COVID-19 Vaccination in India - An Update

Introduction

The world is grappling with the coronavirus pandemic and is fighting hard to beat it. It has been more than two years since the first lockdown was initiated in March of 2020. As of June 2022, the COVID 19 cases in India stand to:

Total cases: 43,138,393

Total recovered: 42,599,102

Active cases: 14,832

Total deaths: 524,459

Total vaccinated: 1,92,38,45,615

Source: Ministry of Health and Family Welfare

National COVID-19 vaccination programme

Let's take a look at the vaccines that are currently available in India:

Covishield

Covishield is brand name of Oxford-AstraZeneca COVID-19 vaccine and is marketed under the brand name Covishield by the Serum Institute of India. The vaccine has been made available to the central government at INR. 157.50 per dose but it is offered free of cost in all government hospitals. The vaccine is also available in private hospitals at INR 390 per dose.

To be eligible for the third (booster) dose of Covishield, there must be a gap of 9 months between the second and the third dose. Once the 9-month gap between the second and third dose has been completed, the individual can book an appointment using their Co-WIN account.

Covaxin

Covaxin, being developed by Bharat Biotech and the government-run Indian Council of Medical Research (ICMR) and the National Institute of Virology (NIV). The vaccine is made available to the central government at INR 225 per dose but it is offered free of cost in all government hospitals. The vaccine is also available in private hospitals at INR 225 per dose.

The subject expert committee (SEC) of the Drugs Controller General of India (DCGI) recommended the use of Bharat Biotech's Covaxin among children aged 6-12 years. The recommendation has been sent to the DCGI, who will give its final nod. Covaxin is currently being administered to children in the age group of 15-18 years. Bharat Biotech has sought permission from India's drug regulator to conduct a phase 2/3 study of its Covid vaccine Covid vaccine Covaxin as a booster dose among those aged two to 18 years.

To be eligible for the third (booster) dose of Covaxin, there must be a gap of 6 months between the second and the third dose.

Once the 6-month gap between the second and third dose has been completed, the individual can book an appointment using their Co-WIN account.

Sputnik V

Sputnik V is manufactured by Dr Reddy's laboratory in India in collaboration with the Russian Direct Investment Fund. Sputnik is available at INR. 1145 per dose. The suggested time gap between two doses is 21 days. A lighter single-dose version of the vaccine called Sputnik Light has been studied in India for its efficacy.

RDIF has partnered with the Serum Institute of India for the local production of Sputnik Light. The vaccine may also be used as a booster dose in previously vaccinated people to maintain herd immunity. The vaccine is estimated to cost around INR. 730.

The two doses of Sputnik V vaccine have separate compositions. The first dose of the vaccine contains a recombinant adenovirus type 26 (rAd26-S) and the second dose is a recombinant adenovirus 5 (rAd5-S).

National Technical Advisory Group on Immunisation (NTAGI) has given its approval to the first dose of Sputnik Covid-19 vaccine to be administered as a booster dose to all those vaccinated with the Russian vaccine.

ZyCov-D

The Zydus Cadila called ZyCov-D vaccine uses plasmids or small rings of DNA that contain genetic information - to deliver the jab between two layers of the skin. The three-dose ZyCoV-D vaccine (administered at 28 days' gap for each dose) prevented symptomatic disease in 66 per cent of those vaccinated, according to an interim study quoted by the vaccine maker Cadila Healthcare. It is also India's first needle-free Covid-19 jab administered with a disposable needle-free injector, which uses a narrow stream of the fluid to penetrate the skin and deliver the jab to the proper tissue.

The vaccine has a storage temperature of 2-8 °C and showed good stability at a temperature of 25°C for up to three months. The vaccine is administered

through the skin into the layers of the tissue with a specialised needle-free injector. One dose of the vaccine is currently priced at INR. 265 per dose. The needle-free applicator will be available at INR. 93 per dose. The vaccine is given in three doses within the gap of 28 days. The Drugs Controller General of India (DCGI) granted Emergency Use Authorisation for ZyCov-D for inoculation in children above 12 years of age.

Corbevax

Corbevax is a recombinant protein subunit vaccine, meaning it is made up of a specific part of SARS-CoV-2 virus which causes Covid-19 - the spike protein on the virus's surface. It is developed by the Texas Children's Hospital Center for Vaccine Development and Baylor College of Medicine and licenced to India's Biological E.

Corbevax can be stored and transported at 2 to 8° Celsius. The vaccine has received approval from the Drugs Controller General of India (DCGI) for use on children between 12-18 years of age (under certain conditions). Corbevax costs INR 990 including taxes per dose, and is available for free in government-run vaccination centres.

Covovax

Novavax is a protein-based COVID-19 vaccine developed by Novavax Inc. USA and is manufactured by the Serum Institute of India by the name Covovax. Covovax is a local version of the Novavax vaccine. The vaccine was more than 90 per cent effective in a late-stage US-based clinical trial.

It requires two doses and needs to be stored at 2 to 8° Celsius. The Subject Expert Committee (SEC) of Central Drugs Control Standard Organization (CDCSO) recommended Covovax for emergency use authorization (EUA) for 12-17 year olds in India in March 2022. A dose of Covovax will cost INR. 900 plus GST, in addition to hospital service charge of INR. 150,

Other vaccines currently under review

Bharat Biotech intranasal vax also known as BBV154 is a novel adenovirus vectored, intranasal vaccine for COVID-19. It has excellent potential for vaccination due to the organised immune systems of the nasal mucosa. Inhaling the vaccine at the site of infection (in the nasal mucosa) - essential for blocking both infection and transmission of COVID-19. It will be non- invasive and needle-free. The Drug Controller General of India approved phase 3 clinical trials of the nasal COVID-19 vaccine developed by Bharat Biotech. The study is set to kick off at nine sites across India including the All India Institute of Medical Sciences in the Delhi and in Patna. The trials will evaluate the safety and efficacy of the vaccine in those who have already been fully vaccinated with Covaxin or Covishield, and will also test it as a primary dose against infection.

A recent study conducted in Israel has shown that after two doses of Tozinameran from Pfizer-BioNTech, the vaccine provides

95.3 per cent protection against the infection and significantly reduces the risk of death. The US FDA has authorised a booster dose in adults who have been previously vaccinated. A recent report has stated that the Indian Government is not willing to import and purchase Tozinameran as domestic output for more affordable vaccines has increased significantly.

Moderna's vaccine has been found to remain stable at -20° Celsius for up to six months. It can be stored in a refrigerator at 4° Celsius for up to 30 days. The Phase 3 clinical trials of the vaccine have shown mandated that those who have received Covishield as their first two doses must take the same as the booster dose and those who have received Covaxin as their first two doses must take the same as the booster dose.

• Pregnant women in India are advised to take either the Covishield, Covaxin or Sputnik vaccine by the health advisories and medical authorities in India.

• On the day of vaccination, inform your vaccination officer about your health condition and medication to avoid any complications.

• Observe any side effects after vaccination and keep your physician informed about them.

Things to remember

• The Government of India has also mandated that those who have received Covishield as their first two doses must take the same as the booster dose and those who have received Covaxin as their first two doses must take the same as the booster dose.

• Pregnant women in India are advised to take either the Covishield, Covaxin or Sputnik vaccine by the health advisories and medical authorities in India.

• On the day of vaccination, inform your vaccination officer about your health condition and medication to avoid any complications.

• Observe any side effects after vaccination and keep your physician informed about them.