By Ashwajit Singh,
It starts right from birth. Tetanus, diptheria, measles, rubella, BCG, polio…the vaccine list starts within a few days/weeks of being born. So, why is it different for Covid-19? A combination of the magnitude of the virus, apprehension among parents and ambiguity on vaccine efficacy are a few reasons.
Let us understand why vaccinating children in India is important?
Experts have already predicted a third wave expected to impact children the most. Projected later this year based on SUTRA model, India needs to prep up now to avoid a repeat of the monstrous second wave.
Vaccinating children will not only protect them but also save other people’s lives. An approach used for flu where British children aged between 2-12 are given a nasal spray every year to protect their grandparents. Vaccines can disrupt the spread of the virus which is constantly mutating to find new hosts who may have a lower immune system or are non-vaccinated. They can thus help build a greater herd immunity.
However, what is reassuring is a recent Lancet study across seven countries that estimated fewer than two out of every million children died with Covid during the pandemic. Corroborating this fact is yet another study from Israel that finds that children up to age 9 have little to do with the spread of the coronavirus. Also, the recent statement from the AIIMS Chief Dr Guleria mentions that there is no evidence that Covid-19 will impact children as they are usually protected and, even if they get it, they have mild infection.
Having said this, there is still no room for complacency.
The B.1.617 variant alongside a cocktail of other strains is said to be behind the deadly second wave of Covid-19 in India. Relatively unaffected during the first wave last year, a higher number of children and adolescents are getting infected in the second wave. With reports of near 16000 children affected by the virus in Uttarakhand recently, there are concerns about the beginning of a third wave in the state.
A closer look at the US Covid-19 trajectory can help us understand this better:
The graph indicates that US has already experienced three waves of the pandemic so far with each wave deadlier than the previous. The country hit its peak of over 300000 infections in a single day during its third wave in January this year. A lesson enough for us to not let our guard down again.
With a vaccination drive that has been faltering and seeing policy shifts, India’s ambitious target of vaccinating at least all its adult population by the end of 2021 seems too optimistic. Approximate calculations indicate that to vaccinate this near 945 million adults, India will need a minimum of 1.89 billion doses. And, at the current rate, it may take up to three years to vaccinate this population! And, imagine what would happen if an additional near 150 million children (between the age group 12-18) were to be also added to this adult population! Yes, India is expected to procure 2.16 billion doses between August and December 2021 but the numbers largely rest on the successful completion and clearance of clinical trials for five different vaccines – a tall order considering some of them are still in phase 1.
Yet another factor to consider would be behavioral dynamics which is also affects vaccination uptake. Though children in metros may be more open and aware, a large number in rural areas are still driven by factors like willingness, perception, trust, norms before they decide to take a jab.
In the wake of a 3rd wave staring at us, clearly the health infrastructure needs to be ramped up. Currently, India has a total of approx. 90,000 ICU beds for adults and less than 2,000 beds for kids –clearly a lot less than required. Many states have already initiated setting up of a Covid task force to help triage and create a good number of beds for children in various hospitals, establishing rehab centres and creche facility for Covid-19 affected children. One needs to also provision for dedicated wards that may be needed as parents may often accompany children (especially infants) in case of any Covid-19 emergency. This may further crowd and pressurize the existing systems and manpower.
What is needed is a decentralized system with data on ICU bed availability and oxygen facilities suited for children. This needs to be periodically updated in a centralized system which is easily accessible by the required authorities. Prime Minister Narendra Modi has already called for data collection on the transmission of Covid-19 among youth and children in each district in a meeting with the district magistrates and field officials of 10 states last week.
Besides maintaining a good stock of all important medicines and vaccines, health workers and doctors also need to be trained to understand and identify children who may need more intensive care versus others. Capitalising on paediatricians can be an advantage here since they deal with vaccines every day. As primary immunisers they have the parents trust and can help negate any vaccine doubts. The Indian Academy of Paediatrics (IAP) has over 30,000 pediatrician members across 30 state branches and 337 city and district branches which covers almost every nook and corner of the country. Yet another segment of frontliners who can be leveraged are trained army doctors, AYUSH doctors & ASHA/Aanganwadi workers especially for the accelerated rural push. One can take a cue from the success story of polio eradication mission in the country. The state of Uttar Pradesh alone had nearly 65% of global polio cases in 2002 with a high vaccine hesitancy. UNICEF aggressive engagement with social mobilisers and celebrities helped mitigate this fear.
Whatever is the intensity, India needs to be ready for the third wave urgently. With vaccine shortage plaguing many states, glitches in booking slots on CoWin platform, global tendering by states hitting the wall, stuttering vaccination drive sadly, India is not yet prepared. Once can hope that a smoother process is in place for vaccine trials currently underway for children. Covaxin trials are expected to begin in a few weeks, AstraZeneca is conducting trials on children between 6 and 17 years of age in the UK and 20 children in Karanataka’s Belgavi have received the first dose of Zydus Cadila’s ZyCoV-D Covid-19 vaccine as part of its phase three trial recently. We hope these vaccines come in quickly because the more is the delay, the faster is the opportunity for the virus to further mutate or evade antibodies. However, the good news is Pfizer vaccine created in collaboration with German biotechnology firm BioNTech is in talks with the government for administering the vaccine to everyone aged 12 and above in the country. It is the only vaccine currently being given to children in some countries including the US & Canada.
While those who compare Covid-19 with the Spanish Flu may say that it may also disappear after three waves, there is no guarantee. The Spanish Flu affected nearly 2/3rd of the world’s population before it disappeared. Covid-19 may also have a few more waves before it may settle down and become more endemic. But, till then the fear of a third wave is looming large. A collaborative, transparent and participative approach is the need of the hour. Accelerated vaccination (with more vaccine options), information exchange, equitable aid distribution, more Covid facilities with beds, oxygen supplies, medicines and building staff awareness can be critical to meeting the challenge. We have learnt hard from the earlier waves and surely don’t want to cross yet another grim milestone because unlike being caught off-guard in the 2nd wave, we now have the prediction so no excuses please…
(The author is Managing Director, IPE Global (think-tank international development firm). Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)