Indians remain wary of booster doses as Covid wanes and side-effect worries rise

• In a national survey conducted by LocalCircles, 50% of citizens said that they were hesitant to take a third or Covid booster dose.
  
• As of now, only 20% of the eligible population in India has received a booster dose.
  
• Currently, there are ten vaccines that people can access for Covid-19 in India.

A new Covid-19 vaccine from the Serum Institute of India called Covovax on Tuesday received approval from the Drugs Controller General of India (DCGI) to be used as a heterologous booster.

A heterologous booster can be administered to adults who have received two doses of either Covishield or Covaxin. A booster or precaution dose is the third dose of Covid vaccine, available after the first two mandatory doses. It can be administered nine months after the second dose.

While many state governments and experts have been trying to urge people to take the booster or third dose, in view of rising cases in China, the uptake has been low. Currently, it’s not mandatory to take a precautionary dose in India.

Only 20% of the eligible population in India has received a booster dose. All individuals aged 18 and above are eligible for a booster dose in India. As per the data provided by the Ministry of Health and Welfare, as of January 12, 2023, over 150 million precaution or booster doses have been administered to Indian adults aged between 18-59 years, in addition to another 60 million administered to senior citizens aged 60 or above, and healthcare workers.

Indians say ‘no’ to boosters

Among the general public, there seems to be a widespread hesitancy over a booster dose. The fact that the number of reported Covid-19 cases is going down, is not helping. On Tuesday, January 17, India reported 89 new coronavirus infections — the lowest since March 27, 2020 – when the pandemic started.

While Indians are wary of all kinds of boosters, they seem to be averse to nasal vaccines in particular. In a national survey conducted by LocalCircles, 50% of citizens surveyed were hesitant to take the Covid-19 booster dose. The survey had 15,958 responses across 304 districts.

As per the survey, of the 10% likely to take it, only 4% said they would take the nasal booster dose. Media reports have also said that the government is unlikely to procure iNCOVACC from Bharat Biotech.

In December 2022, the world’s first nasal vaccine, iNCOVACC was approved for use by the DCGI. Produced by Bharat Biotech, it can be administered as a heterologous booster dose. It’s a non-invasive, needle-free vaccine that will be sprayed into the nostrils with a syringe that has no needles, and is available for individuals aged 18 or above.

The vaccine might be available for ₹850 in private hospitals but governments will give it a miss in spite of the Hyderabad-based company offering it at a lower price to the government. Sources told Economic Times that low demand is making the government take this decision.

In all, currently there are ten vaccines that people can access for Covid-19 in India.

Will Covid vaccine become an annual flu shot?

A Covid vaccine helps the body acquire immunity against SARS‑CoV‑2 – the strain of Coronavirus that causes Covid-19. Most of the available Covid vaccines require two mandatory doses.

Reports say that the immunity provided by Covid-19 vaccines gradually weakens over time. In fact, immunological studies have documented a steady decline in antibody levels among vaccinated individuals.

A booster dose, thus, increases the vaccine’s effectiveness and prolongs an individual’s immunity against the virus. As per a study published in the National Library of Medicine, “a third vaccine dose increased antibody responses ∼10-fold to 100-fold, including boosting neutralising antibodies against the Omicron variant.”

Countries like the US and New Zealand have already rolled out a second booster dose for individuals at increased risk of severe illness from Covid-19.

“With the Covid-19 pandemic, in the absence of a dramatically different variant, we likely are moving towards a path with a vaccination cadence similar to that of the annual influenza vaccine, with annual updated Covid-19 shots matched to the currently circulating strains for most of the population,” said Dr Anthony Fauci, immunologist and former chief medical advisor to the US president.

After the recent spike in Covid-19 cases globally, the National Technical Advisory Group on Immunisation (NTAGI) also considered rolling out a second booster dose or a fourth dose of Covid vaccine for the Indian population. However, the prevalent hesitancy around the adoption of the booster dose hinders this idea.

“The key reasons why people are reluctant to take the Covid booster is the belief that Covid won’t come back to India in severe form and a spate of unexplained cases of sudden cardiac arrest or heart attacks across the country which some are attributing to the Covid vaccine,” said a report by LocalCircles.

The effect of side-effects

Market research company YouGov also reported that in a survey conducted in June 2022, 17% of the respondents were worried about the alleged long-term side effects of the vaccines.

Limited information is available on the long-term aftereffects of the vaccine. Paul Goepfert, M.D., director of the Alabama Vaccine Research Clinic at the University of Alabama at Birmingham, shared that different studies show there are rare but severe side effects from Covid-19 vaccination, namely, thrombotic thrombocytopenia – which is a condition in which a person experiences blood clotting as well as low platelet count, and myocarditis – which is an inflammation of the heart.

The US Food and Drug Administration (FDA), the US’ drugs regulator, also noted that in rare cases Covid-19 vaccination could lead to Guillain-Barré syndrome, in which the immune system attacks the peripheral nervous system. An international study published in the multispeciality journal BMJ Medicine (by the British Medical Association) also noted that there was a ‘small and likely to be temporary change’ in menstrual cycles due to Covid-19 vaccines.

Covid-19 vaccines available for use in India

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