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Thursday, October 22, 2020

Talk it through

Decision on who gets vaccine first must be informed by wide deliberations that must start now.

By: Editorial | Updated: September 19, 2020 8:22:01 am
The odds have been stacked against the Indian woman scientist for a long while now.

Doubts over the Oxford University-AstraZeneca vaccine that had surfaced in the first week of September, after one of the volunteers developed a nerve inflammation, have been put to rest. On September 12, the UK’s Medicines and Healthcare Regulatory Agency certified it safe, after a review by an independent committee. Following the UK regulator’s go-ahead, the Drugs Controller General of India (DGCI) has given permission to the project’s Indian collaborator, the Serum Institute of India, to resume trials on the vaccine in the country. It is still not clear when this vaccine candidate — the frontrunner amongst the preventives against COVID-19 that have entered the final phase of the clinical trials — will be ready for mass use. But some of the uncertainty about the timeframe seems to be lifting. AstraZeneca has said its vaccine could be available “by the end of the year or early next year”. India’s Minister of Health and Family Welfare Harsh Vardhan has also said that he expects that a vaccine against the contagion will be available by early 2021. But in the Rajya Sabha, on Thursday, he added a caveat: “It would still take time to reach everyone.” The minister’s note of caution is important.

Scaling up production of the vaccine will take time, even after it gets regulatory approval. The WHO too reckons that “supplies of the vaccine will be limited in the short to medium term”. The question then is: How should priority be allocated in administering the vaccine? This may involve balancing different, and competing, considerations. Should the health worker at the frontline of the battle against the novel coronavirus be the first to be inoculated? Or should arrangements be made to shield the elderly and those with the comorbidities? What about targeting hotspots in crowded areas to reduce the rate of transmissions? What place should the imperative of reviving the economy have in the vaccination strategy?

Medical ethicists have, for long, advocated public participation in medical research beyond clinical trials or improving research processes. A growing body of scholarship has suggested that fair medical processes require conversations between the healthcare professional and the layperson. India, unfortunately, has been an outlier to such debates — they have rarely gone beyond academic and activists’ circles. But the second-worst COVID-19 infected country cannot afford to leave difficult questions around the vaccine too late. It is important that any decision on who gets the vaccine first is informed by healthy interactions among different sections of people — health experts, social scientists, economists, patients’ groups. It’s time that such conversations began.

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