Ideal vaccination rate should be 5 million persons per day: Dr Anoop Misra

Even as India’s daily covid-19 case load breached the 150,000 mark, the vaccine uptake continues to be low. As the comorbid population continues to be at high risk at contracting coronavirus infection, Dr Anoop Misra, chairman, National Diabetes, Obesity and Cholesterol Foundation, President, Diabetes Foundation (India) talked about vaccine hesitancy, importance of vaccination in comorbid population. Misra, also the chairman at Fortis-C-DOC, also spoke about low pace of vaccination programme, research on covid-19 and way forward. Edited excerpts from an interview:

What are the reasons of vaccine hesitancy? Why it is important for comorbid people to take covid-19 vaccines?

Vaccine hesitancy is not specific to India and is widespread globally. More damaging than vaccine hesitancy are the “Anti-vax’ groups who have actively campaigned against vaccines (not only for coronavirus, but all vaccines). Partly, all sorts of wrong messages in social media are to blame. Unfortunately, clear answers regarding some adverse reactions to vaccine are not being disseminated. More strident messages by celebrities, ministers, and doctors etc., in a joint and combined manner are needed to dispel misconceptions regarding vaccines. It is important that people with comorbid diseases (heart disease, diabetes, hypertension, obesity etc.) must take vaccine to ward off serious damages of organs if they contract covid-19. As per our research and that of many others in India, these people are being majorly affected by multiple diseases like diabetes. Some know it, others have not been tested. We have seen increasing patients in this age group with newly diagnosed diabetes during lockdown and subsequently and have analysed and published that they have more difficult and severe diabetes than previously seen patients.

Are adverse reactions following immunization more in comorbid patients, if yes, why?

Adverse effects are being seen in all age groups and these are largely minor and easily managed. We are now seeing rare cases of increase in blood pressure and blood sugar after vaccination. Again, these have been easily treated. Patients with hypertension should get their blood pressure checked frequently before and after vaccination. People who have history of blood clots (thrombosis) or an allergy (of any kind) should be careful and ask their healthcare provider before taking vaccine.

What is the share of the population in India that has comorbid conditions? How do covid-19 vaccines prevent these people from the highly infectious disease?

If we take population above 18 years of age, and calculate all comorbid conditions, about 40% of people (in large cities, more) will have one or more of these conditions. Of course, there are wide variations, depending upon several factors and socio-economic stratum. Many of these people have inadequate immunity. Hence, one of the simplest ways to boost immunity in people with co-morbid disease is vaccination. In many of these patients, other vaccines such as hepatitis, pneumonia and flu have been recommended for more than a decade. Intermittent vaccination (e.g., yearly) against covid-19 will be a norm in future.

Is government’s strategy to extend vaccine cover to populations groups is effective? What are your suggestions to the government on its vaccine strategy?

Overall, government has done well in vaccinating people as compared to many other nations. However, I believe we could speed up the process. More vaccines should be quickly obtained, and more centres should be set up. Ideal vaccination rates should be about 5 million persons per day which seems difficult to achieve yet.

What are the latest research studies being done on comorbid patients and covid-19? And what do these studies suggest?

Maximum speed of research on drug therapy for covid-19 for people with co-morbid disease is going on, but its pace may slow down as covid-19 cases go down in US, UK, and other European countries because hub of good research is still in these countries. For now, and in near future, more important is to focus on research on generation of robust immune response after vaccine in people with co-morbid diseases, and on resolving the question on how long this immunity will last. Further unanswered questions remain; research on if vaccines-induced antibodies can counter variant viruses and if further booster shots are required.

How is the healthcare sector dealing with the double burden of covid-19 and non-communicable diseases (NCDs)?

The whole focus is currently on covid-19, and little on NCDs. It is also rational to allocate most resources to tackling covid-19 and vaccines. Unfortunately, covid-19 pandemic and poor attention to NCDs is already causing surge of bad cases of heart disease and diabetes. People are not able to follow proper diets, exercise and do not receive proper medical guidance. Huge amount of stress, often financial, is complicating matters further. As a result, people are non-compliant to treatment as well.

What is your opinion on rising cases in India and second wave? What are the risks that comorbid patients will have even after two doses of vaccines?

Clearly, opening of all places, increasing crowds, and exponentially increasing noon-compliance to mask and physical distancing are primary causes. To some extent, variant (mutant) viruses might have played a role. Risk of contracting covid-19 after two doses is rather small, but we do not yet know how long effective immunity will last.

What is your opinion on safety and efficacy of available vaccines and what new vaccines are you looking at?

For now, it is remarkable that we have options of so many effective vaccines developed over rather short period across the world. Most of the vaccines are largely similar in efficacy, with some differences in percentages. However, the data of new vaccines is still being unveiled. An ideal vaccine is the one which gives 70-90% protection against covid-19, and 100% protective against life threatening disease, and could be given in a single dose. However, it is the long-term efficacy (more than 1 year) that will determine if vaccine is really worthwhile.