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Vaccination programme needs to be reviewed

The National Technical Advisory Group on Immunisation (NTAGI), the government’s primary scientific advisory body on the vaccination roll-out, met on Monday but reportedly made no recommendations to the Union Ministry of Health and Family Welfare, and is studying the issues. It had earlier been reported that the NTAGI was due to discuss several pending issues, including the slow take-up of second shots, the possibility of extending vaccinations to children, and the need for booster shots for the sections of Indian society that have been determined to be the most vulnerable to Covid-19. Its guidance on priorities for the next few months of the vaccination programme is urgently needed.

The emergence of the Omicron variant is a reminder that not only is the pandemic not over, but that the vaccination programme itself cannot continue on autopilot without constant re-examination and tweaking. Many countries have responded to Omicron by expanding access to booster shots, for example. Several of those have encouraged individuals to take a different vaccine as the booster from the one that they originally received. The government cannot take such decisions in India without expert advice, which the NTAGI should provide. If the data is insufficient on how boosters should be arranged, the group should set into motion the data collection required to make a decision. For example, if the science determines that mixing and matching vaccines provides the best protection from variants, then the government must be warned so that it can reopen negotiations with additional vaccine providers, including those that make mRNA vaccines.
 

The question of whether children should be included in the vaccination programme, as is being done elsewhere in the world, is also overdue for consideration. The mainstay of India’s vaccination programme, the Oxford University/AstraZeneca vaccine, manufactured by the Serum Institute of India under the name Covishield, has not released the trial data for paediatric use yet. But the government informed Parliament recently that several vaccines for children were going through Phase II/III trials. Specifically mentioned were: Cadila Healthcare’s recombinant DNA-based ZyCoV-D, which is furthest along; Bharat Biotech’s Covaxin; Serum Institute’s licensed version of the Novovax shot; the RBD protein-based vaccine developed by Texas-based Baylor College; and California-based Dynavax and manufactured in India by Hyderabad-based Biological E; and the Janssen/ Johnson & Johnson shot, which has been approved for adults by several countries including the United States. It is possible that the expert panel is waiting for a peer review of the final results of the ZyCoV-D trial before making its recommendations.

Logically, the government should be able to first meet its targets for vaccinating adults with two doses before expanding the programme to children. A third shot for the immunocompromised or the elderly can be incorporated into the existing vaccination programme, now that supply constraints are no longer the issue. Administrative energy can be focused in particular on ensuring that those who are supposed to receive their second shots turn up. Millions of such second jabs are pending. But taking a decision on booster shots, including for health care workers and other vulnerable sections, should not be too long postponed. The effects of Omicron or another variant must not be allowed to set the agenda.