Now for a plan

Addressing a group of chief ministers on Tuesday, Prime Minister Narendra Modi warned that another stage of the Covid-19 pandemic was upon India, and that vigilance needed to be increased. He called for state-level steering committees and also for more localised task forces to examine local breakouts and prevent them from becoming full-fledged outbreaks, and reiterated that the state governments should move away from a dependence on imprecise rapid antigen testing to the gold standard RT-PCR tests for infection. He compared India’s predicament to the risk of drowning in shallow water close to the shore, given the recent news about successful third-stage trials for vaccine candidates. Two of those successful vaccine candidates, from Pfizer and Moderna, are not really relevant for the Indian case. The Russian candidate, Sputnik-5, has also recently announced some good interim results and is being tested in India currently. But the big news from India’s point of view was the results of one set of third-stage trials for the AstraZeneca/Oxford University vaccine candidate, AZD1222, which is being produced in India by the Serum Institute of India, Pune. AZD1222 in trials in the United Kingdom and Brazil showed an average efficacy at preventing Covid-19 infection of 70 per cent, with a 90 per cent efficacy in a particular, much smaller sub-sample that received a different dosage paradigm.

In real-world conditions, given what is currently known, the chances are that the efficacy of AZD1222 will be well below 90 per cent. This is unquestionably good for a vaccine, which is generally approved even at a 50 per cent efficacy. But the pandemic is a special case. The question here is also how effectively and how swiftly the vaccine can allow for the control of the pandemic’s spread and ensure that economic activity returns to a pre-pandemic normal. The lower a vaccine’s efficacy, the more people must receive it in a population so that herd immunity can be achieved. Academic estimates using the population of the United States have concluded that over 80 per cent vaccination is required for a candidate with 70 per cent efficiency to control the spread.

Currently, while the rollout of the AZD1222 vaccine can happen as soon as the first months of 2021, the manufacturers have stated that in their estimation the current state of Indian preparation means that it will take more than two years for the entire Indian population to be vaccinated. The fact is, however, that this is too long a period for the economy to suffer under the constraints associated with the pandemic. These are not just caused by government restrictions, but also by the real and justifiable concern among individuals about spreading or contracting the disease in the absence of large-scale immunity in the population.

In other words, now that India is at the point where greater clarity is being achieved on the vaccine endgame, it is time to draw up a transparent plan on how the vaccination effort will proceed, one that is open to public comments, has buy-in from state governments, and is on an accelerated timetable. The prime minister’s comments to the chief ministers are thus particularly relevant and welcome. Mr Modi stressed that a timetable would be drawn up swiftly, and in consultation, and the state governments must start preparing for implementation. The government machinery must match the prime minister’s words with action. Before the end of the year, a vaccine rollout master plan should be achieved.


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