Perhaps covid-19 vaccines are not the way forward in India

The BBC recently reported on the vigour with which India is rolling out its vaccines, whilst reminding us of India’s high rate of infections. But while India has had many infections, the rate of infection compares favourably with the rest of the world. India has also consistently maintained some of the lowest rates of death found anywhere. https://ourworldindata.org/coronavirus/country/india

A range of explanations has been put forward. Some suggested that it was because the traditional measures of mask wearing and hand washing had been so rigorously applied. Others suggested that heat and humidity actually made corona viruses less active. An interesting explanation was that to survive the many diseases and lack of access to clean drinking water Indians have immune systems which are robust and strong.

However a key explanation, the use of the repurposed medicines hydroxychloroquine and ivermectin appears to have been completely ignored.

While numerous studies had found hydroxychloroquine to be highly effective as a prophylactic or early stage treatment when combined with zinc and azithromycin, hydroxychloroquine had actually been banned or strongly discouraged in large swathes of the world.

This followed on from major trials into hydroxychloroquine including the World Health Organisation’s Solidarity Trial and The Oxford Recovery Trial which appeared to have some serious flaws. These trials used very high doses of hydroxychloroquine on late stage patients, a point at which hydroxychloroquine would no longer be appropriate to use.

In fact the Indian Health Ministry wrote to the WHO to alert them of the fact they were using doses 4 times higher than in India and tried to explain that if used correctly HCQ was in fact a very effective medication for covid19.

Unfortunately, the WHO did not listen and when the hydroxychloroquine arm of the Solidarity trial had negative outcomes they concluded that hydroxychloroquine was to blame and proceeded to prevent it being used in many parts of the world.

In contrast the Indian Health authorities had a good understanding of hydroxychloroquine and used it widely and appropriately.

As early as March the Indian Council of Medical Research under the Ministry of Health and Family Welfare recommended the prophylactic use of hydroxychloroquine among asymptomatic health-care workers treating patients and its use was widely expanded throughout the country.

A similar story played out with ivermectin. Even safer and more effective, it can be used at all stages of treatment and is another cheap, well established repurposed drug. Dr Pierre Kory founding member of the FrontLine Covid-19 Critical Care Alliance explained that ivermectin was able to obliterate transmission of the virus, with miraculous effectiveness and that it had been the subject of dozens of studies.

India listened to Dr Kory and established a home covid kit with zinc, doxycycline and ivermectin which cost $2.65 per person.

Following this discovery it was adopted in place of hydroxychloroquine in some of India’s largest states. By the end of 2020 Uttar Pradesh which had distributed free ivermectin for home care had the second lowest fatality rate in India.

The massive decline in death rates described earlier followed shortly in the heels of the adoption of ivermectin and it seems likely that ivermectin played a critical role.

However, on January 16th 2021 India followed the West in its decision to roll out vaccines.

Initially the Indian population were slow in their take up of the vaccine perhaps because the rate of infection had remained low.

However since the adoption of the vaccine corona virus cases in India have been rising steadily:

Furthermore, some of the states which have had the highest number of vaccine doses administered such as Maharashtra, Karnataka and Tamil Nadu now have very high levels of infections.

And India’s increase in infections is now being duly followed by an increase in the rates of death.

It would of course be negligent to speculate on the relationship between rates of disease and rates of vaccination. This is a job for the Indian health authorities who have all the facts at their fingertips.

And immunity is not established immediately following the vaccine. In fact, in many countries spikes in rates of infection have occurred.

In Gibralter following the introduction of the vaccine the death toll from covid19 rose from 16 to 84 within a month. A similar spike in the rate of infection occurred in the UEA following the introduction of the vaccine on the 23rd of December. Similarly when the vaccine was introduced in Israel on December 20th an increase turned into a dramatic spike while the rates of covid infection in unvaccinated Palestine, declined. Serbia’s vaccination programme got going in earnest in early February. By mid-February there was a spike in infections. Hungary started vaccinated at the end of December. This was followed by a delayed spike.

Spike in covid-19 cases following covid-19 vaccination in UEA
Covid -19 cases spiked in Israel following vaccination while they decline in unvaccinated Palestine
A spike in confirmed covid-19 cases following the introduction of the vaccine in Serbia

Various explanations have been put forward to account for this rise of infections following the vaccine with one author suggesting that the immune system may be weakened immediately following the vaccination. Unfortunately the UK health authorities tend to assume that a person who dies following a covid vaccination had pre-existing covid so this question is seldom researched.

India should not expect the vaccine rollout to go without incident. Here in the UK a very large number of side effects have been reported and nearly 600 deaths.

In addition, 18 countries have halted use of the astra-zeneca vaccine over concerns about blood clotting. It is interesting to note that 8,402 of the 8,483 adverse events recorded in India from the covid vaccine roll out were a response to the covishield vaccine developed by Oxford Astra-Zeneca.

While many in the UK are aware of these safety concerns the position of the average Briton is that the benefits outweigh the risks.

However, the benefits are not all that they seem. According to Dr Reid Sheftall you would have to give the vaccine to 119 people in order for one person to benefit from the vaccine. This is far from the 95% efficacy touted in the media for the Pfizer vaccine.

Here in the UK voices which question the government narrative cannot gain traction. We have the military working with the government to overcome vaccine hesitancy . Departments in government help to ensure information which challenges the government’s viewpoint is regarded as ‘dis’ information and labelled ‘fake news’.

This is unfortunate. In order to ensure the most effective health strategies a forum is required in which experts from a range specialisations can thrash out the arguments which arise from different sources of information and findings. This is unlikely to happen in the UK.

India has acted with caution and integrity in managing the covid health crisis and this has been reflected in India’s positive results. Let us hope that an open and international discussion on the best ways of dealing with covid is something which the Indian Health Authorities can do.

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