The second wave of the Covid-19 coronavirus pandemic is wreaking havoc in India. At the beginning of the year, it seemed India had effectively controlled the spread of the virus. The vaccination drive had also begun. India hoped to vaccinate 250 million people by July 2021.
With light at the end of the tunnel, a sense of normalcy crept in. And India let its guard down against the virus. Cinema halls, restaurants, schools, gyms reopened. Weddings, religious gatherings and travel resumed. Farmer unions from Punjab and Haryana blocked the state borders of Delhi in protest against the farm laws. The states of Assam, Kerala, Tamil Nadu, West Bengal and the Union Territory of Puducherry went to the polls and saw massive election rallies.
This complacency observed by the people and the governments across the nation has put India in a precarious position. On April 30, India breached the 4-lakh mark for new cases and registered 3523 deaths. The supply of vaccine doses, availability of beds, medical oxygen, remdesivir is the need of the hour. The baton to manage the crisis is in the hands of the state governments. Vaccinating the population while managing the crisis is the only way forward.
India started vaccinating people on January 16, 2021. The country registered 16,000 odd new cases. It was the average during the period from mid-January to the beginning of March. Due to the low number of cases, the vaccination drive was slow. The phased, gradual rollout of vaccines reached only a section of the population.
The first phase of vaccination rollout saw the elderly get vaccinated. All people above the age of 65 were eligible. The second phase started on March 1. Senior citizens above the age of 60 and people above the age of 45 with comorbidities were brought under the vaccination program. Later, all people above 45 could get vaccinated.
In the third phase of the vaccination drive, The government announced vaccinations for people above the age of 18. They would be eligible to get vaccinated from May 1. However, a shortage of vaccine doses has delayed vaccinations. Only six states – Maharashtra, Rajasthan, Uttar Pradesh, Chhattisgarh, Gujarat and Odisha – are going forward with vaccinating the population above 18 from May 1. The vaccination program in these states is restricted to a few districts.
According to the data on the Ministry of Health and Family Welfare (MoHFW) website, a total of 154,989,635 doses of vaccine were administered to date. 127,056,746 people received one dose of the vaccine (Covaxin or Covishield). 27,932,889 received both doses. This amounts to 9 per cent of the population receiving a single dose. 2 per cent of the population has been fully vaccinated.
Apart from the slow pace of vaccination rollout, the vaccination drive of India slowed down due to the non-availability of raw materials to manufacture vaccines. The other reason for a slow down is that the government did not order enough vaccines. The Union Government paid for 1.1 crore vaccines in January. A bulk order would have given the Serum Institute of India (SII) and Bharat Biotech enough capital to produce vaccines for the entire population.
Condition in the Different States in the Country
The crisis created by the second wave of the pandemic saw a breakdown of health infrastructure. Many states in the country are dealing with a shortage of beds, ventilators, oxygen supply, medicines and vaccines. The Supreme Court and the High Courts in various states have taken suo-moto cognizance of the situation. They have rapped the states and the Centre on their knuckles about the prevailing situation and redressal measures.
Instances of hoarding of medical supplies and oxygen have also been reported. The police arrested the individuals involved and registered cases. With the state governments overlooking vaccination programs, a peek into the measures adopted by different states will paint a picture of the existing situation.
The state of Maharashtra is the worst affected by the pandemic in the country. It is reporting more than 60,000 cases and 1000 deaths daily. The Health Ministry warned the state in January about the rising number of coronavirus cases.
Corruption by travel operators and government officials entrusted with screening international passengers saw the spread of the virus. Fires broke out in COVID designated centres in the state. An oxygen leak at a hospital in Nashik saw 22 people dead. The state saw a shortage of Remdesvir.
At the moment, the state of Maharashtra is under lockdown. Maharashtra Chief Minister Uddhav Thackeray addressed the state on the issues of availability of medical oxygen, vaccines and more.
On the issue of oxygen, he said the state can produce 1200 MT of oxygen. He told the hospitals that they should have oxygen generating plants. Tenders were issued for them, and the procurement has begun. “We are using 1700 MT per day. We are trying to transport oxygen on a timely basis but if the numbers keep rising, this can be a problem”, he added.
The CM addressed the state on the situation of availability of vaccines in the state. He said that the state government is ready to purchase 12 crore doses of vaccines. He further added, “We are in talks with all vaccine-making companies – not just Serum Institute of India and Bharat biotech, but also Sputnik V… As per the Central government, 18 lakh doses will be allotted to us in May”. The state of lockdown in Maharashtra could be prolonged due to the high number of cases.
The situation in the state of Delhi is horrific. The state faces a double crisis- a crisis created by the spread of the pandemic, another created due to political bickering. It is exacerbated by the hoarding of medicines and medical oxygen.
The Supreme Court and the Delhi High Court stepped in to bring a semblance of accountability in the state. The state is suffering from a lack of beds, oxygen and medicines. The Delhi High Court came down hard on both the state and central government. The courts minced no words in their observations. The Delhi High Court warned of contempt action against the Centre if it did not supply Delhi the allotted amount of oxygen. Taking cognizance of the deaths at Batra Hospital due to lack of oxygen, the court told the Centre “enough is enough”. It further asked the Centre, “Do you mean we will shut our eyes to the people dying Delhi.”
On black marketing of oxygen and medicines in the state, the court told the Delhi government that ‘the system has failed’. It cautioned the government to get its house in order. The bench of Justice Vipin Sanghi and Justice Rekha Palli told the government, “If you can’t manage it, tell us. Then we will ask the Central government to take over. We can’t let people die”. The court also ordered the Delhi government to release Remdesivir seized from the hoarders.
The Supreme Court told the Delhi government there must not be any politics on the matter of the Covid-19 pandemic. It said, “We want to send a message to the Delhi government that it must take the approach of cooperation. Please send the message to the highest level that at extreme times, there should not be any political bickering.”
The Delhi Police arrested seven people for black marketing oxygen cylinders and Remdesivir. In the latest incident, it busted a racket in East Delhi’s Laxmi Nagar and arrested three people. The accused people allegedly sold the drug Remdesivir at an exorbitant price of ₨ 40,000 per injection. The police seized three Remdesivir vials, ₨ 1,20,00 in cash, 100 oximeters and 48 small oxygen cylinders.
A political blame game is played by the ruling-BJP government and the AAP-ruled Delhi government. Accusations were hurled thick and fast on the issue of money sanctioned for oxygen manufacturing plants in Delhi. At present, Delhi has 99,361 active cases and a death toll of 16,147. The Delhi government extended the lockdown for another week to control the rising number of cases.
The statements of Chief Minister Yogi Adityanath and the ground reality in Uttar Pradesh (UP) are mismatched. The CM on television stated that there was no shortage of beds, oxygen supply or drugs in the state. The reality paints a different picture. Hospitals in the cities of Meerut and Agra put up notices asking kin of patients not to admit them due to a shortage of oxygen supply. The situation is the same in the case of the availability of hospital beds.
Kins of patients are running from pillar to post to secure the availability of oxygen and Remdesivir. The hospitals are putting the onus of getting oxygen for patients on their relatives. An oxygen manufacturing plant shut its offices indefinitely after a scuffle broke out between management and the local population. People are adding to the problem by occupying beds despite not requiring hospitalization. Several people occupied beds in private hospitals of Noida and Greater Noida. The Gautam Buddh Nagar administration vacated over 200 people after they did not need hospitalization as per their health condition.
The hoarding and black marketing of Remdesivir and oxygen supplies is happening in large numbers in UP. A week-long crackdown by the state police resulted in the arrest of 29 people. The police seized 628 Remdesivir vials and 185 oxygen cylinders. The UP government announced a total lockdown from April 30 to 7 am on May 4. A silver lining for Uttar Pradesh is the number of recoveries is higher than the number of new cases. UP recorded 30,180 new cases and 38,826 recoveries on May 1. 304 people succumbed to the virus.
The cases of Covid-19 are increasing at an alarming rate in Karnataka. Over the last 24 hours, Karnataka recorded 35,024 new cases. Of these, 19,637 were reported from the city of Bengaluru. On May 1, the state reported 40,990 new cases and 18,341 recoveries. The city of Bengaluru reported 19,353 cases. 271 people succumbed to the virus in the state.
The Karnataka government claimed that 25 per cent of newly infected patients were untraceable. 3000 people placed in home quarantine have gone missing. The hospitals and officials are unable to reach them. The patients have turned off their mobile phones. The mobile phones of a few people are unreachable—this a super spreader calamity due to a lack of civic sense. On the status of vaccination rollout in the state Chief Minister B S Yeddyurappa stated on Thursday that the Government of India supplied 99.40 lakh doses of vaccine to the state. 93.50 lakh doses of vaccine were administered, and 5.9 lakh doses are available. He added that the vaccination drive for the age group 18-45 would be undertaken in a phased manner.
Karnataka is not starting the third phase of vaccination from May 1. It has a shortage of vaccinations. The state government launched the third phase with a symbolic gesture. The CM stated the state is procuring an additional one crore doses of the Covid-19 vaccine from private companies. The state of Karnataka is under lockdown for two weeks. The statewide curfew will last till May 4. Its southern neighbour Kerala faces similar difficulties. The Kerala government has ordered one crore vaccine doses for its vaccination drive.
At the height of the second wave, the Health Minister of Telangana Etela Rajendra has resigned on land grabbing charges. Chief Minister K Chandrasekhar Rao ordered a probe into the irregularities. The number of cases reported by the Telangana over the last week ranged between 7000-10,000. There is no district-wise break up of cases provided by the government. There is an acute shortage of vaccine doses in the state. People supposed to receive the second dose are finding difficulties in registration.
The state government has not rolled out the third phase of vaccination for the age group 18-45. Meanwhile, the government has recalled the doses of vaccine from private hospitals. It asked the private hospitals to obtain vaccines directly from the manufacturers. The situation is the same in all the states across the country. Smaller states like Goa and the states in the North East are recording smaller numbers. Thus they remain out of the news cycle.
Manufacturers have informed state governments about a delay in the supply of vaccines. Maharashtra asked SII to provide 120 million doses. SII told the government supply would not be possible till May 20. Rajasthan said that it was given a tentative date of May 15. Odisha said Bharat Biotech could make a supply of vaccines only in mid-May.
The alarming numbers in the second wave of the pandemic result from a collective failure. A short-sighted approach in placing orders by the Central government has resulted in a vaccine shortage. The people contributed by disregarding safety protocols of masking and social distancing. It will take a while before India overcomes the second wave.
Hypocrisy of Federalism: Reply on Oxygen Related Deaths
On Tuesday, the Union Health Ministry reported to the Parliament that no deaths were recorded due to a lack of oxygen across the country during the second wave of the pandemic.
The officials and ministers in eight states also denied fatalities due to the lack of oxygen. Whereas reports indicate that approximately 320 patients may have died in the second wave of the COVID-19 pandemic due to oxygen shortage.
The report by the Union Health Ministry to the Parliament has triggered massive criticism across the country. It has also prompted some significant accusations against the Bhartiya Janata Party [BJP].
The denial of the officials and ministers of the eight states regarding the same has also triggered a major rebuttal from within their parties, accusing them of aiding the Centre in hiding oxygen-related deaths.
According to a volunteer-driven data collation effort, DataMeet, Media from across 20 states report that there were approximately 619 deaths recorded due to lack of oxygen. However, later the cause of deaths was disputed with other factors that attributed to the fatalities.
The state health minister of Maharashtra, Rajesh Tope also sided with the Centre’s stand of no-oxygen-related deaths.
“As far as Maharashtra is concerned, we have never said that any death due to oxygen shortage,” he said to a local TV channel on Wednesday.
However, in April and May, the shortage of oxygen supply in the state had prompted the Chief Minister, Mr. Uddhav Thackeray, to request the Prime Minister, Narendra Modi, to inspect the proposal of pressing the Indian Air Force to arrange additional oxygen supplies for the state.
A medical board in Hisar- a region in Haryana, had openly established oxygen shortage as a cause of deaths in the region.
Additionally, after an inquiry, 22 patients succumbed to Covid due to the lack of oxygen in Haryana.
According to the reports of DataMeet, figures indicated that approximately 68 deaths took place across the state of Madhya Pradesh due to lack of oxygen.
However, Vishwas Sarang, the medical education Minister, stated, “We received at least 10-12 complaints related to deaths due to oxygen supply disruption. Medical experts found the cause of death was other medical complications, not hypoxia,”
In Goa, between May 10- May 14, approximately 83 patients succumbed to death.
But according to Dr Shivanand Bandekar, the Dean of Goa Medical College and Hospital stated, “We can’t put this as a direct answer. People who come to GMC, they are all referred because we are a tertiary (care) center where criticality is high and most of the patients die because of Covid pneumonia where oxygen is a part of the treatment. So we cannot directly say this (disruption in the oxygen supply) is the reason why they have died,”
However, during the hearing at Goa at the time of these deaths, the state government had admitted that “some of the casualties may have taken place” due to supply disruption.
Within the same hearing, the Bombay High Court had said, “We have long passed the stage of determining whether patients are suffering from the lack of oxygen or not. The material placed before us establishes that patients are indeed suffering and even in some cases succumbing for want of the supply of oxygen, in the State of Goa.”
Officials and ministers of several states like West Bengal, Odisha, Bihar, and Uttar Pradesh took a similar stand while siding with the Centre on their “no deaths due to Oxygen shortage” statement.
Even though various reports and data reflect a significant number of deaths due to a shortage of oxygen supply within different states, the Center and the state officials have refused to acknowledge them and have denied that these fatalities are attributed to the lack of oxygen supply.
Health Activist Amulya Nidhi from Madhya Pradesh, claims that volunteer groups from across the country have clear case studies and data that report deaths of patients across various states due to a lack of oxygen supply. “If they are so sure about it, they should allow an independent team of experts to probe the matter,” he said.
Why Are people Not Taking Covid Vaccine?
Since the beginning of the Pandemic in 2020, all people have wanted is to find a way back to normal. A way from virtual lives to real, social lives. Being trapped at home with limited movement has been fun for no one. And yet, when a solution is finally being offered, people are hesitant to embrace it. Vaccines are the solution to once and for all immunise us against this virus, but many people fail to embrace the cure. Even though the vaccination reduces risks in exposure to the mutating variants of the Novel Coronavirus, there are people reluctant to take the possibly life-saving shot.
A vaccine race began throughout the world to curb the spread of Covid, India being one of the leaders. Immunisation is proven to be the most successful means to prevent diseases. Still, there is always hesitance that follows with the process. Many reasons cause vaccine hesitancy, but three of the main reasons are inadequate knowledge and fear of side effects, the speed of vaccine development, and rumours and myths.
The biggest fear that prevents people from taking the vaccine is a fear of side effects caused by inadequate knowledge. Many of us might show reluctance in taking the vaccine, fearing the severity of side effects. This tends to happen because most people do not understand how a vaccine works and nudges our bodies to create antibodies in our system to immunise us to the virus.
Many people reason that the side effects make them sick when they have been in perfect health for so long. They believe that it is the vaccine that makes them sick. This cannot be further from the truth. The public needs to be made aware of the workings of the vaccine to promote the vaccination drive around the world.
The other cause for hesitancy is the speed at which the vaccines have been developed. Many people believe that simply because the development speed of Covid immunising shots was quicker as compared to past viruses, corners have been cut in the process. It is essential to know that this is not true as all the procedures have been followed during the development of vaccines. None of them have been permitted for distribution without clinical trials and the approval of the FDA.
The last reason is that of rumours and myths. The rural population, a key demographic in our country, is reluctant to take the vaccine due to a lack of information provided to them. The inadequacy makes them quick to believe in rumours and myths surrounding immunisation, consequently making them reluctant to participate in the process. Reports of death post the vaccine have fanned the rumour mills in rural areas regarding the fatality of the vaccine.
Hesitancy in vaccination can also be seen in another key demographic, women. The proof for this in India is the disparity in men’s vaccination ratios which are starkly contrasting. Rumours and myths surrounding vaccines have led the population to believe that taking the jab affects fertility in women. It is essential to know that vaccinations do not cause infertility in men or women. It is this kind of rumour-mongering that causes fear in people.
Misleading tweets by prominent figures also cause vaccine hesitancy. One prime example is senior advocate Prashant Bushan, whose tweets about the efficacy and safety of covid vaccines were tagged as “misleading” by Twitter.
Misinformation being spread by prominent people is another cause of reluctance in people not taking the vaccine, which must be stopped to defeat the Pandemic.
Many people who have already suffered from Coronavirus also believe that they do not need the vaccine as they are already immune to the disease. This is a falsehood that needs to be cleared as a vaccine prolongs the effectiveness of the immunisation, keeping the person safe for a more extended period.
Vaccines are preventative medicines that allow us to acquire immunity against the virus, preparing our bodies to protect us in case of exposure to the disease. While vaccination may not provide complete safety, it reduces the severity of the infection and the chances of death.
With newer and stronger variants emerging as mutations of the Coronavirus, all of us must be fully vaccinated. It is the only way to ensure the safety of ourselves and those around us. It is also the only way to make a return slowly but surely to what we knew as “normal” and stop living life as we have known for the past one and a half years.
"No one from govt has come to visit us or order an enquiry into my wife's death.I still curse myself for persuading my wife to take the vaccine.I thought it would save us from the virus, but it killed her".
The govt is not monitoring adverse events from vaccine nor releasing data pic.twitter.com/pcJv9cqUYW
— Prashant Bhushan (@pbhushan1) June 28, 2021
ZyCov-D Proposed As World’s First DNA COVID Vaccine
With the Delta Variant setting its wave globally, ZyCoV-D, India’s first Plasmid DNA Covid-19 vaccine, is in the running for an Emergency Use Authorization from the Drug Controller General of India (DCGI). Vaccine maker Zydus Cadila, which already has anti-Covid treatments on the market, claims to have conducted the largest clinical trial in India so far at over 50 centres, with over 28,000 volunteers ranging in age from 12 to 18 years old.
According to the firm, with its 66.6 per cent effectiveness for RT-PCR positive patients in the interim study, ZyCov-D has already demonstrated solid immunogenicity, tolerance, and safety profile. It went on to say that no moderate instances of Covid-19 were seen in the vaccination arm after the third dose was administered, indicating a 100 per cent effectiveness for mild illness.
What is Zydus’ approach?
By mid-August, the business intended to be manufacturing 10 million doses each month, according to managing director Sharvil Patel. “We are currently only focusing our efforts on making sure we can make doses available for India,” Patel said in a virtual news conference. If the injection is approved, it will become the country’s sixth vaccination to be approved for use.
Patel added that data on immunogenicity for the adolescent children subgroup would be submitted in the next four to six weeks.
The pharmaceutical company has also provided data on a two-dose regimen for the injection.
What are DNA vaccines?
ZyCoV-D, if authorized, will be the world’s first DNA vaccine, according to Zydus, since it uses a piece of the SARS-CoV-2 virus’s genetic code – DNA or RNA – to trigger an immune response against the virus’s spike protein.
How are DNA vaccines Different from mRNA vaccines?
In contrast to the viral vector vaccines or inactivated vaccines like Covishield and Covaxin, DNA and RNA vaccines trigger an immune response by using a portion of the virus’s genes.
The distinction between DNA and RNA vaccinations is that the latter is passed on to a different molecule known as messenger RNA. The DNA vaccination also uses a tiny electrical pulse to convey the message to the cell.
DNA and RNA vaccines are less expensive than standard protein vaccinations. They are praised for their efficacy and capacity to be produced more quickly. Because DNA and RNA vaccines rely on genetic code rather than a live virus or bacterium. They may theoretically be made more widely available.
According to research published in the medical journal Frontiers in Immunology in 2019, “preclinical andclinical trials have shown that mRNA vaccines provide a safe and long-lasting immune response inanimal models and humans.”
According to WHO, DNA vaccines have a variety of potential advantages over traditional methods, including activation of both B and T cell responses and improved vaccine durability.
Is ZyCov-D needle-free?
A needle-free injectable method is reported to be used to deliver ZyCoV-D. (NFIS). In most NFISs, a jet of fluid is accelerated to a high enough speed to penetrate the skin through a tiny diameter nozzle. The vaccination may have a greater acceptance rate among youngsters who are afraid of needles, according to Sharvil Patel, managing director of Cadila Healthcare.
The three doses of Zycov-D should be given on days 0, 28, and 56, according to Zydus Cadila. The firm is, however, working on a two-dose vaccination.
According to the company’s information, the vaccine candidate may be stored for a long time at two to eight degrees Celsius and for a brief time at 25 degrees Celsius.
What does the Government have to say about the indemnity of the Vaccine?
The Government is still deliberating whether vaccine makers should be indemnified, as Pfizer and Moderna have asked. While a final decision is still pending, key authorities have stated that there is agreement.
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