New Delhi: India’s three Covid-19 vaccine candidates are progressing well, Indian Council of Medical Research (ICMR) director-general Balram Bhargava said on Tuesday. He added phase II/III clinical trials for the recombinant Oxford University vaccine candidate will begin within a week at 17 sites across India. Serum Institute of India, which is the local manufacturer of the vaccine, will conduct the trials.

“Inactivated virus vaccine candidate by Bharat Biotech and the DNA vaccine by Zydus Cadila have completed phase I studies in 11 sites and started phase II trials. Phase I and II trials are for safety studies and very early efficacy studies,” said Bhargava.

At least 141 vaccine candidates are being studied globally, of which 26 are in different phases of clinical trials.

Bhargava said India is making all efforts to ensure a vaccine is available whenever it is ready. He added it includes prioritising and fair distribution, maintaining the cold chain, stockpiling and training of people to administer vaccines. “Availability of the vaccine is the key but what is more important in managing the disease is sustained behavioural change that includes wearing of masks, maintaining hand hygiene, and observing social distancing.”

Dr GC Khilnani, a former pulmonology department head at New Delhi’s All India Institute of Medical Sciences, said the vaccine will be the ultimate solution for curbing the outbreak. “Many vaccine candidates are showing promise in initial trials, but whichever makes it finally should reach masses in time.”

Union health secretary Rajesh Bhushan separately said India’s current case fatality rate (CFR) of 2.10% has been the lowest since the first phase of the lockdown (around 3.3%) that was imposed to check the Covid-19 spread from March 25.

“There has been a progressive decline in country’s CFR and it is now the lowest since lockdown began and also one of the lowest globally. The mortality analysis that we have done is broadly in line with the global scenario, although percentages may differ,” said Bhushan.

The latest mortality analysis shows 68% of the Covid-19 deaths in the country are among men and 32% among women. Most deaths–50%- -are in the age group of 60 and above, followed by 37% among people between 45 and 60. About 11% of people, who succumbed to the disease, were between 26 and 44.

“The death data tells us that not just the senior citizens, but also our population between 45-60 years is vulnerable and needs to take extra care,” said Bhushan.

Jugal Kishore, who heads the community medicine department at Safdarjung Hospital, said elderly and those with co-morbidities are vulnerable and need special focus. “All our data points to that, and it is important for the country to achieve the target of CFR below 1%.”

Increased testing

Bhargava said they have been doing intelligent and calibrated testing. He added remote areas with the inadequate testing facilities, or those districts with the high caseload, are being given priority. “We set up labs in areas where there were no labs or very few labs and deployed high throughput testing machines in special economic zones, where the public movement was higher and larger international airports. Our target is to go up to one million tests a day.” He added it is important for states to analyse the data well to deploy resources accordingly.”

Homegrown ventilator industry

Even though less than 1% of the country’s Covid-19 patients are on ventilator support at any given time, India has managed to establish full self-reliant ventilator manufacturing facilities and is even ready to export the machines. On Tuesday, the Directorate General of Foreign Trade issued a directive permitting the export of indigenously manufactured ventilators from the country.

India has commissioned about 60,000 ventilators to some 20 odd domestic manufacturers.

“There were just a few manufacturers of ventilators in India some four months ago and even those making them in India relied heavily on imported parts. When the outbreak started, many of those countries imposed restrictions for the export of ventilators and there was a surge in global demand. There was no option but to encourage domestic manufacturers to get into the fray, and we have managed it with great success,” said Bhushan.

Public sector undertakings Bharat Electronics Limited and Andhra Med-Tech Zone are providing 43,500 ventilators. Maruti Suzuki opened its manufacturing lines and supported the production of about 10,000 ventilators.

“From a price range of about Rs 10-20 lakh, the domestic manufacturers are selling a ventilator within Rs 1.5 and 4 lakh price range. Even the spare parts are being manufactured locally and it is a great achievement in four months,” said Bhushan.