India / Oxford vaccine may better fit India than Pfizer or Moderna's: Vaccine scientist

New Delhi: Shedding light on the suitability of the various COVID-19 vaccines under development, India’s top vaccine scientist professor Gagandeep Kang says that the Pfizer vaccine, which is 90% effective, is “very unlikely to be a solution for India”. This is because India simply does not have the cold storage capacity to be able to store and transport this vaccine at -70⁰ or -80⁰ Celsius temperatures. Also, the Pfizer vaccine has a very limited shelf life, at times as little as 24-48 hours.

Speaking about the Moderna vaccine, which is said to be 94.5% effective and only requires storage at -20⁰ Celsius and has a shelf life of up to 30 days, Kang says that at its present price of $37.50 a dose, it is unaffordable for India. “We cannot afford $37.50 a dose. India has never paid more than $3 per dose for any vaccine,” she said. However, Kang did add that “when a market like India comes calling, the price will come down if we buy a substantial amount”.

In a nearly 50-minute interview to Karan Thapar for The Wire, Kang – who played a critical role in the development of India’s indigenous rotavirus vaccine as well as in the development of vaccines for cholera and typhoid – said that it’s likely the Oxford-AstraZeneca vaccine could be the right one or the best one for India. This vaccine only requires storage in a temperature range from -2⁰ to -8⁰ Celsius which can be provided by an ordinary refrigerator. It does not require a freezer.

Professor Kang, a fellow of Britain’s Royal Society said that India should “tailor” its vaccination programme “to what can be done, in which places and for which people”. In other words, the country could need a variety of specific responses including a variety of different vaccines to handle its diversity.

However, Kang expressed concern about the manner in which the government could identify people who fall into the four already identified priority groups for vaccination. These groups are first, healthcare professionals, second, police and the armed forces, third, people above 50 years and, fourth, people below 50 years with co-morbidities. Kang raised the question, “How well will we do in identifying people and then sequencing between them?”

Kang pointed out that there are different types of healthcare professionals, some who come in immediate contact with COVID-19 patients and others who provide critical support services. Will we discriminate between them? If so, on what basis? Kang also said that doctors and nurses can be differentiated between those who work in government hospitals and those who work in private hospitals. Will they be treated equally? These, she says, are the sort of issues that still require answering.

Kang, who is a professor at the Wellcome Trust Research Laboratory at the Christian Medical College in Vellore, said that the overall picture of vaccine development in response to COVID-19 is “exciting proof that vaccines work and work better than we thought”.

Kang also spoke about the post-Diwali big coronavirus picture facing the country as winter sets-in. She said it’s perfectly clear that India’s first wave is declining and diminishing but whether or not there will be second or subsequent waves depends very much on the behaviour of people. Whilst the dry cold weather and failure to wear masks and maintain social distancing could lead to a second wave she also felt these would not be as bad as the second and third waves experienced in Europe and the US.

Speaking to The Wire about the conclusion of a seven-member expert panel commissioned by the Department of Science and Technology, of which she was a part, which claimed in mid-October that if preventive guidelines are maintained the disease will have “run its course” by February 2021, Kang gave The Wire some critical clarifications. She said this was a mathematical model built on publicly available data and not on all data available with the government. So, since the data is incomplete, the model and its conclusions may not be perfect. The model had predicted that the first peak, which is presently steadily declining, will be over by February next year and, thereafter, the rates of infection will be lower than they are today. The disease will have moved from the pandemic stage to the endemic stage.

However, Kang made clear that this mathematical model conclusion could be overturned by peoples behaviour i.e. their failure to wear masks and social distance but, instead, congregate in large numbers in confined or unventilated spaces. As she put it “any time people let their guard down the possibility of a second peak exists”.

Speaking specifically about Delhi, which is seeing daily increases of over 7,000 – and is running against the nationwide grain of a declining trend – Kang said this could be explained by certain specific features unique to the capital. First, there is the high mobility of people in Delhi. Second, it’s a magnet for surrounding states. It attracts economic migrants and, therefore, disease prevention or spread becomes more difficult. Third, pollution levels in Delhi are high and this can impair lung functions.

Asked whether a limited circuit-breaker type lockdown was necessary in Delhi or the National Capital Region, Kang responded with a question of her own, “Do you need a circuit-breaker or a change in practice across the city?” She said circuit-breakers or lockdowns are temporary measures. Unless peoples behaviour is changed the situation will be very difficult to rectify. She pointed out that months have gone by without the government taking effective steps to change behaviour or even involve in its planning and decision-making people who can advise how this is best done.

Repeatedly questioned whether the Delhi government had made a mistake allowing buses to run full or permit up to 200 at weddings – this was done not when the numbers are declining but increasing – Kang was reluctant to express a clear opinion but instead said these were difficult decisions to make because they involved balancing different concerns.

The above is a paraphrased precis of Gagandeep Kang’s interview to Karan Thapar for The Wire. Although not inaccurate it’s recounted from memory. Please see the full interview for a full and proper understanding of Kang’s point of view.