A vexing vaccine?

January 27, 2021 marked a pivotal day for Bangladesh as it witnessed, with bated breath, the advent of the elixir that has dominated the discourse for months now with the administration of the very first jab on Nurse Runu Veronica Costa at the Kurmitala Hospital in Dhaka. 

While the relatively quick access to vaccines might have taken a lot of us off guard, many have screwed their eyes beyond legitimate concerns on the 'Indian' tag on vaccines, even resorting to brazen claims of espionage and subjugation by microchips. 

With a deferral in provision of doses that has left the European Union at loggerheads with manufacturers, Bangladesh should acknowledge the relative stability with which the rollout is being planned out with vaccines sourced from the biggest vaccine manufacturer of the world, the Serum Institute of India.

Even though the country has largely approved mass vaccination campaigns for decades- an initiative that has in turn helped formulate one of the most imposing public health success stories globally – why are voices being raised so vehemently against the use of a vaccine that has cleared phase III trials within a span of six months and thus created medical history?

Bangladesh has procured 30 million doses of the Covishield vaccine from the Serum Institute of India, to be delivered free of cost by the state.

AstraZeneca, the British Swedish company that pioneered this vaccine in conjunction with researchers of Oxford University, formed an alliance with the Serum Institute of India (SII) to open up distribution channels to countries much lower down the priority list. 

The vaccines available to Bangladesh are the Oxford AstraZeneca vaccines in pure essence.

Impressive findings of phase III clinical trials, published in a landmark article in 'The Lancet', have ascertained an efficacy of 70 percent, with efficacy rates hitting close to 90 percent when a half dose and a subsequent full dose is administered four to 12 weeks apart.

This sounded horns to garner attention and hence was the first vaccine approved in the UK, clearing all regulatory barriers. What must be brought to limelight is that no detrimental side effects have been reported following inoculation.

India has been vaccinating its massive population and so far, all suspected mortalities following vaccination have not been due to the jabs according to post mortem reports. Norwegian fatalities have also been due to non-vaccine causes.

What has indeed been reported for one in 10 people are side effects which are a hallmark of any jab – mild symptoms such as localised pain, swelling, headaches, chills, and fever which can easily be managed by physicians.

There have been concerns raised by German officials on the vaccine efficacy in individuals aged over 65 years.  Representatives of AstraZeneca have argued that it does indeed confer a strong immune response in elderly patients.

Vaccine developers have been furious at what they have deemed flawed reporting referring to vaccine efficacy being a meagre 8 percent in patients aged above 65 – clarifying that the figure depicts the percentage of elderly subjects enrolled much later in the due process of the trials and not the potency of the vaccine in these subjects.

UK regulator MHRA Chief Dr June Raina has opined that data on the strong immunogenicity of the vaccine in people aged over 65 exists and is being strengthened with time.

What has been spreading like wildfire across the country is the insidious hoax that an Indian vaccine, compromised in quality, has been sent over to be tested upon the Bangladeshi population and turn the country into a breeding ground of guinea pigs subjected to Indian hegemony.

Debunking these is an exigency which could otherwise lead to a hoard of misinformation and even self-justified violence on the part of impressionable zealots.

SII is a manufacturer of the Oxford vaccine, not its developer. According to a BBC report, SII is a global vaccine powerhouse responsible for the production of 60 percent of the world's vaccines.

Even before the pandemic struck, the institute was brewing 1.5 billion doses a year, inoculating two out of three children in 170 countries against polio, mumps, meningitis and measles. The SII has even joined Covax, a WHO backed initiative to procure vaccines for lower income countries.

Bangladesh is not the only feather atop its hat – Sri Lanka, Nepal, Mauritius, Afghanistan, Bhutan, Maldives, Seychelles and Morocco have cleared safety protocols to receive doses of the vaccine from SII. Brazil has considered 2 million doses whereas South Africa has been looking for similar sized consignments. 

Where else would Bangladesh look for a vaccine? The vials, shipped at a reasonable $4 each (relative to Moderna at a stifling $33 and Pfizer at $20), would be the most cost effective and logistically viable option.

First off, the vaccine, an attenuated non-pathogenic adenovirus, can be stored at standard refrigerators (-2 to 8 ^o C), in congruence with the humid climate of villages lacking ultra-cooling systems.

The Moderna vaccine, however, needs a painstaking –70^o C, temperatures which cannot be sustained at most cold chains worldwide.

Coincidentally, a manufacturing flaw has plummeted stocks of vaccines in the depots serving the EU such that deliveries have been cut down by 60 percent in the first quarter. Austria is receiving half of its consignment and Lithuania just 20 percent.

The manufacturing process in India has been left unscathed by this crisis and even a fire at its factories could not halt the production of vaccines and its timely deployment.

Bangladesh has made its mark for its astounding success in public health, thanks to whopping levels of immunisation coverage.

The Expanded Programme on Immunisation, EPI, introduced in 1979 and gaining pace in the 1990s, has been a game changer for the country. The EPI has prevented 2 million deaths from 1987 till 2000, and accounts for preventing 2 lakh deaths per year.

The EPI coverage reached a mind-boggling 92 percent in 2013 from just under 16 percent in 1988. Firdaus Quadri, a renowned infectious disease specialist from icddr,b, has asserted that approval rate for the first dose of the BCG vaccine against Tuberculosis is 95 percent.

Vaccination underpinned the eradication of two deadly diseases from Bangladesh, smallpox in 1975 and poliomyelitis in 2014 as well as the elimination of maternal and neonatal tetanus in 2008.

This speaks volumes on how a hospitable nature approving mass use of vaccines has prevailed in the country that has received global recognition.

The scenario now is starkly different. We are in the midst of a pandemic that has been marred with cynicism, not mentioning unbridled fear of the unknown. The Covid-19 pandemic ravaged urban Bangladesh but did not raise much alarm in the remotest parts of the country.

Even though lockdown restrictions were hardly followed by the general population, the pandemic mainly affected urbanites, with medical professionals bearing the full force. Regardless, economic repercussions did hit all walks of life.

The drastic new modalities of life that people had to adapt to almost overnight gave birth to a sense of skepticism in the minds of the common man.

The anti-vax campaign hence found its footing in the country. Opportunists, fanning the fires of panic and impulse, disseminated misinformation and sensationalised propaganda, with social media handing over the much-needed crucible more than ever.

A recent survey conducted by the Institute of Health Economics of the University of Dhaka found that only 32 percent of people in Bangladesh were willing to get vaccinated in the first phase. Many blamed sketchy trial results, exaggerated reports on vaccine related deaths and rapacious adulteration of vaccine concoctions.

Religious dogmatism has also instilled barriers along the way, with questionable reports of pig fat being used as elements of the vaccines- claims that have been outright rejected by all major vaccine developers.

References to anti-vax campaigners on the backdrop of the US presidential election have drawn flak, with right wing nationalists declaiming that it is a disruption of personal freedom.

Fringe groups in Bangladesh seeking entitlement have resorted to such means, bringing forth comparisons with such unsubstantiated references and wild conspiracy theories.

Bangladesh had seen a considerable spike in morbidity and mortality in the earlier phase of the pandemic, when ICU wards were overburdened, oxygen cylinders deemed exorbitantly untouchable and medical front liners disproportionately devastated by the disease.

Till date, 122 medical professionals have laid down their lives battling the virus. Real figures of the death toll in the population in general may never surface.

Yes, the situation has not gone haywire following the initial spike of cases but we simply cannot count on complacency after averting the worst swathes of the disaster.

Vaccination as an attempt to establish herd immunity is the only scientific expert-backed conduit we have in our midst to restore normalcy in our society-we simply cannot let ego and aggression win over us. It is in our hands to define where our stakes lie and what norms we settle with.

Mohammad Fardeen Shihab is a 3rd year MBBS student at Uttara Adhunik Medical College

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.