STUDY SHOWS WHY SECOND DOSE OF COVID-19 VACCINE SHOULD NOT BE SKIPPED - The Daily Guardian
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STUDY SHOWS WHY SECOND DOSE OF COVID-19 VACCINE SHOULD NOT BE SKIPPED

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The second dose of a COVID-19 vaccine induces a powerful boost to a part of the immune system that provides broad antiviral protection, according to a study led by investigators at the Stanford University School of Medicine.

The findings published in the journal Nature strongly supports the view that the second shot should not be skipped. “Despite their outstanding efficacy, little is known about how exactly RNA vaccines work,” said Bali Pulendran, PhD, professor of pathology and of microbiology and immunology. “So we probed the immune response induced by one of them in exquisite detail.”

The study was designed to find out exactly what effects the vaccine, marketed by Pfizer Inc., has on the numerous components of the immune response.

The researchers analyzed blood samples from individuals inoculated with the vaccine. They counted antibodies, measured levels of immune-signalling proteins and characterized the expression of every single gene in the genome of 242,479 separate immune cells’ type and status. “The world’s attention has recently been fixed on COVID-19 vaccines, particularly on the new RNA vaccines,” said Pulendran, the Violetta L. Horton Professor II.

He shares senior authorship of the study with Kari Nadeau, MD, PhD, the Naddisy Foundation Professor of Pediatric Food, Allergy, Immunology, and Asthma and professor of paediatrics, and Purvesh Khatri, PhD, associate professor of biomedical informatics and of biomedical data science. The study’s lead authors are Prabhu Arunachalam, PhD, a senior research scientist in Pulendran’s lab; medical student Madeleine Scott, PhD, a former graduate student in Khatri’s lab; and Thomas Hagan, PhD, a former postdoctoral scholar in Pulendran’s Stanford lab and now an assistant professor at the Yerkes National Primate Research Center in Atlanta. “This is the first time RNA vaccines have ever been given to humans, and we have no clue as to how they do what they do: offer 95% protection against COVID-19,” said Pulendran.

Traditionally, the chief immunological basis for approval of new vaccines has been their ability to induce neutralizing antibodies: individualized proteins, created by immune cells called B cells, that can tack themselves to a virus and block it from infecting cells. “Antibodies are easy to measure,” Pulendran said. “But the immune system is much more complicated than that. Antibodies alone don’t come close to fully reflecting its complexity and potential range of protection.”

Pulendran and his colleagues assessed goings-on among all the immune cell types influenced by the vaccine: their numbers, their activation levels, the genes they express and the proteins and metabolites they manufacture and secrete upon inoculation.

One key immune-system component examined by Pulendran and his colleagues were T cells: search-and-destroy immune cells that don’t attach themselves to viral particles as antibodies do but rather probe the body’s tissues for cells bearing telltale signs of viral infections. On finding them, they tear those cells up.

In addition, the innate immune system, an assortment of first-responder cells, is now understood to be of immense importance.

It’s the body’s sixth sense, Pulendran said, whose constituent cells are the first to become aware of a pathogen’s presence. Although they’re not good at distinguishing among separate pathogens, they secrete “starting gun” signalling proteins that launch the response of the adaptive immune system- the B and T cells that attack specific viral or bacterial species or strains. During the week or so it takes for the adaptive immune system to rev up, innate immune cells perform the mission-critical task of holding incipient infections at bay by gobbling up — or firing noxious substances, albeit somewhat indiscriminately, at — whatever looks like a pathogen to them.

The Pfizer vaccine, like the one made by Moderna Inc., works quite differently from the classic vaccines composed of live or dead pathogens, individual proteins or carbohydrates that train the immune system to zero in on a particular microbe and wipe it out. The Pfizer and Moderna vaccines instead contain genetic recipes for manufacturing the spike protein that SARS-CoV-2, the virus that causes COVID-19, uses to latch on to cells it infects.

In December 2020, Stanford Medicine began inoculating people with the Pfizer vaccine. This spurred Pulendran’s desire to assemble a complete report card on the immune response to it. The team selected 56 healthy volunteers and drew blood samples from them at multiple time points preceding and following the first and second shots. The researchers found that the first shot increases SARS-CoV-2-specific antibody levels, as expected, but not nearly as much as the second shot does. The second shot also does things the first shot doesn’t do, or barely does.

“The second shot has powerful beneficial effects that far exceed those of the first shot,” Pulendran said. “It stimulated a manifold increase in antibody levels, a terrific T-cell response that was absent after the first shot alone, and a strikingly enhanced innate immune response.”

Unexpectedly, Pulendran said, the vaccine — particularly the second dose — caused the massive mobilization of a newly discovered group of first-responder cells that are normally scarce and quiescent. First identified in a recent vaccine study led by Pulendran, these cells- a small subset of generally abundant cells called monocytes that express high levels of antiviral genes — barely budge in response to actual COVID-19 infection. But Pfizer vaccine-induced them.

This special group of monocytes, which are part of the innate museum, constituted only 0.01 per cent of all circulating blood cells prior to vaccination. But after the second Pfizer vaccine shot, their numbers expanded 100-fold to account for a full 1 per cent of all blood cells.

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Medically Speaking

VACCINATION IS THE BEST STRATEGY FOR CONTROLLING SPREAD OF COVID-19

Dr Sarthak Chakravarty

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Vaccination is our best strategy for controlling this viral spread. Although once a person has been vaccinated their chances of getting infected are reduced by 85%-95%, there is still a 15% to 5% chance that they can still get infected with coronavirus.

Researchers have concluded that relaxation of non pharmaceutical interventions, once vaccination of the population has reached a tipping point short of herd immunity can increase the probability of the emergence of a resistant strain that natural selection then favours.

So to counter such a resistant strain pharmacological interventions are of utmost importance at present. Whenever we will let our guard down there will a rise of a new strain as we have all seen in the second wave that had hit India during the months of April to June. This type of pandemic emergencies will keep on rising unless we act and follow the rules of safety.

Darwin’s theory of survival of the fittest can be deferred by modern medical science and its accomplishments. But the participation of the common masses is of equal importance. At present vaccine is the only thing standing between us and the covid-19 virus. We have become accustomed to the pandemic and focus on the reduction of spread and deaths from an epidemiological point of view. With time we will gain new perspectives and newer dimensions to our thinking and approach.

Along with vaccination, one must continue all safe practices including sanitization, social distancing and wearing masks. Post-vaccination also a person can become Covid positive and therefore must be careful and vigilant in seeking medical help.

Mainly 3 factors are responsible for the spread of the vaccine-resistant virus –

• Slow rate of vaccination

• A large number of infected people

• Mutation speed of the virus

These can be tackled by nonpharmaceutical interventions pre and post-vaccination also. These include maintaining safe practices and boosting our immunity naturally through methods shown by the AYUSH Ministry of Health. Studies have shown that in a population where almost 60% of vaccination has been achieved, there is stability in the mutation of the virus and the spread of infection. With proper medical intervention, this is possible. So we must continue taking all possible precautions against the Covid 19 virus and must get vaccinated against this disease.

KEY TAKEAWAYS

Get Vaccinated at the earliest

Continue all safe practices

Do not delay approaching medical help

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Medically Speaking

Millet-based diet can help in managing blood glucose levels

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Eating a millet-based diet can reduce the risk of developing type-2 diabetes and help manage blood glucose levels in people with diabetes, suggests a new study.

The study indicated the potential to design appropriate meals with millets for diabetic and pre-diabetic people as well as for non-diabetic people as a preventive approach. The findings of the research were published in the journal ‘Frontiers in Nutrition’. Drawing on research from 11 countries, the study showed that diabetic people who consumed millet as part of their daily diet saw their blood glucose levels drop 12-15 per cent (fasting and post-meal), and blood glucose levels went from diabetic to pre-diabetes levels.The HbA1c (blood glucose bound to hemoglobin) levels lowered on average 17 per cent for pre-diabetic individuals, and the levels went from pre-diabetic to normal status. These findings affirm that eating millets can lead to a better glycemic response.

The authors reviewed 80 published studies on humans of which 65 were eligible for a meta-analysis involving about 1,000 human subjects, making this analysis the largest systematic review on the topic to date.“No one knew there were so many scientific studies undertaken on millets’ effect on diabetes and these benefits were often contested. This systematic review of the studies published in scientific journals has proven that millets can keep blood glucose levels in check and reduce the risk of diabetes. It has also shown just how well these smart foods do it,” said Dr S Anitha, the study’s lead author and a Senior Nutrition Scientist at ICRISAT.

Millets, including sorghum, were consumed as staple cereals in many parts of the world until half a century ago. Investments in a few crops such as rice, wheat and maize, have edged nutritious and climate-smart crops like millets out of the plate.

“Awareness of this ancient grain is just starting to spread globally, and our review shows millets having a promising role in managing and preventing type 2 diabetes. In the largest review and analysis of research into different types of millet compared to other grains such as refined rice, maize and wheat we found that millets outperform their comparison crops with lower GI and lower blood glucose levels in participants,” observed Professor Ian Givens, a co-author of the study and Director at University of Reading’s Institute of Food, Nutrition and Health (IFNH) in the UK.

According to the International Diabetes Association, diabetes is increasing in all regions of the world. India, China and the USA have the highest numbers of people with diabetes. Africa has the largest forecasted increase of 143 per cent from 2019 to 2045, the Middle East and North Africa 96 per cent and South East Asia 74 per cent.

The authors urged the diversification of staples with millets to keep diabetes in check, especially across Asia and Africa. Strengthening the case for reintroducing millets as staples, the study found that millets have a low average glycemic index (GI) of 52.7, about 36 per cent lower GI than milled rice and refined wheat, and about 14-37 GI points lower compared to maize.All 11 types of millets studied could be defined as either low (55) or medium (55-69) GI, with the GI as an indicator of how much and how soon a food increases blood sugar level. The review concluded that even after boiling, baking and steaming (the most common way of cooking grains) millets had a lower GI than rice, wheat and maize.

“Millets are grown on all inhabited continents, yet they remain a ‘forgotten food’. We hope this will change from 2023 when the world observes the United Nations declared International Year of Millets, and with studies like this that show that millets outperform white rice, maize and wheat,” said Rosemary Botha, a co-author of the study who was based in Malawi at the time of the study, with the International Food Policy Research Institute (IFPRI).“The global health crisis of undernutrition and over-nutrition coexisting is a sign that our food systems need fixing. Greater diversity both on-farm and on-plate is the key to transforming food systems. On-farm diversity is a risk-mitigating strategy for farmers in the face of climate change while on-plate diversity helps counter lifestyle diseases such as diabetes. Millets are part of the solution to mitigate the challenges associated with malnutrition, human health, natural resource degradation, and climate change. Trans-disciplinary research involving multiple stakeholders is required to create resilient, sustainable and nutritious food systems,” said Dr Jacqueline Hughes, Director General, ICRISAT.

Professor Paul Inman, Pro-Vice-Chancellor (International) of the University of Reading, stressed that “The rapidly accelerating threats of climate change and global health crises, including obesity and diabetes, require everyone to pull together in action. The partnership between ICRISAT and the University of Reading is doing exactly this, bringing together our world leading expertise in human nutrition with ICRISAT’s long-established role as a leader in agricultural research for rural development.”

The study also identified information gaps and highlighted a need for collaborations to have one major diabetes study covering all types of millets and all major ways of processing with consistent testing methodologies. Structured comprehensive information will be highly valuable globally, taking the scientific knowledge in this area to the highest level.

“This study is first in a series of studies that has been worked on for the last four years as a part of the Smart Food initiative led by ICRISAT that will be progressively released in 2021. Included are systematic reviews with meta-analyses of the impacts of millets on diabetes, anemia and iron requirements, cholesterol and cardiovascular diseases and calcium deficiencies as well as a review on zinc levels,” explained Joanna Kane-Potaka, a co-author from ICRISAT and Executive Director of the Smart Food initiative.

As part of this, ICRISAT and the Institute for Food Nutrition and Health at the University of Reading have formed a strategic partnership to research and promote the Smart Food vision of making our diets healthier, more sustainable in the environment and good for those who produce it,” added Kane-Potaka.

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Medically Speaking

NEED TO SHOO AWAY LUNG CANCER-CAUSING CULPRITS

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Lung cancer has emerged as one of the commonest cancer these days. We are aware of World Lung Cancer Day which takes place on August 1st every year. This day is symbolic to create awareness not only to early diagnosis and management needs to the lung cancer but more importantly to shoo away the things which can be and are causative of lung cancer. It is the day to talk of healthy lungs and strategies for maintain lung health and not just talk of cancer but to prevent cancer.

But the point is that whether really, we do not know that smoking causes lung cancer and health-related issues. We all know! Smoking remains one of the commonest reasons for lung cancers in almost 80% of the patients. All know – SMOKING HARMS! Then why create awareness.

If we indulge in activities that harm us despite knowing that it harms, then what to do! We do create awareness during November as well for lung cancer awareness month. Yes, despite all these, there remains the importance of further creating awareness.

However, such “day” also needs to create a positive hope among patients suffering from lung cancers. We need to assure all these patients of the support from curative and palliative intent as well.

Lung cancer management strategies have seen many improvements in recent times. Not only the diagnostic modalities have improved but also the treatment strategies including surgery and medical therapy have found a significant improvement in the recent past. Early identification remains the key to appropriate and optimal management.

It also becomes prudent to understand that early identification before it spreads remains essential and thus the patient must not ignore symptoms that persist for some time without any explained reason. Timely screening is important, and this awareness must be created in addition to preventive strategies like quit smoking.

At this juncture, it also becomes essential to support the patients, who are in advanced stages of lung cancer. These patients do require medical support and many things can be offered to them for palliative support to improve their quality of life. These patients with advanced cancers have many symptoms like pain, difficulty in breathing, cough, blood in cough and so forth. Despite advanced cancers, these symptoms can be optimized to make the patient comfortable.

Many strategies are available like the use of medicines (analgesics) and other interventions like removing the fluid from the chest due to cancer and using techniques like pleurodesis which decreases the formation of fluid in the chest and thus makes the patients comfortable by reducing the symptoms due to advanced cancer.

Hoping this World Lung Cancer Day brings a bright ray of happiness by igniting the lamp of creating an aura of positive energy leading to the promulgation of a healthy lifestyle and creating awareness of timely screening and optimal management of lung cancers.

Aditya Kumar is the Honorary Director, IRC. Dr Rakesh Garg, is Onco-Anaesthesiologist and Palliative Care Physician. Dr Brairch, is from AIIMS, New Delhi

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Medically Speaking

IMA LAMBASTS KERALA GOVERNMENT, SAYS RECKLESS ATTITUDE LED TO SPIKE IN CASES

Meenakshi Upreti

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As the number of Covid cases continue to spiral in the state of Kerala, IMA president Dr J.A. Jayalal lashed out at the Kerala government saying that reopening without a plan led to rise in cases. Batting for starting schools again, the IMA president said that ‘schools should be opened in a graded manner’. Here also he hit out at the Kerala government saying that had the state acted responsibly and ‘started opening up gradually, the situation would have been better’.

Notably, IMA has already called Kerala government’s decision to ease COVID-19 restrictions on the occasion of Eid al-Adha or Bakri Eid as ‘unwarranted’. In an exclusive interview with Medically Speaking, the IMA President claimed that the Kerala government was adamant on opening the schools and relaxing covid restrictions which lead to thousands of cases and hundreds of deaths in the state.

He further added that the massive shortage of vaccine is a result of the lack of planning on the part of the state & Central government. On the third wave he said “I do not agree with the prediction that the third wave will have a disastrous effect. I am confident that the third wave will come. The way in which we have taken up the vaccination drive, followed by the Covid appropriate behaviour and the natural immunity of the people- all these things will ensure that the third wave will not be as disastrous as the second wave,”. Following are a few snippets from the exclusive interview:

Q. The IMA has time and again warned the central and state governments. You told the Kerala government not to go ahead with the bakr eid celebrations. What will be your first reaction to those state governments and people who are going ahead with festivities thinking that the second wave is over and we have a short window to celebrate?

A. Prof Dr Jayalal: Democracy always leads by popularity. During the pandemic, the health of the people is of utmost importance. The IMA plays a major role to tell what is right and how the people should mend their ways to ensure safety and security in the country.

Q. What do you say about the Kerala government? The IMA government asked them to not go ahead with the bakr eid celebration. Also, the number of tourists in states like Himachal Pradesh have peaked in the past few days. What do you think the state governments should do and where are they lacking?

A. Prof Dr Jayalal: It is the duty of the government to tell the people what to do. Unfortunately, the Kerala CM was very adamant on opening the schools and relaxing the Covid restrictions. This led to 17,580 cases and 138 deaths in Kerala. India is a federal structure. We cannot allow one state to go according to their whims and fancies. That is going to have an impact on the entire country. That is why we are asking the government to come forward to curtail these cases. The cases are increasing day by day. That is why the IMA is asking the people and governments to mend their ways.

Q. Do you think that schools should remain shut for the time being?

A. Prof Dr Jayalal: We need to exclusively plan about reopening the schools. People should not come in crowds. They should maintain social distancing, wear masks and follow the vaccination protocol. The schools should not be kept closed for a long time as it can have a psychological impact on the children. We will advise that schools should be opened in a graded and sustained way. The schools need not be open on all five days. The students can be called for just two days.

Q. Children have been silent carriers of Covid in the last wave as well. How important is it to vaccinate them? Where are we when it comes to vaccinating the children in our country?

A. Prof Dr Jayalal: If the parents and the adults of the family are vaccinated and masking is practised then Covid will not have a disastrous effect on the children.

Q. Where do you see we are months from when the drive started? Many experts feel that we would not be able to vaccinate the whole population of the country by the end of the year. What will be your reaction to that?

A. Prof Dr Jayalal: On June 21, India proved that 8.8 lakh people were vaccinated. That means that we have the capacity to vaccinate upto ten million people. Secondly, the country needs to have a sufficient supply of vaccines.

Q. Where are we lacking? Why such a massive shortage of vaccines?

A. Prof Dr Jayalal: We are lacking because the government did not plan on how they would be going with the vaccine production. They were just depending on two companies which had a limited capacity. They can make 2.5 or three million vaccines. That does not meet the needs of the ten million people. We are taking a lot of time to import the Sputnik vaccine, although the permission has already been given. In Tamil Nadu, a big nine hundred crore vaccine unit is idle. If the government was really interested, they would have worked some ways by which the vaccine production would have augmented. But we are ready to support the government and before 2021 we plan to vaccinate the complete population.

Q. When we speak of shortage of supply, we have seen a great tussle between the state and the centre. Similar tussle played out when the Centre said that ‘no deaths have been reported because of lack of oxygen supply’. How would you react to the politics happening around it and to the statement that ‘no deaths happened due to the shortage of oxygen’ ?

A. Prof Dr Jayalal: What the mind does not know, the eyes will not see. That is what is happening with the Honourable Health Minister today. He has said that none of the states have given an official report about deaths due to shortage of oxygen, so he is not wrong on his part. This is the most painful thing during Covid. There have been so many doctor deaths but the government has no official data about their deaths.

Q. Many doctors say that the third wave is impending. Some say that it is already here. Where will you say India stands when it comes to the third wave?

A. Prof Dr Jayalal: I do not agree with the prediction that the third wave will have a disastrous effect. I am confident that the third wave will come. The way in which we have taken up the vaccination drive, followed by the Covid appropriate behaviour and the natural immunity of the people- all these things will ensure that the third wave will not be as disastrous as the second wave. I expect that the number of cases will be lesser than projected. The mortality rate will also be less because we have augmented our infrastructure, manpower and the resource material. When we are well prepared to face the situation, we have nothing to worry about.

Q. Do you think we are well prepared?

A. Prof Dr Jayalal: In comparison to the second wave, we are well prepared for the third wave. We know our faults and gaps now. Those gaps have been filled up. Unless the virus is arrogant with us, we will sail safely through the third wave.

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Medically Speaking

IMA LAMBASTS KERALA GOVT, SAYS RECKLESS ATTITUDE LED TO SPIKE IN CASES

In an exclusive interview with Medically Speaking, the IMA President claimed that the Kerala government was adamant on opening the schools and relaxing covid restrictions.

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As the number of Covid cases continue to spiral in the state of Kerala, the IMA President Prof. Dr. J.A. Jayalal lashed out heaving at the Kerala Govt saying that reopening without a plan led to rise in cases. Batting for starting schools again, the IMA president said that ‘schools should be opened in a graded manner’. Here also he hit out at the Kerala Govt saying that had the state acted responsibly and ‘started opening up gradually, the situation would have been better’

Notably, IMA has already called Kerala government’s decision to ease COVID-19 restrictions on the occasion of Eid al-Adha or Bakri Eid as ‘unwarranted’.

In an exclusive interview with Medically Speaking, the IMA President claimed that the Kerala government was adamant on opening the schools and relaxing covid restrictions which lead to thousands of cases and hundreds of deaths in the state.

He further added that the massive shortage of vaccine is a result of the lack of planning on the part of the state & Central government. On the thirdwave he said “I do not agree with the prediction that the third wave will have a disastrous effect. I am confident that the third wave will come. The way in which we have taken up the vaccination drive, followed by the Covid appropriate behaviour and the natural immunity of the people- all these things will ensure that the third wave will not be as disastrous as the second wave,”.

Following are a few snippets from the exclusive interview:

The IMA has time and again warned the central and state governments. You told the Kerala government not to go ahead with the bakr eid celebrations. What will be your first reaction to those state governments and people who are going ahead with festivities thinking that the second wave is over and we have a short window to celebrate?

Prof Dr Jayalal: Democracy always leads by popularity. During the pandemic, the health of the people is of utmost importance. The IMA plays a major role to tell what is right and how the people should mend their ways to ensure safety and security in the country.

What do you say about the Kerala government? The IMA government asked them to not go ahead with the bakr eid celebration. Also, the number of tourists in states like Himachal Pradesh have peaked in the past few days. What do you think the state governments should do and where are they lacking?

Prof Dr Jayalal: It is the duty of the government to tell the people what to do. Unfortunately, the Kerala CM was very adamant on opening the schools and relaxing the Covid restrictions. This led to 17,580 cases and 138 deaths in Kerala. India is a federal structure. We cannot allow one state to go according to their whims and fancies. That is going to have an impact on the entire country. That is why we are asking the government to come forward to curtail these cases. The cases are increasing day by day. That is why the IMA is asking the people and governments to mend their ways.

Do you think that schools should remain shut for the time being?

Prof Dr Jayalal: We need to exclusively plan about reopening the schools. People should not come in crowds. They should maintain social distancing, wear masks and follow the vaccination protocol. The schools should not be kept closed for a long time as it can have a psychological impact on the children. We will advise that schools should be opened in a graded and sustained way. The schools need not be open on all five days. The students can be called for just two days.

Children have been silent carriers of Covid in the last wave as well. How important is it to vaccinate them? Where are we when it comes to vaccinating the children in our country?

Prof Dr Jayalal: If the parents and the adults of the family are vaccinated and masking is practised then Covid will not have a disastrous effect on the children.

Where do you see we are months from when the drive started? Many experts feel that we would not be able to vaccinate the whole population of the country by the end of the year. What will be your reaction to that?

Prof Dr Jayalal: On June 21, India proved that 8.8 lakh people were vaccinated. That means that we have the capacity to vaccinate upto ten million people. Secondly, the country needs to have a sufficient supply of vaccines.

Where are we lacking? Why such a massive shortage of vaccines?

Prof Dr Jayalal: We are lacking because the government did not plan on how they would be going with the vaccine production. They were just depending on two companies which had a limited capacity. They can make 2.5 or three million vaccines. That does not meet the needs of the ten million people. We are taking a lot of time to import the Sputnik vaccine, although the permission has already been given. In Tamil Nadu, a big nine hundred crore vaccine unit is idle. If the government was really interested, they would have worked some ways by which the vaccine production would have augmented. But we are ready to support the government and before 2021 we plan to vaccinate the complete population.

When we speak of shortage of supply, we have seen a great tussle between the state and the centre. Similar tussle played out when the Centre said that ‘no deaths have been reported because of lack of oxygen supply’. How would you react to the politics happening around it and to the statement that ‘no deaths happened due to the shortage of oxygen’ ?

Prof Dr Jayalal: What the mind does not know, the eyes will not see. That is what is happening with the Honourable Health Minister today. He has said that none of the states have given an official report about deaths due to shortage of oxygen, so he is not wrong on his part. This is the most painful thing during Covid. There have been so many doctor deaths but the government has no official data about their deaths.

Many doctors say that the third wave is impending. Some say that it is already here. Where will you say India stands when it comes to the third wave?

Prof Dr Jayalal: I do not agree with the prediction that the third wave will have a disastrous effect. I am confident that the third wave will come. The way in which we have taken up the vaccination drive, followed by the Covid appropriate behaviour and the natural immunity of the people- all these things will ensure that the third wave will not be as disastrous as the second wave. I expect that the number of cases will be lesser than projected. The mortality rate will also be less because we have augmented our infrastructure, manpower and the resource material. When we are well prepared to face the situation, we have nothing to worry about.

Do you think we are well prepared?

Prof Dr Jayalal: In comparison to the second wave, we are well prepared for the third wave. We know our faults and gaps now. Those gaps have been filled up. Unless the virus is arrogant with us, we will sail safely through the third wave.

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Medically Speaking

IT IS A COMMON MISCONCEPTION THAT STORING AND MAINTAINING PFIZER NEEDS HUGE INVESTMENT: JESAL DOSHI, B MEDICAL SYSTEMS

According to Jesal Doshi, Deputy CEO of B Medical Systems, it is tough to alter people’s minds about vaccine efficacy while kept in an ice box or a local refrigerator.

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A few weeks ago, B Medical Systems, a global player in the vaccine cold chain industry, announced a partnership with Dr. Reddy’s Laboratories for the pan India rollout of Sputnik V vaccines.

B Medical Systems will be offering their vaccine freezers, which can store vaccines at temperatures as low as -25°C. To address the immediate needs, these units were delivered by air freight from Luxembourg.

According to Jesal Doshi, Deputy CEO of B Medical Systems, it is tough to alter people’s minds about vaccine efficacy while kept in an ice box or a local refrigerator. Mr. Doshi claims that various vaccinations require different temperatures and that if they are not provided the appropriate temperatures, they would lose their efficacy.

Mr. Doshi claims that Pfizer is a very effective vaccine with a logistic cost of less than a rupee, and that the Indian government’s failure to get the vaccine into the nation is a source of significant concern.

Here are a few excerpts from the discussion with Mr. Doshi:

You have recently tied up with Dr Reddy’s lab for pan-India rollout of Sputnik V. Tell us more about that? Tell us about the work B Medical has done to help with the rollout of Covid 19 vaccines?

Jesal Doshi: For more than 40 years, B Medical Systems has been the world’s oldest and biggest firm dedicated only to the cold chain of vaccinations providing safe transportation for vaccines, pharmaceuticals and blood. We are a company based in Luxembourg, Europe, and we have been operating there until early this year, when we were invited to start manufacturing in India by Prime Minister Narendra Modi. We built up our own manufacturing plant in India after receiving that invitation in a record-span of four months. This is the first time we’ve manufactured outside of Luxembourg, and I’m quite proud of the fact that we chose India to do so.

Coming to the pact with Dr. Reddy’s, nearly every vaccination is temperature sensitive and may lose its potency if not kept at the proper temperature. Sputnik requires a temperature of -18 degrees Celsius for storage, whereas other vaccinations require a temperature of 2-8 degrees Celsius. Pfizer, on the other hand, requires storage at -60°C or lower, making it difficult to retain these vaccines at a proper temperature under such harsh circumstances, which is where we come in. We ensure that any vaccine, at any temperature under any condition is maintained correctly and hence assuring that the recipient receives the rightly stored and transported vaccine.

There are many areas where the terrain may be hostile, electric supply may be erratic – How do you manage in such areas?

Jesal Doshi: There are two different challenges, one being the terrain and the other one being very peculiar to the nation, i.e., “Thanda Hai To Chalta Hai” wherein people use iceboxes and cold-drink refrigerators for storing vaccines that require a temperature of 2-8 degree Celsius, rendering them totally useless.

Second, our firm employs equipment that operates on a wide range of power sources. For example, we have equipment that can run entirely on solar energy, a DC battery, kerosene, or regular power. Using any of these power sources, they can all sustain temperatures ranging from -18 to 25 degrees. We operate and maintain the whole cold chain supply in extremely remote locations such as Afghanistan and Congo.

We already have immunisation programmes in India but here we are talking about vaccinating the entire adult population is this country – do you think we have the cold chain support to do that?

Jesal Doshi: India has administered more or less about 40 crore people and believe it or not, it was the easy part of the journey because now we will face issues reaching people in the most difficult locations. If you look at the figures, you will notice that majority of the population in the rural areas haven’t received vaccines yet.

We are providing solutions to the central as well as the state government and working with Dr. Reddy’s for the Sputnik. We are ensuring that vaccines reach the remotest areas so that every individual is vaccinated.

For the benefit of your views help us understand the importance of a reliable cold chain system in these times?

Jesal Doshi: I think even if you have the best vaccine in the world, it will not work without an appropriate cold chain. Vaccines can decompose if not dealt with the right temperature. Most nations immunise all of their children, but after decades of mass immunisation, we have yet to reach a 100% vaccination rate, with the main issue being a lack of effective cold chain.

In India, there is an absence of an appropriate cold chain to take charge of the Sputnik vaccine. This is also the reason why Pfizer has not been introduced in the country. Till now, we have introduced Pfizer in more than 25 countries around the world including Africa.

Is India ready or will be prepared to bring Pfizer into the country considering the high efficacy of the vaccine?

Jesal Doshi: It is a misconception that storing and transporting Pfizer needs huge investment. When you look at the challenges around the vaccine shortages, it is very affordable to bring vaccines like Pfizer into the country, transportation of which costs not more than a rupee.

How can India improve its current cold chain system?

Jesal Doshi: In such cases, increasing vaccination availability might be a viable option. You must adhere to a regimen and ensure that there are no negative repercussions. Pfizer, for example, is widely disseminated around the world because to its effectiveness and lack of reported adverse effects. The vaccination is still not available in the country, which is a source of great disappointment for me.

Take us through the challenges you faced during this drive bad the lessons learnt from it.

Jesal Doshi: It is a matter of great pride for India to be regarded as the world’s vaccine capital, but the issue today is to maintain and supervise the safe storage and transportation of vaccines. Real-time monitoring is provided, allowing you to follow the availability of vaccinations throughout the world and ensure that each one is properly maintained. You can help save lives by maintaining a proper cold chain.

Mr. Doshi’s advise on the necessity for improvements in health infrastructure and vaccine availability during this epidemic, in which many people are dying, is extremely important.

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