1. Maximising the boost: India must test the feasibility of mixing vaccines to help enable informed choice

Context: Heralding a new frontier in India’s vaccination programme, the apex drug regulator has approved two more vaccines under emergency use authorisation (EUA), and an antiviral drug. 
 
CORBEVAX:  
2.    Manufactured by Hyderabad-based Biological E.
3.    It is a protein subunit vaccine, which means that instead of the whole virus, it uses fragments of it to trigger an immune response. It contains a harmless S protein. Once the immune system recognises the protein, it produced antibodies to fight a real infection when it happens. 
4.    The antigenic parts of the virus have been developed by Texas Children’s Hospital Centre for Vaccine Development and in-licensed from BCM (Baylor College of Medicine) Ventures. 
5.    EFFICACY: Against Delta strain it “indicates a vaccine effectiveness of more than 80% for the prevention of symptomatic infections based on published studies”.

MOLNUPIRAVIR: ORAL ANTIVIRAL DRUG
6.    Developed in collaboration by US firms Ridgeback Bio therapeutics and Merck, initially to treat influenza, is are purposed oral anti viral candidate to treat Covid patients. 
7.    It has been cleared for the treatment of adult patients with Covid-19 “who have a high risk of progression of the disease”.
8.    It works by introducing errors into the virus’s genetic code, which prevents replication. 
9.    Dosage: Molnupiravir comes in 200mg pills; the recommendation in India is for 800 mg twice daily for 5days. It is not authorise for use for longer than five consecutive days, or in patients younger than 18 as it may affect bone and cartilage growth.  
10.    Production: It will be manufactured by 13 Indian drug makers: Dr Reddy’s, Natco, MSN, Hetero, Optimus, Aurobindo, Mylan, Cipla, SunPharma, Torrent, BDR, Stride, and Pune based Emcure.
COVAVAX: RECOMBINANT NANOPARTICLE VACCINE
11.    Manufactured by Serum Institute of India (SII), is also a protein subunit vaccine, but uses recombinant nano particle technology. 
12.    It has been developed by US-based Novavax. 
13.    Harmless copies of the spike protein are grown in in sect cells; the protein is then extracted and assembled into virus-like nanoparticles. 
14.    Novavax has use dan immune-boosting compound(adjuvant).The same technology is used in HPV and the Hepatitis B vaccine. On November 17, the Philippines FDA granted SII a licence to market the vaccine in the country. On December20, the WHO issued Emergency Use Listing to the vaccine.
15.    EFFICACY: A trial in the UK that demonstrated an efficacy of 96.4% against the original virus strain, 86.3% against Alpha and 89.7% efficacy overall;  
Advantages of more than one vaccine: 
16.    Having more vaccines in the arsenal bodes well because of the uncertainties that the pandemic brings about. 
17.    The experience with the new variant Omicron is that it is so infectious, it does not discriminate among the vaccinated and the unvaccinated, though severe disease and death is disproportionately among the latter. Here too, those who are above 40 years continue to be the most vulnerable. 
18.    India has overwhelmingly been reliant on Covishield and that is a matter of concern. 
 
New Vaccine guidelines  on precautionary doses
19.    Teenagers aged 15 to 17, who will be eligible for vaccination from January 3, will be administered only Covaxin doses, a note from the Health Ministry said on Monday.
20.    Healthcare workers and frontline workers who have received two doses would be eligible for a “precaution dose” from January 10, though those with a gap of at least 39 weeks since the second dose would be prioritised.
21.    Those 60 years and above with co-morbidities who have received two doses of COVID-19 vaccine, would on doctor’s advice be provided a similar “precaution dose” from January 10. The prioritisation and sequencing of this dose would also be based on the completion of nine months — 39 weeks from the date of administration of second dose.
 
Combination studies:
22.    The only study on mixing Covaxin and Covishield — that resulted from a mix-up in Uttar Pradesh — showed that antibody levels were higher than two doses of either vaccine. 
23.    A combination of Novavax and AstraZeneca (Covishield) was also effective in boosting antibodies, according to the COV-BOOST study in the United Kingdom. 
24.    India’s top medical institutions must immediately test the feasibility of mixing all available vaccines so that these may be made quickly available if needed giving recipients the option of an informed choice. 
Conclusion: The second wave revealed a treatment fiasco with remdesivir — sans any therapeutic merit — that saw irrational demand and black marketing. While molnupiravir has many more manufacturers, it is important to ensure against hoarding or indiscriminate use given its potential side-effects.
 
 

2. The efficiency myth of Aadhaar linking: The Government has made several dubious claims to push the Aadhaar project

Context: The Union Government hastily passed a Bill to link voter IDs with Aadhaar cards. 
•    The Government claims that the move will prevent frauds and remove duplicate IDs. 
•    But as evidenced by a report by journalist Kumar Sambhav, such a move violates an individual’s Right to Privacy, enables voter profiling and excludes genuine voters — perils that have also been outlined in a statement issued by the Rethink Aadhaar campaign and endorsed by many organisations. 
 
Impact of Aadhar on increasing efficiency in welfare programs:
•    Aadhaar was, among other things, purportedly meant to improve efficiency in welfare programmes.  
•    Cash transfers in many welfare programmes, such as payment of MGNREGA wages, are done using the Aadhaar Payment Bridge System (APBS). For this to work, it is mandatory to link workers’ Aadhaar with their MGNREGA job cards and their bank accounts where the Aadhaar number of the worker becomes their financial address. 
•    Government claims on savings in welfare programmes due to Aadhaar have been methodically debunked by Jean Drèze and Reetika Khera, among others. Government claims that “the estimated cumulative savings/benefits due to Aadhaar in MGNREGA till March, 2021 is Rs 33,475 crores.”
Negative impact of Aadhaar: 
•    Wage payment delays in MGNREGA have been persistent. An analysis of more than 18 lakh wage invoices for the first half of 2021-22 by LibTech India demonstrated that 71% of the payments were delayed (called stage 2 delays) beyond the mandated period by the Union Government. 
•    Nearly 7 lakh invoices in our sample were done through the APBS; 11.65 lakh were account-based payments where the workers’ name, account number, and the IFSC code of their bank were used to transfer money.  
 
•    Problems with efficiency claims:  Between 2015 and 2019, there was intense pressure on field-level bureaucrats to increase Aadhaar linking. A recently completed study of nearly 3,000 MGNREGA workers by Anjor Bhaskar and Preeti Singh shows that 57% of job cards of genuine workers were deleted in a quest to show 100% linking of Aadhaar with job cards. 
•    Opacity surrounding APBS and the consequent dilution of accountability. Cash transfers through both the payment methods can fail. The most common reason for payment failures in account-based payments is when the account number of the worker in the system is incorrect. This can be rectified at the block. However, the most common reason for payment failures through the APBS is enigmatically called “Inactive Aadhaar.” This has nothing to do with an individual’s Aadhaar being inactive but happens when there is a software mapping failure with the centralised National Payments Corporation of India, the clearing house for APBS. Workers and officials alike are clueless on resolving these payment failures.
•    Several cases of misdirected payments in APBS when the Aadhaar number of one person gets linked to somebody else’s bank account so her money gets credited to somebody else’s account. These are very hard to detect as these will appear as successful transactions on the dashboard. As per UIDAI, its functions include “setting up of facilitation centres and grievance redressal mechanism for redressal for grievances of individuals.” However, no such mechanisms exist.
Conclusion: When Aadhaar’s use in welfare — for which it was purportedly intended — is itself shrouded in opacity, unreliability, and exclusions, we must be very worried if it is linked to voter IDs as it will further hollow out government accountability. It will fundamentally alter the citizen-State relationship. This must concern everyone as thousands of crores of taxpayers’ money have been spent on it.