On January 16, India is set to launch the world’s largest national immunization programme with two of its ‘made in India’ vaccines. India sits at the center of the COVID-19 response, not just because it has the second-highest number of global cases, or only due to its success in curbing the spread of the virus, but because India is set to be, yet again, the global pharmacy. This time, it will produce and supply COVID-19 vaccines to people all over the world.
Earlier this month, India’s drug regulator approved the Oxford University-AstraZeneca vaccine Covishield, manufactured by the Serum Institute of India for Emergency Use Authorization (EUA), alongside Covaxin, an indigenous vaccine, developed by Bharat Biotech International and co-sponsored by the Indian Council of Medical Research and National Institute of Virology. Covaxin, for which critical phase three trial data isn’t yet available, was approved with the caveat that it is for “restricted use in emergency situation in public interest as an abundant precaution, in clinical trial mode, especially in the context of infection by mutant strains.”
As many as 300 million Indians will receive the vaccine in the next few months, starting with the 30 million healthcare and frontline workers at the vanguard of the fight against COVID-19, and followed by 270 million people who are over 50 years old and those with comorbidities. The upcoming inoculation drive builds on India’s successes in eradicating smallpox and polio, and reaching more than 27 million pregnant women and 25 million infants each year through its existing Universal Immunization Programme. However, with COVID-19’s vast geographical spread, the diversity of India’s population, and deepening inequalities fueled by the ongoing pandemic, the vaccination drive will be fraught with challenges. In anticipation of these challenges, state and federal governments in India have coordinated swiftly and recently conducted dry runs of the immunization program throughout the country. These dry runs tested not only the operational feasibility of various states to roll out the vaccine effectively, but also the electronic vaccine intelligence network—Co-WIN—that will be used as a comprehensive digital database of every COVID-19 vaccine administered in India.
COVID-19 vaccination will happen in India soon. But whether it will succeed will depend upon public’s confidence on the vaccine, how well people are informed and educated, how well their questions and doubts are answered and finally, how much participation the program receives. History shows that even highly effective vaccines cannot curb a pandemic without high population coverage. A survey conducted in December found that 69% of Indians will be hesitant and will not rush to take the COVID-19 vaccine even if it became available. Vaccine hesitancy concerns will negatively impact India’s COVID-19 immunization response. Health authorities must actively address the transparency issues related to the trials of the approved vaccines and combat vaccine-related misinformation. This pandemic has taught us the importance of communication like never before. Now more than ever, the government needs to be transparent—disclose vaccine side effects, report the number of people impacted by them and the severity of their side effects, explain the different stages of vaccine trials, and the importance of the vaccines to the general public.
The success of the vaccination campaign in India depends on inspiring public confidence in the safety and efficacy of vaccines. A transparency deficit not only has domestic ramifications but may also limit global acceptance of Indian vaccine exports. National COVID-19 vaccine programs in China and Russia have already suffered from scarce and confusing data, questionable government promotion, and rushed approval processes. These doubts have already impacted their possible uptake by countries around the world. Today, India holds a strategic global position for widely distributing its vaccine products around the world. With this great power comes even greater responsibility.
Kashish Aneja is a practicing lawyer in New Delhi, and an international legal consultant specializing in Global Health Law. Currently, he’s consulting for the O’Neill Institute, and over the past 2 years, he has worked on projects for the World Health Organization (WHO), Centre for Reproductive Rights and GAVI the Vaccine Alliance. He is the co-founder of Society for Democratic Rights, New Delhi.