Vaccines are around the corner bringing much needed cheer at the year end. Modern life is all about instant gratification and people want to take the jab and move around like nothing ever happened. But as experts correctly emphasize vaccines will not prevent Covid-19 but vaccination will. The gigantic task of logistics of transport, storage and delivery has been planned perhaps reasonably well. So is the prioritization of 300 million population. But when vaccines are a product of nationalistic fervor, driven by the political drive to make it available at the earliest, inevitably there will be fear with regard to its efficacy and safety.

Vaccines normally go through rigorous testing which takes years. The collapsed timeline justifiably creates some doubt in the recipient population. It also becomes a difficult thing when politics and the pharma industry tango together. It is said about the Pfizer and Moderna vaccines that they have not been tested on children and pregnant women. They have not been tested adequately on Asian ethnicities. The Indian exercise started a little later than elsewhere, but the logistic plan seems to be in place. The cold storage and transportation plans are ready perhaps.

But it will be the biggest vaccination over a four-month period the country has ever seen. Trained inoculators to administer the intramuscular vaccine may not be adequate finally. To be fair, the country ordinarily handles 30-50 million vaccinations a year at the high point. But the population will require safety data, particularly when it is stated that Covaxin has been cleared without the Phase 3 trial data having been firmed up.

The indemnity issue is another road block. The manufacturers want to be indemnified against lawsuits filed against them. If the numbers of suits are few and far between, involving seriously affected people it is understandable. But if the numbers are larger, the companies cannot take the hit. They followed the timeline given by the politicians and want to be covered by the sovereign.

But looked at from the other side, only when pharma companies take the risk would they ensure that side-effects are minimal. If the risk is passed on to the sovereign while they pocket the profit, there will be an attempt to free ride and push the vaccine regardless of side effects. Let’s not forget that Governments would like to give vaccination as quickly as possible to have political dividends. Since the Government of India will find it difficult to take that risk, it may just bring in a law estopping any litigation just like the US did.

If cases do not remain within the projected percentage of complications, people will stay clear of vaccination. There is a suggestion in the US that the default option should be vaccination with an optout clause. In India, this is unlikely to happen with priority inoculation and people are more likely to be herded in for vaccination. But when people do not turn up for vaccination, the number falls. Others meanwhile watch it and eschew vaccination. If the vaccination does not reach 70 per cent, we have a Catch-22 situation. More the shortfall, more lukewarm will be the response and the desired herd immunity will recede further.

It is not just a matter of misconceptions or rumours. It is a palpable possibility that side effects will be watched for some time before people choose to take a job. While people can be educated and rumours quelled, how do you handle any reaction and the domino effect it unleashes sociologically? Rather than relying on public education which many experts feel has not worked very well in public health crises, it is the demonstration effect which will finally work. Going by experience elsewhere, 70 per cent of people will have to trust the vaccine so that it will reach the tipping point and the masses will be willing to take the job. Generic information that the ‘vaccine is safe’ is a lot inferior to personalized guidance from people whom they trust. This is one vaccination where political leaders or religious heads will have a smaller role. People finally distrust both. The guidance should come from scientific sources and from those who have got the jab so that others would like to catch up with them.

If all these take time, herd immunity will most probably come by then. Modelling done by the National Model for Pandemic Spread consisting of finest mathematical minds and top clinicians concluded that in India for one reported infection, 90 infections have gone unreported. That will put the number at about 100 crore. But a serological prevalence survey is required. In some cities, towns and villages the figure could be way off. In UP and Bihar, it is 1:300 and in Delhi it is 1:25. Focus should be on habitations with low infection and different defensive and combat plans should be worked out. Meanwhile complacency is not an option.

We will have to follow the ‘New Normal’ of wearing masks, keeping distance from each other and hand washing. This will involve avoiding crowded and confined places. Let not anyone be deluded that the need for the mask and recommended conduct will be over soon. Since our individualism is marked by selfabsorption, we may find it to be a nuisance to begin with. Bur these recommended behaviours matter for others. Let’s learn to speak up and insist on mask, social distancing and hand sanitization so far as others are concerned, while we try to avoid crowded, confined and close contact places.

The writer is a former Secretary, Government of India. The views are personal.