Emerging from Holy Family hospital in New Delhi, Ram Verma, a sanitation worker, breathed a deep sigh of relief. As one of the first in India to receive a coronavirus vaccine on Saturday – marking the start of the world’s largest vaccination programmes – he had been feeling a little jittery.
“I must admit I was nervous,” said Verma, who had received his Covaxin jab in a centre set up in the hospital car park. “A lot of us were. I thought I might faint or have side-effects. After all, it is something totally new. But I’m fine. There is nothing to worry about.”
Anila Singh, a nurse at Ram Manohar Lohia hospital in the capital, said she had almost cried with relief, when she heard she was to be among the first to receive the vaccine. “I thought of all those I had seen dying, all the families who lost someone they loved and my own daily fear about catching the virus, it all surged back,” she said. “Finally we are going to turn the page.”
Across India, 3,006 vaccination centres began the mammoth task of vaccinating 300 million people by August, with healthcare workers, police and army members given first priority. India ranks second in the world for Covid-19 cases, registering more than 10.5 million cases and more than 151,000 deaths.
Two vaccines have been given emergency approval for India’s immunisation programme: the Oxford/AstraZeneca vaccine, known in India as Covishield, and Covaxin, a domestic product developed by the Indian pharmaceutical company Bharat Biotech in conjunction with the Indian council of medical research, a government body.
While it was a slow start on Saturday, pressure was on to pick up the pace. Within a week, Mumbai plans to vaccinate 50,000 people daily, while in Delhi the figure is even more ambitious. “Once we have 1,000 vaccination centres in the city, we will vaccinate 100,000 every day,” said Dr Suneela Garg, who heads Delhi’s vaccination taskforce.
The prime minister, Narendra Modi, hailed the start of the vaccine programme as a moment of pride for India, proclaiming it “shows the world our capability”. Yet a shadow hung over proceedings, as doctors, health rights advocates and scientists have called into question the adequacy and safety of Covaxin and accused the government of side-stepping protocol to get it approved.
The vaccine has not completed phase 3 human trials and there is no conclusive final data on its efficacy, placing India among Russia and China, which have also decided to roll out a vaccine still in its trial phase. The government has said Covaxin is “100% safe” and on Saturday 5.5 million doses of it were dispatched out across the country, though they will be given in “trial mode”.
On Saturday, the resident doctors’ association of Ram Manohar Lohia hospital wrote a letter to the hospital’s superintendent expressing concern about Covaxin and requested they be allowed to have Covishield instead.
Dr Nirmalya Mohapatra, a senior resident doctor and vice-president of the association, said: “There is a lot of apprehension because we don’t have the same data for Covaxin. We are healthcare workers and we are worried that Covaxin might not protect us from another wave of infection because it is still in trials. So we are just requesting to be given a choice about which vaccine we are given.”
Mohapatra said that without a choice being offered, it could lead to widespread refusal to take up the vaccine among doctors. On Saturday at Ram Manohar Lohia hospital, only 31 of the 100 healthcare workers registered to be given the vaccine turned up, partly due to a technical hitch but also attributed to concerns among staff that the hospital is only offering Covaxin.
Bharat Biotech has also been accused of ethical violations for allegedly testing Covaxin on people in the slums of Bhopal in Madhya Pradesh, without them being aware it was a trial. Seven people have claimed they were told they were receiving a vaccine that would protect them from the virus, and were paid 750 rupees, with no awareness it was an untested vaccine or that they might have received a placebo.
In a letter to the government, multiple health rights organisations, including the All India Drug Action Network, the Forum for Medical Ethics Society and the People’s Health Movement India, demanded the Covaxin trial be halted in Bhopal. “The testimonies demonstrate inducement which represents a breach of the tenet of voluntary participation without inducement or coercion,” they said. “Many participants were misled to enrol in the trial, their vulnerabilities preyed upon.”
Bharat Biotech denied any ethical violations and said the trial fully complied with “good clinical practice guidelines and all regulatory provisions that apply to the conduct of clinical trials in India”.
The questions over Covaxin have also not helped in the government’s desperate attempts to counter misinformation and fake rumours about the vaccines that have been circulating on WhatsApp and fuelling hesitancy. On Wednesday, the Delhi chief minister, Arvind Kejriwal, had appealed to people to stay alert against vaccine misinformation.
At the Spinal Injuries Centre in New Delhi, Dr Kali Datta Das, a surgeon, said some fake rumours on WhatsApp about the vaccine had caused a last-minute ripple of anxiety on Saturday. However, he remained upbeat. “We vaccinated 100 staff today and it was a very positive mood because people felt that there is finally a solution in sight to Covid-19,” Das said.