Should India consider increasing doses of Covid-19 vaccines?
The world is warming to the idea of booster doses for Covid-19 vaccines, but India is still limiting its efforts.
In a variety of countries, including the US and Israel, these doses have been recommended. They were introduced despite a worldwide shortage of vaccines, with some countries in Asia and Africa struggling to obtain even the first shot among citizens.
With supply gradually increasing and evidence that vaccines are losing their effectiveness, vulnerable populations may benefit from a fresh infusion of antibody-producing sera.
According to Dr Swapneil Parikh, a Mumbai-based physician and author of The Coronavirus Book, India, in fact, shouldve considered booster shots yesterday. There is a very urgent need for immunocompromised individuals to receive an additional dose, regardless of which vaccine they took, he added.
Covid-19 is a drug that suppresses the bodys immune response, and people with diabetes, cancer, or AIDS are at heightened risk of contracting it. In the majority of cases, the bodies of such patients produce less disease-fighting antibodies than those of healthier individuals.
Senior citizens, on the other hand, are at risk of the same fate. In addition, this group is more susceptible to severe Covid-19 and death. The World Health Organization (WHO) recommends booster shots as a priority for this age group.
What the WHO says about booster doses?
On Oct. 11, the WHOs Strategic Advisory Group of Experts (SAGE) recommended additional doses in the primary series for immunocompromised individuals.
Extra doses, which are essentially an extension of the primary vaccine series, differ in technical terms from booster dose.
A third dose of Covishield, the AstraZeneca vaccine brand manufactured in India, after a short period will be considered an additional dose. The WHO notes that immunocompromised individuals frequently do not develop a protective immune response after completing etiological primary series, while older adults may respond poorly to solitary primary studies.
On the other hand, a booster, according to the WHO, is given when, even after having received the primary vaccination, the individuals immunity has fallen below 'a level considered sufficient in that population'.
For ease of understanding, however, the terms booster dose or Boost shot are being used to refer to both categories.
While there aren't enough data from India specifically on declining antibody counts, there is sufficient evidence from the globe supporting such doses.
Should India give booster shots?
On Jan. 16, India began vaccinating its frontline and healthcare workers, and on March 1, it expanded the programme to the elderly and immunocompromised.
More than 692 million people -- or over 70% of the eligible population -- have received the first dose to date. According to the governments Cowin dashboard, nearly 90% have been of Covishield, and the rest of the homegrown inactivated virus vaccine, Covaxin.
While some individuals may be in urgent need of booster doses, experts argue, this may not be the case for others. Given the high prevalence of population seroprevalence after the massive second wave, it may be wise to target first and second doses to the entire population before going in for a third dose to frontline and healthcare workers, according to Gautam Menon, physics and biology professor at Ashoka University.
In the case of healthcare workers, for example, India might consider developing a more nuanced approach.
Healthcare workers who work with immunodeficient patients may be considered for additional doses. For example, oncologists, elderly doctors, or clinically vulnerable individuals, Parikh advised.
Given SAGEs latest recommendation for vaccines like Sinopharm and Sinovac, which have shown a decrease in immunity over time, India may also have to consider supplementing Covaxin. The WHO hasn't offered a suggestion specific to Covaxin, since the brand isnt yet on the WHO's list for emergency use.
There's also a moral dilemma for India right now.
Booster dose versus vaccine equity: comparing vaccine eligibility to booster dose
As a policy, the WHO has objected to countries opting for wide-ranging booster doses.
In the face of rising vaccine demand and a decreasing supply of booster doses, broad-based administration of dose increases the risk of exacerbated inequities in vaccine access by driving up demand... while priority populations in some countries, or in subnational settings, have yet to receive ocular vaccinations, it said in an interim statement on Oct. 4.
Between March and June, when the second Covid-19 wave was raging through India, the government unofficially halted exports, urging producers to focus on domestic demand.
Experts said the decision made sense at the time. India will, however, have to consider its international obligations now, with improved supplies and a reduced case load.
We have a commitment to provide doses to low- and middle-income countries, Parikh said. He said that healthcare and frontline workers in some countries of Africa and Asia have not even received first doses of the vaccines in certain countries.