India’s healthcare workers who will be among the first to get Covid-19 vaccine as the country begins its immunisation drive from January 16 are torn between their professional commitments and personal well-being, amid concerns about the safety and efficacy of at least one of the two approved vaccines.

“We are apprehensive,” said Manish Mishra, a doctor at the government-run Patna Medical College and Hospital in Bihar. “But we have very little choice since we are the first points of contact with patients. If we are infected, we can infect a large number of patients.”

India will begin its vaccination drive with two options in the armoury: Oxford-AstraZeneca’s Covishield vaccine manufactured by the Pune-based Serum Institute and Bharat Biotech’s indigenously-developed Covaxin vaccine.

Many scientists and doctors believe India’s drug regulator rushed into clearing Covaxin – it has no large-scale efficacy and safety data so far.

Controversial Covaxin

Government authorities have strenuously tried to allay concerns about the safety of Covaxin.

A member of the national task force on Covid-19 management, Randeep Guleria, initially said the vaccine will only be used as a “back-up” in case of a surge in cases.

He added it will be given in the “clinical trial mode” – which means the consent of the recipients will be sought and they will be monitored for side-effects like they are in a trial.

No choice?

But now it appears the both the vaccines would be administered simultaneously and healthcare and frontline workers may not have a choice, after all.

In a press briefing on Tuesday, Union health secretary Rajesh Bhushan said it in almost as many words. “No country offers beneficiaries such choices,” he said, responding to a query on whether healthcare workers would have the option to choose between the two vaccines.

The procurement patterns also suggest that the two vaccines will be used side by side. The government has procured 11 million doses of Covishield and 5.5 million doses of Covaxin. The government paid Rs 200 per dose of the former. As for Covaxin, the government bought 3.85 million doses at Rs 295 per dose. Bharat Biotech has offered the rest of the 1.65 million doses for free as “special gesture” to the government.

Top officials at the National Expert Group on Vaccine Administration for Covid-19 which is overseeing the drive did not respond to email queries seeking more details about the exact pattern of division of the two vaccines among the targeted beneficiaries.

Courtesy: Press Information Bureau

‘Will obviously opt for the Oxford vaccine’

Healthcare workers, for their part, appear to be less than enthusiastic about Bharat Biotech’s vaccine . “Given a choice, we will obviously opt for the Oxford vaccine, but we have no idea what will come here and if there will be a choice at all,” said Mishra.

Not just doctors, even community health workers are apprehensive. “We are worried that the government plans to give us a vaccine whose trial is not yet completed,” said D Nagalakshmi, an accredited social health activist or ASHA from Karnataka. “We are still deciding what to do.”

Doctors also expressed scepticism about the government’s plans to monitor recipients of Covaxin for side-effects like they are in a trial. “How is Bharat Biotech or the government going to ensure that for so many people?” asked Prabir Chatterjee, a doctor currently based in rural Bengal who has spent several years serving India’s immunisation program in different capacities.

“They will depend on the primary health workers, but they have got other work to do, they cannot be running behind people monitoring symptoms,” he said. “They are not research institutes to run trials.”

‘We are being made guinea pigs’

The second vaccine, Serum Institute’s Covishield, has not been been free of controversy either. While the Oxford-AstraZeneca vaccine has shown favourable results in large scale trials in Brazil and the United Kingdom, data from Serum Institute’s India trials are yet to be fully examined. That, some activists and researchers think, is problematic as some vaccines tend to produce different levels of protection in different ethnicities.

This has made some health workers apprehensive of both the vaccines.

Navanil Baruah, a doctor at a leading private hospital in Guwahati, is one of them. “It is not about Covishield or Covaxin. I am not going to take any of the vaccines till they go through the normal scientific processes that vaccines go through before being released in the market,” he said. “In this case, they were not approved because of science, but due to politics and commerce. Science is being bulldozed by politics.”

Critics of the government have alleged that its move to fast-track vaccine approvals, particularly of the indigenous Covaxin vaccine, was meant not to serve public interests but score political brownie points among its supporters.

Baruah said there was a “strong suspicion” among doctors that “adverse events [in the vaccine trials] were being suppressed”. “We are not beneficiaries here, we are being made guinea pigs,” he complained.

Chatterjee, the rural Bengal doctor, concurred. “What they are trying to do is to test the vaccines on the doctors and nurses,” he said. “It is sort of a post marketing surveillance to figure out which vaccine is better and can be used on the public at large. Basically, let the doctors and nurses suffer.”

Post marketing surveillance is the practice of monitoring the safety of drugs and medical products after it has been released in the market.

‘We are frontline workers’

Yet many healthcare workers interviewed for this story said they were duty-bound to take the vaccine despite concerns of safety and efficacy. As Divya Madhusudan, a nurse at a private hospital in Delhi, said, “We are frontline workers, we have to take care of the patients, so we have to take it – it is not a matter of choice.”

Trupti Girkar, a nurse at Mumbai’s King Edward Memorial Hospital, said she thought it was her responsibility to get vaccinated to inspire public confidence in the vaccine. “If we only refuse, how can we expect the public to take it?” she reasoned.

Indeed, many healthcare workers seem to believe that a vaccine is crucial to halt the charge of the virus, particularly in the wake of the emergence of new mutations that are believed to make it more infectious.

“There are many doubts over the safety and efficacy of the vaccines, but if you were to ask vaccine or no vaccine, we will go for vaccine,” said Manas Gumta, a Kolkata-based government doctor. “Vaccine is very important to contain the disease and for the security of healthcare workers. So many of them have already perished from the virus.”

Gumta added, “We can only hope that the government compensates [the recipients and their families] in the case of serious adverse events.”

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.