Efficacy of vaccine: Recipients don’t have the option to choose one vaccine over the other

As India is all set to begin its largest vaccination drive on January 16 using two Covid-19 vaccines, there are a lot of rumors surrounding the same. The healthcare workers are the first to receive the vaccine but there is no option to choose one vaccine over the other.

Addressing a press conference, the Union Health Secretary Rajesh Bhushan informed that more than one vaccine is being administered at many places in the world and currently no country gives the recipients the option of choosing the shots.

Both Pfizer and Moderna are available in the U.S and the healthcare workers and nursing home residents who are recipients, have no option to choose the vaccine. Similarly in U.K people will be administered with either a Pfizer, Moderna or AstraZeneca’s vaccine but can’t choose one over other.

US and UK have very different emergency use approval whereas the Health Secretary hasn’t mentioned the safety and efficacy data used by the regulators in India.

The restricted use approval for Pune-based Serum Institute’s Covishield was granted based on safety and immunogenicity tested in India on a small number of participants. The safety and efficacy data was provided from large trials over 24,000 participants in Brazil, South Africa and UK whereas the restricted use approval was granted to Hyderabad-based Bharat Biotech’s Covaxin in the absence of any efficacy data. The approval was based solely on a small number of participants studied during phase-1 and phase trials.

It is important to note that vaccine efficacy is studied only during a phase-3 trial.

As per the statements given by Union Government, vaccine sites will offer either Covishield or Covaxin, to make sure the recipients don’t have an option to choose one vaccine over the other. As the COVID-19 vaccination is not compulsory, people can choose not to get vaccinated after walking into a site that provides only Covaxin.

This situation has raised a lot of ethical questions as to administering one healthcare worker with Covaxin whose efficacy is unknown and others with Covishield whose efficacy is known when both face the same risk of infection at work.

Reports cite that the state government will decide which vaccine goes to which sites and sources state that a few states have already said they would use Covishield as the “default option”.