

The Centre will not have the complete database of people with co-morbidities, especially those in rural areas, making it tough to identify recipients. Besides, it is not yet known whether those who had recovered from covid can be vaccinated or not.

What’s the price?

SII has a pact to provide 200 million doses to the COVAX facility—a WHO-backed facility created to ensure equitable global access to covid-19 vaccines—at $3 per dose, or around 220. SII plans to provide the vaccine to the Indian government at a similar rate. There is no clarity yet on whether the private sector, like private hospitals, will be allowed. If allowed, the vaccine could be priced at 500-600 per dose. About 300 million Indians can afford to pay for the vaccine, Shobana Kamineni, executive vice chairperson of Apollo Hospitals Enterprise Ltd, had said. Governments and multilateral organizations, such as COVAX, usually bargain for a lower price because of the volumes procured.

Will the private sector play a role in distribution?

As of now, it remains unknown. The Indian government has a robust distribution network due to the Universal Immunization Programmes (UIP), which targets 26 million newborns and 30 million pregnant women every year. UIP uses 27,000 functional cold chain points and around 76,000 cold chain equipment. Nevertheless, this capacity will be stretched for catering to the covid demand. Private companies are preparing ahead of the curve, while awaiting government guidelines.

What about other vaccines?

There are three vaccine candidates expected to be launched after January. Bharat Biotech, whose inactivated virus vaccine is currently in phase 3 trials, is expected to be the second vaccine to be launched, by March or April. Zydus Cadila is also expected to launch its three-dose DNA plasmid vaccine. The two indigenous vaccines are expected to provide more than 500 million covid-19 doses in 2021, provided they successfully complete the trials and get regulatory approvals.

Russia’s Sputnik V, based on the human adenovirus platform, is expected around April 2021.

Does this mean that covid-19 can be vanquished?

Frankly, we don’t know. While there are many ifs, the early signs are positive. It’s a great achievement to get a vaccine out so quickly. Now, a lot will depend on vaccine delivery, and what we learn from the early recipients.

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