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By Dr Lalit Kant

Union Minister of Health & Family Welfare Dr Harsh Vardhan has said in a statement that he would take the first shot of the Covid-19 vaccine to address any ‘trust deficit’ over its safety. This statement gives me a feeling of déjà vu. Almost ten years ago, the then Health Minister Ghulam Nabi Azad had taken one of the first shots of the H1N1 flu vaccine. We had failed then to build trust over vaccine safety, and are likely to fail again, unless appropriate steps are initiated now — in addition to the Health Minister taking the vaccine. 

In 2009-10, the world experienced the H1N1 influenza pandemic. There was a ‘race’ among vaccine manufacturing companies to produce a vaccine and countries scrambled to get vaccines. India had reported the first case of Influenza A/H1N1 in May 2009. The Government of India had then imported 1.5 million doses of the vaccine and also provided Rs 10 crore each to three vaccine manufacturers as advance market commitment for 6.25 lakh doses from each of the companies. We had taken all the right steps to get the vaccine but failed to deliver it to the communities. Not only did we not use most of the doses of the imported vaccine, but also failed to lift even a single vial of the vaccine, worth Rs 30 crore, ordered from the Indian manufacturers. One of the reasons for that had been the poor acceptance of the vaccine because of safety concerns.

 During the H1N1 pandemic of 2009, inter alia, there were doubts raised about the safety of the vaccine. Even after making the vaccine compulsory for healthcare personnel, very few took it because the fear of adverse reactions, specifically for Guillain-Barré syndrome, was high among them. 

India has small but vociferous anti-vaccine groups. The anti-vaccine movement, which has its roots in the US and the UK, has gained ground in parts of the country now. In the past, they have raised their voices against the use of the Measles-Rubella (MR) vaccine, the pentavalent vaccine (for diphtheria, pertussis, tetanus, hepatitis B, and H influenza B) and polio vaccines. Social media posts — which are worryingly effective — from these groups have also been circulated in India. 

The approval of the Covid-19 vaccine is being fast-tracked so that the vaccine becomes available early and is able to control the pandemic and save millions of lives. The fact that something which would normally take 10 years to develop and tested for safety and effectiveness is being made available under “expedited approval” within a few months has given an impression that the vaccines are being rushed to the market and not sufficiently tested for safety and efficacy. In a significant move, India’s Ministry of Health & Family Welfare has permitted vaccine manufacturers in India to make and stock Covid-19 vaccines which are currently under clinical trials. Though these are welcome steps and would expedite the earlier availability of Covid-19 vaccines in the country, they are fuelling public concerns for pushing inadequately tested vaccines.

 One of the theories making the rounds is that the disease is not as deadly as has been made out to be and that it only affects a small group of people which is immune-compromised. Another theory is that the coronavirus vaccine has tracking chips that would later be activated by 5G and used to influence the behaviour of people. Groups are busy sowing doubts even before a Covid-19 vaccine exists and this can undermine the country’s efforts to vaccinate high-risk groups.

 While Covid-19 vaccines are under development, the nature and extent of vaccine hesitancy must be assessed and addressed timely. An effective communication strategy is needed now to address the fears and uncertainties.

 The writer is an Infectious Disease Epidemiologist and Independent Consultant.

By Dr Anil Chandna & Dr Anmol Kalha

The unprecedented pandemic brings with it a huge weight of fear and suffering. Now after lockdown, almost all aspects of human existence are challenged, institutions as we know them, stumble and leadership struggles to give direction to find a way through uncharted waters. Healthcare reassembles itself as all elective procedures are on hold and only OPDS are on and the entire focus is on containing and responding to the challenges of the virus.

Dentistry came to a sudden stop from 22 March 2020, as lockdown after lockdown brought the realisation that there was a serious issue at hand. All clinics were shut, institutions closed and advisories were abound high- lighting the risks of dental care, the virus being a silent passenger of aerosols, salivary glands, the mouth and the very air that was breathed in the close proximity of the patient. Since then, a slew of discussions have only served to highlight the fears and the new challenges of perhaps returning to the analog era from a rapidly advancing digital era of dentistry. The massive influx of technology, newer materials and techniques helped to build a business in India which was valued at roughly $1.36 billion, employing almost 20 lakh people directly or indirectly. 313 recognised institutions with almost 15,000 faculty and staff would add another annual dimension of Rs 1,800 crore and the stakes are high.

Before the pandemic hit and alarm bells rang regarding the lack of job opportunities, less than 50% of the graduating dentists were register- ing with dental councils for clinical practices. Rising costs of infrastructure and equipment, concentration of dental practices in metros had begun to create a negative aura to this profession, which was at one hand being grudgingly accepted as a part of mainstream healthcare. It continued to be the privilege of the wealthy and the elite as all spending was from private incomes, practically no insurance and very little in- vestment by the government to employ dentists or create opportunities in the rural sec- tor. The lack of direction even at the height of the pandemic is very obvious as no clear directions have emerged from the Ministry of Health and Family Welfare on resumption of dental practices. Advisories are there from the Dental Council and the professional associations but at the end of the day, executive directions can only be issued by the administration. A proposal to create DGDS in the Health Ministry was tabled to handle direct responsibility and regulate the dental profession but it languishes at the lack of interest and intent.

The road ahead

1. The lack of financial support will seriously impact the young dentists who entered into practice carrying a huge burden of rentals and loans. This has a huge impact as earnings dropped to zero at the beginning of the lockdown and after and the return will be slow with additional costs of PPEs, masks, trained assistants, limited appointments and the inherent fears that abound in the minds of doctors and patients both on the virulence of the virus. Add to this, the fear of quarantines and health issues in the event of a possible infection and the ripple effects begin to gather furious momentum. Is there a bail out? No one knows.

2. The practices and clinics were unregulated and not really meeting the baseline norms of asepsis and infection control before the pandemic. The first attempt to regulate was made by the government in the form of the ‘Clinical Establishments Act’ which defined the minimum requirements for both rural and urban practices. This was to be implemented in full measure and will need to be done if dentistry has to return to its position in mainstream health care.

3. Dental institutions will have to transform to provide departments of bio-safety, create adequate processes in the clinics as the fears and threats are real. Students will need training in infection control protocols, standards drill beyond the webinars and luminaries who espouse unreal wisdom. The positive aspect is that as international travel and living overseas un- veils the threats to students, there will be a return to In- dian institutions and those who transform and adapt will not only survive but flourish, after all a population of 1.3 billion people will always have oral healthcare needs.

4. Dental treatment will have to return to realism and efficiency with minimal contacts, greater reliance on diagnostics and skills rather than a massive influx of apparent technology and advertising. The whole concept of cost of care will need to be redefined. It will be about value and not just availability.

5. Investment in training of dental assistants and para- dental staff will be worth the while as the new dentistry will need a set of people with skills in infection control and assisting. This could open up an entire new field for dental institutions with excess capacity as it is and certificate courses would be very much in demand.

6. Investment in manufacture of dental materials and equipment with an export focus is very much a possibility. As global supply chains are suspended, China-centric manufacture will shift and could go in favour of intrinsic manufacture and marketing. If we are the pharmacy to the world, so could it be for dental materials and equipment.

7.We are in the midst of a population shift from urban to rural. It’s time for the government and private players to look at dental setups in rural India.

The virus is here and while there is a hushed silence, it has not solved all the issues of oral health. The world is rebooting and so should dentistry in India. There may be a lull but all is not lost. It may be a slow re- turn but return we will; after all, India has shown tenacity and resilience in the face of all adversity. Dental Council of India is putting all efforts under the Health Ministry for better outcomes.

Dr Anil Chandna is the executive member of Dental Council of India and Dr Anmol Kalha is a senior dentist.

Dr.Harsh Vardhan, Union Minister of Health and Family welfare, Science and Technology and Earth Sciences and Santosh Gangwar , Union Minister of State (Independent charge),Labour and Employment released a booklet on ‘COVID-19-Safe workplace guidelines for industry’ through virtual platform in the presence of Dr. VK Paul, Member (Health), NITI Aayog.

During release Dr.Harsh Vardhan said, “These guidelines are commendable and timely. This will help in welfare of the industrial workers. The guidelines act as a comprehensive planning guidance for employers and workers to use it to help identify risk levels of Covid-19 at individual workplace settings in their premises and to determine appropriate control measures”. These guidelines include all important preventive measures which are required stay away from the virus. These guidelines has workplace safety based measures like respiratory hygiene, frequent hand washing, social distancing and frequent sanitization of the workplace.

The Health Minister further said, “Government of India under the leadership of Honourable Prime Minister is committed to the welfare of the workers. As the country is moving towards the unlocking of economic activities, it is important that the guidelines are followed within the industry premises. Scientific prevention, precaution, and a positive attitude will help us in our fight against COVID. These guidelines will provide the guidance for the assessment, categorization and mitigation of risk related to varied work related exposures to Covid-19 and contingency plan.”