Challenges In Achieving Herd Immunity For COVID-19 Through Vaccination



Challenges In Achieving Herd Immunity For COVID-19 Through Vaccination

Challenges in achieving herd immunity for COVID-19 through vaccination.

Currently, there are several vaccine candidates for COVID-19 that are being developed around the world. Pharmaceutical firms, such as Pfizer Moderna, Oxford University AstraZeneca, and even India's Bharat Biotech developed their variants of the vaccine, and are currently undergoing phase three trials where the effectiveness and safety of the vaccine are being tested out countries like Russia, which has developed a Sputnik five vaccine has already started administering the vaccine to the high-risk groups, such as frontline health care workers. Then countries like the United Kingdom, have already announced the rollout of the vaccination program. Even India has been making progress, and recently Indian Prime Minister Narendra Modi visited various facilities in India, where the COVID-19 vaccines are being developed and tested. Recently the Prime Minister has even claimed that the trials have reached an advanced stage and very soon India might be rolling out its vaccination program. In this context, senior officials representing the government has stated that the government is looking at only partial vaccination. This was stated by the union health secretary, and as well as by the director-general of the Indian Council of medical research. They have said that the government is looking for partial vaccination of the country's population. So that a critical mass can be vaccinated. To achieve herd immunity against COVID-19. Herd immunity is nothing but a stage where a sufficient percentage of the population has achieved immunity against a particular infection. This immunity could be achieved, either through the natural course of infection or to the administration of a vaccine. According to the COVID-19 vaccination strategy that the Indian government is formulating. It is looking to partially vaccinate a critical mass of the population or a certain subset of the population to achieve herd immunity.

However,  there are several challenges to achieve herd immunity to partial vaccination. The first biggest challenge is to achieve herd immunity to partial vaccination, experts estimate that nearly 70% of the population should be covered through vaccination. Now this itself is going to be a huge logistical challenge, because in a country like India with a billion-plus population. It is not going to be an easy task to distribute and administer vaccines to such a large population. The next biggest challenge is a subset that will be chosen, on what basis or on what scientific rationale. Will the government chooses the subset because vaccination is also about achieving health equity. When a vaccination program is universal that it promotes health equity, and it does not create a divide within the population. But if a particular subset of the population is being chosen and if the government is looking to immunize only a critical mass of the population, then how the subset would be chosen, would affect health equity in the country. So this in itself raises several ethical questions and ethical challenges for the government, and it will have to determine how the high risk of the low-risk populations will be categorized and what would be the scientific rationale or the scientific basis for such decisions.

See we already know that COVID-19, particularly affects older people, and as well as those suffering from comorbid conditions. So there is no doubt that these categories, would fall under the high-risk category. Along with this, we have the frontline health care workers as well. But they constitute a very small subset of the entire population, and hence prioritizing the high-risk groups and choosing them is going to pose several challenges to the government. In our health equity and trust in the vaccination program, the government will have to ensure that the entire process of choosing the subset of the population is transparent and objective. The whole decision-making process should be based on scientific evidence and these decisions will have to be communicated without post transparency to the public through such communication, the government will have to explain the scientific basis for its decisions, and it will also have to put in place a mechanism through which appeals could be received for the population which has been left out. and to this mechanism, crucial public inputs could also be generated. Only when such a transparent and ethical process is followed by the public trust or vaccination program. And only then the government's objective of building herd immunity to partial vaccination can succeed. Next, we cannot ignore the fact that the transmission of COVID-19 has been quite uneven to the population around the world. It has been noticed that a few infected individuals have spread the infection to large groups in what we refer to as a super spread or events. At the same time, it has also been noticed that a large group of individuals may not transmit the disease to others, and the scientific community is yet to identify the reasons behind this uneven spread and uneven transmission of the disease. Apart from this, there are still several unknowns, about the source of the coronavirus. We still don't know how long people will enjoy natural immunity after they have been infected by the disease. So in that case the question that arises is that, should we vaccinate, those who have already been infected. Do they already have natural immunity against the disease and even if they have natural immunity, how long would that immunity last. The next challenge is that these vaccines have to be administered infrequent doses and currently, most of the vaccines that are being developed require a two-part administration. So determining the frequency of inoculation, and the number of doses in itself is going to be a challenging task for the health authorities and the government. The general public around the world displayed a lot of vaccine hesitancy, especially about COVID-19, because of how the development and testing process has been rushed through by the government's clinical trials are only partially helpful in determining the true safety of the vaccine, and its real side effects will only emerge. After a large segment of the population has been vaccinated. So this might push several away from the vaccination program, and hence it is of utmost importance to build trust with the vaccination program and the vaccine itself by maintaining transparency, not just in the development and testing process, but also in the selection process of the population, which will be administered with the vaccine. The next question is that of infant vaccination. This is the standard process for most other infectious diseases, an infant receives several doses of different vaccines, in the first few months itself, not just to protect the infant, but also to prevent the emergence of a new chain of transmission. Then we cannot ignore the fact that our government machinery is not so efficient when it comes to vaccination programs. If we look at, India, we have taken several decades to achieve universal immunization about several vaccines. So that being the case, we can safely assume that by the time we achieve universal immunization for COVID-19, it is going to be for several years. And hence, the government should come out with a well thought out strategy that is based on scientific principles to roll out and administer the COVID-19 vaccine. The government will also have to ensure that other immunization programs are not affected because currently governments and health authorities are under a lot of pressure to contain the spread of COVID-19 and break the chain of transmission. Under this pressure, if the government and the health authorities divert the immunization infrastructure of other diseases towards COVID-19, then it might affect the immunization program for other diseases and this would again affect health equity in the country. So considering all these challenges in achieving herd immunity to vaccination the government should formulate a plan, which aims for universal immunization with a transparent and objective process through which the high-risk groups, shall first administer vaccines.

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