Vaccination is health right not a privilege

Bangladesh's Globe Biotech is the only company, globally, to be listed with three vaccine candidates – DNA plasmid vaccine, Adenovirus Type 5 Vector and D614G variant LNP-encapsulated mRNA and other companies have one or two varieties. The candidature of the Globe Biotech vaccine has been shown on the WHO list as a DNA plasmid type vaccine at the preclinical stage.

A Nepalese company Anmol Healthcare Ltd has placed order to buy two million shots of vaccine developed by Bangladeshi company Globe Biotech Ltd after it passes trials. However, Bangladesh government is yet to announce any plan to buy local vaccine. Government has set to import some three crore doses whenever available.

There is a debate all over the world on who should have been at the top of the list to get priority for Corona vaccine. Traditionally, first in line for a scarce vaccine should be the health workers and the people most vulnerable to the infection.

Some experts have already developed draft guidelines for the deployment of early vaccines and proposed a framework for the equitable distribution of any vaccine. These guidelines mostly focus on using the vaccine to protect individuals as targets of the virus, as opposed to using vaccination to slow viral transmission.

An advisory group of the WHO has proposed focusing on the protection of older and more vulnerable people, essential health-care workers and groups in dense urban environments. Another group of experts opined that the less prevalent the virus is, the less that vulnerable people need protecting. Some epidemiological research suggests that vaccinating the most vulnerable may not be the right thing to do.

 A modeling study (2009) on vaccination strategies for influenza concluded that the optimal policy should be on the basis of various measures including deaths and economic costs and a number of other things. If the vaccine apparently immunises only around 50 percent of those vaccinated, then focusing on the most vulnerable was the best strategy. With low vaccine efficacy, even vaccinating most of the population would not be able to prevent continued viral spreading, and so the vulnerable would need direct protection.

High vaccine effectiveness makes it possible to greatly curtail viral spread, thereby making the most vulnerable — even unprotected — far less likely to be exposed to the virus. It also came up in the study as to how many doses of the vaccine were available. If few doses were available, it would be best to vaccinate the most vulnerable. If there were enough doses to vaccinate a decent fraction of the population, then targeting the spreaders would be a better idea, as the achieved immunity level could eliminate viral spreading, although the required fraction depended on how easily the virus could transmit. This study was for influenza, not the novel coronavirus, so its conclusions can only be suggestive.

The comparisons between data emanated from both the 1918 and 1957 influenza epidemics, the latter of which was more coronavirus-like, with fatalities among older people. The researchers found that the best strategy is to target the most vulnerable and vaccinating the younger people and children to reduce viral transmission. There is no published study so far on current coronavirus. It should be noted that protection is only one part of vaccination.

Canada has identified key populations that also include health care workers, caregivers in long-term care facilities and all essential front-line responders essential in managing the COVID-19 response. People who are unable to work remotely and are at risk of exposure, such as police, firefighters and grocery store staff, are also among the key groups in consideration.

 The National Academy of Medicine of USA report proposes regarding distribution of vaccine in four phases as it becomes available. The first recipients are obvious picks: health-care workers, emergency responders, people with underlying conditions, and older adults living in group settings.

WHO recommends that priority be given to people who score high on the Social Vulnerability Index, which identifies factors such as poverty, lack of access to transportation, or crowded housing that are linked to poor health system. The goal is to rectify the pandemic's disproportionate burden on minorities and poor people and to work toward a new commitment to promote health equity.

In Bangladesh, the Covid-19 Vaccine Management Taskforce has prepared a draft list of ten groups and professions and placed for approval of higher authority. If it is approved, a selected number of people of some profession and group will get the first shots from the 3 crore vaccine doses being procured by Bangladesh.

The largest group to get the Covid-19 vaccine is the people aged sixty and above, which includes residents of old homes and religious leaders. In the initial phase, 4.5 lakh government sector health workers and seven lakh private sector health workers will get the vaccine.  Another 1.5 lakh health management and support workers, including employees of various government and private hospitals. Besides, 5.5 lakh Bangladesh Police personnel will get the shots, with a priority on traffic police officials.

Among others, three lakh front liners of the Bangladesh Army, 50,000 journalists and 5,000 civil surgeons, deputy commissioners, and ministry officials will be vaccinated. The vaccine will be distributed to 2.10 lakh Freedom Fighters as well. Moreover, there will be in line, 70,000 public representatives including members of Parliament, chairpersons and members of Upazila and Union Parishads. Depending on the availability of the vaccine shots, it will gradually be distributed to immuno-compromised people, sufferers from chronic diseases, teaching professionals, and public transportation workers.

The policy and plan have not mentioned whether the government has given priority to the prevention of corona or reduction of spread of virus. The primary vaccine program is set for 1.5 crore people or 9% of the population and ten categories of professions and groups. All other countries have common policy of priority to elderly persons and frontline medical professionals.

The writer is Legal Economist.