Coronavirus

Developing The COVID-19 Vaccine Is Only Half The Battle

Even if researchers' quest for the coronavirus vaccine concludes quickly — and that's a big if — the solution would still need to me manufactured, packaged, paid for and distributed.

Conceptual vaccine and new coronavirus reflected in a drop.
Conceptual vaccine and new coronavirus reflected in a drop.
Javed Iqbal

-Analysis-

The coronavirus, and our response to its spread, has dramatically altered our way of life, and many experts warn that our lives may never go back to normal unless we find a vaccine. But even with a vaccine, we may never go back entirely to the way we used to live.

By the more optimistic measures, it will take close to two years to develop a functional vaccine. Researchers have already started several extensive efficacy studies involving thousands of volunteers, which is the most cost-intensive part of figuring out a vaccine and the riskiest. During these studies, researchers need to wait for people in the survey to get accidentally infected with the virus, and then analyze how often those given the vaccine get sick.

Producing vaccines is an intricate process, illustrated by the fact that even after 30 years we have no vaccine for HIV. The dengue fever virus was identified in 1943 but an early vaccine was approved only last year. The fastest vaccine ever produced was for mumps, in four years.

In addition, a vaccine may not work as intended. One vaccine that sounds safe in a small group of individuals might produce side effects when investigated in a more comprehensive review. Another may hardly protect half of the people who get it from COVID-19, or provide protection but not enough to make a difference to the pandemic's evolution.

Finally, even if researchers develop a "perfect" vaccine, and soon, there are other matters we will need to address before policymakers can claim victory.

To start with, there are ethical issues, especially regarding decisions on who gets the vaccine first. Any government will have a tough time allowing a vaccine manufactured in their country to be exported while there is a problem at home. Countries where the vaccines are manufactured could hoard them or companies could also sell doses to the highest bidders. The U.S. government has promised $1.2 billion for least 300 million doses of AstraZeneca's vaccines, with the earliest doses to be delivered as soon as October.

Pandemics, just like natural calamities, almost always hit poorer communities worse.

Another issue is that countries with fewer resources may not be able to afford or access enough vaccines without price restrictions. Rich countries can thus monopolize the vaccine, potentially leaving many people in developing countries to continue to bear the brunt of COVID-19. In 2009, during the H1N1 swine flu that killed 284,000 people worldwide, richer countries were able to get the vaccines earlier than developing countries by directly negotiating large advance orders. In other words, distribution of the H1N1 vaccine was eventually based on purchasing power, not the risk of transmission.

Governments, institutions, healthcare workers and other stakeholders will have to fight similar fights to procure PPE and ventilators. Pandemics, just like natural calamities, almost always hit poorer communities worse. With fragile health systems, already burdened health care workers and insufficient equipment in low-income countries, the long-term impacts of how governments respond to the coronavirus pandemic could be overwhelming. The virus is likely to continue to disrupt global supply chains as long as countries with large populations don't get the needed vaccines.

Medical team conduct sample Covid-19 tests in Kashmir, India. — Photo: Aasif Shafi/Pacific Press/ZUMA

Even where promising results for vaccines have been reported, there are considerable challenges to scaling up production and transportation. Bill Gates, whose foundation is investing $250 million to help spur vaccine development, has warned of a severe deficit of a banal but indispensable component: medical glass. Without ample supplies of this grade of glass, there will be fewer vials to transport the billions of doses that will ultimately be required.

After the vaccine has been manufactured, distributing it in countries like India will be another tricky task. India supplies 60% of the vaccine doses purchased by UNICEF every year, and the Serum Institute of India is the world's largest vaccine manufacturer, producing and selling over 1.5 billion doses every year. But Indian bureaucracy also moves notoriously slowly. In 2016, for example, about 38% of all children failed to receive their necessary vaccines in the first year of life.

Finally, there is no global entity that could finance and procure vaccines at scale. Nor is there a globally fair allocation system for such vaccines. International collaboration is important when dealing with pandemics of such magnitude. Merck, which ultimately developed the Ebola vaccine, required the help of the Canadian and American public health agencies plus the WHO.

It will be necessary to have such a global collaboration to ensure everyone who needs the coronavirus vaccine gets it.

*Javaid Iqbal is a Global Fellow at Brandeis University, Massachusetts.

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Coronavirus

Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."


Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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