Covaxin or Covishield? A dilemma for India's healthcare workers

A sanitation worker waits to receive a dose of Bharat Biotech's Covaxin at a hospital in New Delhi, on Jan 16, 2021. PHOTO: REUTERS

BANGALORE - After 12 days of worrying, a senior resident in a Shivamogga government hospital got his Covid-19 vaccine jab on Wednesday (Jan 27).

"I'm still not sure if 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. I just wish the government was more transparent so that we didn't have these fears," he said.

India hopes to inoculate 300 million people against Covid-19 by August, and began with health workers since 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: Covishield, the AstraZeneca-Oxford University vaccine manufactured by Pune-based Serum Institute of India, and Covaxin, an indigenous vaccine candidate developed by Hyderabad-based 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," the letter read.

Only about 55 per cent of registered healthcare professionals turned up in Karnataka. Delhi, Tamil Nadu and Maharashtra, the states with the largest number of health professionals, too saw less than half turn up.

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

"I didn't go when it was my turn. I'd like to see data that proves the vaccine's efficacy first. I don't want to be a guinea pig," the senior doctor at Hassan said. He wanted the option to get Covishield.

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

"A Lancet article on Covaxin and the fact that the 60 people who took the vaccine didn't have any side effects convinced me. All we wanted was more data to dispel our fears," said the Shivamogga doctor.

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.

Health workers wait in the observation area after receiving a Covid-19 coronavirus vaccine at the Rajawadi Hospital in Mumbai on Jan 19, 2021. PHOTO: AFP

State health authorities are citing the study to coax those reluctant about getting the jab. But some experts warn that only a Phase III 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 is, what percentage of people would be protected from the disease. That has to be tested in as close to a population setting as possible. That is a phase three trial," said Dr Shahid Jameel, a Delhi-based virologist and director at the Trivedi School of Biosciences at Ashoka University.

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 one to 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, but has not published the details of the investigations.

"Because of the uncertainty over the deaths of people who got Covishield, me and my husband (also a doctor) sought out and signed up for Covaxin," said Dr Shanthi Ravindranathan, secretary of the Doctors' Association for Social Equality in Chennai.

But she empathised with many of her friends who wavered.

"Doctors believe science and the usefulness of vaccines. But in a pandemic, when approvals are given in a hurried manner without required trials and politicisation around the vaccine, it's normal for questions to arise in anyone's minds. Government strategy should be to communicate and build confidence to eliminate any mistrust," Dr Ravindranathan said.

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