India may soon allow Covid-19 jab for pregnant women, but where are the vaccine stocks?

A 34-year-old, seven-month pregnant dentist carrying her second child lost her battle against Covid-19 in Delhi. A 25-year-old lady, the wife of a jeweller in Hyderabad, carrying her first child, succumbed to the dreaded virus. These are not isolated cases. The second wave of Covid-19 sweeping through India is now hurting a very vulnerable section of the population – pregnant women.

There may be some relief coming, albeit a bit late for some. In the next two to three days, the Indian health ministry is likely to issue guidelines on the use of vaccination for pregnant women. This could be a very important development because this is a section of the population that usually tends to get excluded in the clinical studies of vaccines. In fact, experts have consistently pointed out how very few vaccines get evaluated for pregnant and lactating women, which always raises the concern of whether they will get excluded forever because of concerns for their health and that of the child they are carrying. The safety of this section of the population is critical not just because it is about handling two lives in each case with one nurturing the other but also because they are not sick, but could be vulnerable to sickness.

But then, look around in India and the perception of real risks and threats may get redefined. In the light of the high covid-19 caseload – currently at around 3.6 lakh new cases in a day, a view seems to be now emerging among experts that the benefits of vaccinating pregnant women today far outweigh the risks. Financial Express Online has reliably learnt from official sources that there is a thought process in favour of vaccinating pregnant and lactating women. In tune with this, a decision by the health ministry with appropriate guidelines to this effect are expected in the next couple of days.

This apparently follows the recommendations by the Standing Technical Sub-Committee of National Technical Advisory Group on Immunization, which deliberates on vaccines.

The development gains importance in the light of the concerns raised by some of the leading obstetricians and pediatricians in the country, who, unlike in the first wave of Covid-19 last year, are now in its second wave, seeing pregnant women getting infected with covid-19.

A Global Concern

The risks to pregnant women has been a matter of concern among well-known global experts. For instance, Dr Soumya Swaminathan, chief scientist at the World Health Organisation (WHO) has maintained that “globally, it has been observed that pregnant women are at a higher risk of complications and that of premature birth because they already have a low respiratory reserve and therefore vaccinating them is perhaps the best option available.” For otherwise, some of them might end up needing critical care if matters aggravate.  Also, all the vaccines approved by the WHO, she says, “none of them have been contraindicative in pregnancy.”

It all then boils down to an issue of benefit versus risk and therefore, in situations where there is a large viral transmission happening, most experts feel, the benefits of vaccination outweigh the risks.

Respiratory Problems

Seeing a noticeable increase in the number of pregnant women getting exposed to covid, Dr Ramesh Kancharla, the founder of Rainbow Hospitals with a chain of around 15 hospitals across six cities in the country says, “in the second wave we are seeing pregnant women coming up with manifestation of respiratory problems needing oxygen as well as ventilatory support in some cases. This aspect of seeing impact on the lungs was not so on the first wave,” he says. Therefore, the only option available to safeguard them and prevent these problems, he says, “is by making vaccination available for them.”

If, as is now getting apparent, this view is considered and vaccination extended to pregnant and lactating women, the big question then is around ways in which the target population will be covered. After all, it is not a small number. With India adding 26 million live births each year, the number of pregnant women is high and even if two per cent of them were to be seriously impacted by covid, the number would run into lakhs.

Demand-Supply Gap

The immediate problem, therefore, is of making the vaccine available. At least till July, when most Indian vaccine companies are expected to come up with ramped up vaccine-making capacities – Serum Institute of India, for instance, is intending to produce 100 million doses a month from July as against 60 million a month at the moment. More supplies of Covaxin from Bharat Biotech and of Sputnik-V are also expected while newer vaccines like the one from Zydus Cadila are also expected.

Consider the numbers on the vaccination journey this far. Since, the vaccination drive began on January 16, 2021, about 177 million vaccinations doses have so far been administered and since May 1st, when the inoculation was opened up for the 18-44 year age group, roughly around 4 lakh in this age segment have been able to get their first dose of vaccine in the first 12 days of the month, which may seem a big number in an absolute sense but still a small share of the over all population. Also, the rate of vaccination is down today to around 1.8 million a day, which is lower than a relative high of around 4 million a day touched in early April and far short of the 8 to 10 million a day that experts have been seeking for India.