COVID-19 vaccine programme: Under-45s with comorbidities feel left out

Senior citizens at the vaccination facility at Dahisar Jumbo COVID Centre on Wednesday. Pic/Satej Shinde

Three days after the start of vaccinations for senior citizens and those aged between 45 and 59 years having comorbidities, some citizens have questioned if those below 45 don't have comorbidities. Families who have young ones fighting life-threatening ailments, on dialysis, chemotherapy, or immunosuppressants/steroids, have argued that such people are at greater risk of contracting COVID-19 as they also have to go out for work, visit hospitals, etc.

An elderly woman at the Dahisar Jumbo COVID Centre's vaccination centre on Wednesday. Pic/Satej Shinde

A Chartered Accountant (CA) from Thane district who did not wish to be named, said, "My wife underwent a bone marrow transplant for multiple myeloma four years ago and my son, in his early 20s, undergoes dialysis at home after his body rejected a transplanted kidney. Both of them are at high risk. While my wife is above 45 years, my son can't get the vaccine. Isn't this unfair?"

Dr. Shailesh V. Shrikhande, deputy director, Tata Memorial Hospital (TMH), Mumbai, said, "Those aged below 45 years will be covered gradually. Government authorities are keen to get everyone vaccinated. With a population of 130 crore in India, the demand and supply of vaccination will surely not be easy for anyone to manage the world over."

Dr Shrikhande added, "I belong to a family of doctors, all of us have by default got vaccinated, as we are front line workers. But my mother (83) is renal patient and has to undergo dialysis once in 4 days and my father who is also a surgeon and is ninety years old, both are yet to be vaccinated and we will be going as per the advice of our nephrologists and other specialists, who will advise us about the immune condition of my mother, and whenever they suggest, we will go ahead with vaccination. I would advise younger people with comorbidities to not panic or hurry. The vaccines' efficacies are being monitored and adverse reactions in comorbid people are being evaluated. Even after the vaccination, COVID hygiene will have to be maintained for more than a year."

"TATA Memorial Centre is exploring possibilities of offering vaccination to cancer patients and cancer hospital employees," he added.

‘Immunise to stop resurgence'
Dr. Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals, said, "It is pertinent to note that a sizable Indian population below 45 years suffers from comorbid ailments like high blood pressure, diabetes, chronic kidney failure, heart ailments, thalassemia, cancer, etc.

"Why should this young and sick population be discriminated against and denied the COVID-19 vaccine? These people do go out of their house for jobs, hospital visits, etc. This could make them more vulnerable."

Dr. Shaikh quoted an article published in the journal ‘Science' on February 2, which concluded that the resurgence of COVID-19 in the US has been driven by adults aged 20 to 49 years. The study also concluded that mass vaccination for this age group could control COVID.

"Indeed, denying the vaccine to the young with comorbidities could result in a resurgent COVID in India," Dr Shaikh said.

‘Include youngsters in Phase 3'
Dr. Subhash Hira, Professor of Global Health at the University of Washington-Seattle and advisor to several UN and Indian health agencies, said "India has embarked on delivering the world's largest indigenous COVID-19 vaccine program to its young and adult (21 years) population. It is based on findings of several quick studies done by health and research institutes, such as the MOH & the ICMR. In Maharashtra, an early government report of 882 COVID-19 cases recorded 66 deaths with the following breakdown: 2% deaths occurred in 21-45 years of age, 70% deaths in 45-60 years age having two or more co-morbidities, and >23% deaths in 61-80 years of age. Furthermore, based on scientific data available globally, the national health leaders at Niti Aayog and MOH drafted a strategic design to get the best outcomes of COVID-19 vaccine delivery starting in January 2021 as the nation took the leap forward to protect its citizens. In Phase1, over 10 crore frontline workers in the health, enforcement, and national service sectors were to be covered by June 2021. Phase 2 starting in March 2021 will cover another 10-crore elderly, and over 4/21 crore of vulnerable individuals in the age group of 45-60 years, with significant comorbidities. These serious illnesses are considered mostly to be diabetes>10 years standing, heart conditions, cancers, immune-compromised states such as HIV/AIDS and host of several permutations and combinations of chronic illnesses. However, in Phase 2, individuals with similar co-morbidities and genetic disorders, but who are under 45 years of age, will be left behind, but possibly to be included in the subsequent strategy of Phase 3 starting in July-August 2021. The phased, differential delivery of COVID-19 vaccines in India is a strategically planned program to ensure best outcomes in providing protection from severe COVID-19 disease and death."

Added Dr. Hira, "Now each case of severe COVID-19 disease and death is preventable. Hence, vulnerable individuals in the age of 45 years and having co-morbidities deserve to receive vaccine protection. I suggest that as the Phase 2 kicks in, these variations and outliers should be looked at by the Task Force at the State level. The solutions will be easy to get while the nation grapples with many more challenges such as the emergence of variants of SARS-COV-2. India will be a winner because it is in a unique position of producing indigenous vaccines."

Dr Bharat Shah, senior nephrologist and founder trustee of NGO Narmada Kidney Foundation, said, "Anyone below 18 years of age, is not advised to take either of the COVID vaccines. For those who are on immunosuppressants, we recommend Covishield and not Covaxin as it is made of inactivated virus. Generally, transplant patients on immunosuppression are advised not to take live-attenuated or inactivated viral vaccines."

July-Aug
Months this year that Phase 3 of the national vaccination drive is scheduled to begin.