India's healthcare workers hesitate to get vaccine jab

After 12 days of worrying, a senior resident in a Shivamogga government hospital got his Covid-19 vaccine jab on Wednesday.

“I’m not sure it will work, but since my colleagues (who also got the jab) did not have any side effects, I thought okay, let me get it too,” he said.

India hopes to inoculate 300 million people against Covid-19 by August. It started with health workers on Jan 16, but many registered doctors and nurses did not turn up for the free shot.

All health workers quoted here requested anonymity since the Indian Home Ministry has ordered strict action against anyone “creating unwarranted doubts” about the Covid-19 vaccines.

But, across the country, medical circles are abuzz with discussions on how to evade the jab, or which of the two approved vaccines is better.

The Indian government authorised two vaccines on Jan 3: AstraZeneca-Oxford University’s Covishield; and Covaxin, an indigenous shot developed by Bharat Biotech International.

Covaxin has been approved for restricted emergency use, although its efficacy trial is not complete. It is being rolled out “on clinical trial mode”. Those getting Covaxin have to sign a form consenting to be treated as trial volunteers.

If they refuse, they get no Covid-19 vaccine at all.

“This is discriminatory,” said the Karnataka Association of Resident Doctors in a Jan 18 letter to the state Health Ministry. “Before receiving Covaxin, we have been made to (sign) an undertaking stating that the clinical efficacy of Covaxin is yet to be established. The undertaking and the discrepancies in the distribution of the vaccine sound very suspicious.”

Only about 55 per cent of registered healthcare professionals turned up in Karnataka.

New Delhi, Tamil Nadu and Maharashtra, the states with the largest number of health professionals, also saw less than half turn up.

A doctor from Hassan, one of the six districts in Karnataka that have been allotted Covaxin, said that in the first week, only a handful turned up for vaccination in their centre. The other 237 centres are offering Covishield.

“I didn’t go when it was my turn. I’d like to see data that proves the vaccine’s efficacy first,” said the Hassan doctor. He wanted the option to get Covishield.

Turnout, however, is slowly improving in the second week of vaccination.

The Shivamogga doctor said: “A Lancet article on Covaxin and the fact that the 60 people who took the vaccine didn’t have any side effects convinced me.”

He was referring to a Jan 21 article in medical journal Lancet citing the results of Covaxin’s phase one clinical trial. The safety trial shows that the inactivated Sars-CoV-2 virus is safe and triggered “enhanced immune responses” in the volunteers.

The state health authorities are citing the study to coax those reluctant to get the jab. But some experts warn that only a phase three trial – as yet unfinished for Covaxin – can prove that it works.

“Immunogenicity is indicative that the vaccine would work, but it won’t say to what extent. It does not predict efficacy. That has to be tested in as close to a population setting as possible,” said Dr Shahid Jameel, a Delhi-based virologist.

Centres administering Covishield, on the other hand, have had no-shows over fears of side effects and adverse events.

Nine health workers who received Covishield died between one and five days after the shot, with all deaths ascribed to cardiovascular problems or “brain stroke”. India’s drug regulator said the deaths were unconnected to the vaccine.

“Because of the uncertainty over the deaths of people who got Covishield, me and my husband sought out and signed up for Covaxin,” said Dr Shanthi Ravindranath, secretary of Chennai’s Doctors’ Association for Social Equality.

But she empathised with many of her friends who wavered.

“When approvals are given in a hurried manner… it’s normal for questions to arise in anyone’s minds,” she said.

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