As Kerala, like the rest of the country, awaits the roll out of the COVID-19 vaccine, questions on how the vaccine should be prioritised, given the fact that at least in the initial phases it has to be conserved for specific risk populations, are being raised.
Right now, approximately one crore front-line health-care workers in both private and public sector in the country have been projected as the priority group to be vaccinated first, followed by those in higher age groups. The State has already initiated an exercise of line-listing its health-care workers.
While no COVID-19 vaccine has yet been approved in the country for emergency use authorisation, there are many who feel that rather than blindly following the Centre’s directive, the State should have a clear assessment of who should be the real priority population who needs immediate protection from the ravages of COVID-19, especially since the State has a higher proportion of elderly population than the rest of the country.
Lower mortality
Health workers are considered to be at increased risk because of their high-risk work environment and their constant interactions with patients. However, while COVID-19-related mortality has been high among health-care workers in other States, in Kerala, incidents of loss of life amongst them have been few.
“When the vaccine is being reserved for specific populations, should we not be administering it first to the group where we can have the highest mortality benefit? If so, people who are now dying in the State due to COVID-19 — those in higher age groups, those with chronic renal failure/diabetes — should be administered the vaccine first as they are the ones who need the immediate protection of a vaccine while the pandemic is still raging,” says a senior medical professional.
He points out that doctors themselves have been discussing this in many professional foras, including the State Medical Board, whether the State should take a second look at its priority population.
Younger group
Health-care workers are a relatively younger age group and most of whom would have already had prior but silent exposure to the virus, rendering them immune for at least several months. While it is not yet known how robust or long lasting this protection is, it would certainly place health-care workers lower in priority than the population of non-immune and at risk elderly in the community.
That also raises the moot question whether the State has really been able to ascertain which segment of the population has been the most vulnerable during the pandemic, because this data can only be gleaned from an analysis of the actual COVID-19 death data in the State.
“Missing” deaths
Kerala’s “missing” or “undercounted” COVID-19 deaths and the consistent manner in which many COVID-19-continuum deaths of persons were being kept out of the official list (because they had died after testing antigen negative), have since long been a matter of serious debate.
Many public health experts have been unhappy that the State has not done a death data reconciliation exercise because accurate death certification during the pandemic is vital for assessing the impact of COVID-19 in the State. Only such data can provide actual information on who died during the pandemic, their medical conditions and other essential characteristics.
“Though the elderly are dying more, mortality has been observed across all age groups in the State during the pandemic. In the absence of proper data, we can only guess who among these have the maximum vulnerability,” they point out.