In the wake of Omicron, India has taken a different path, with the prime minister recently proposing a "precaution dosage" for frontline employees, healthcare personnel, and older people with complex medical conditions. So what exactly is a precaution dose; is it different from a booster? And, what are the possible choices of vaccine for the third dosage?

Precaution doses

The PM of India on 25th December said that "precaution doses" (boosters) of COVID vaccinations would begin on January 10 for health and frontline workers, as well as people over 60 with co-morbidities. Additionally, he said that vaccinations for children aged 15-18 would begin on January 3 using Covaxin.

The nation has gained knowledge through delivering 141 crore doses and considerable capacity expansion via oxygen supply has occurred. There are conflicting estimates and reports of Omicron, suggesting that India's policy response would be directed by its experience, infection prevalence, and vaccine effectiveness in use.

The judgments put an end to discussion over the timing of booster dosages. The PM said that these calls would be based on scientific research and evaluations generated from studies and the vaccine rollout, as has been the case since the immunisation programme began on January 16.

Individuals over the age of 60 with comorbidities will have the option of taking the 'precaution' or booster dosage on their physicians' advice. India has made judgments based on its own circumstances and facts, in addition to global experiences.

Students and parents are likely to be reassured by the decision on immunisations for youngsters. Covaxin is the second vaccine, after Zydus Cadila's ZyCoV-D, to get regulatory approval for limited use in children aged 12-18. However, the vaccine programme will initially include only children aged 15 and older. He also said that approvals for a nasal vaccination and the first DNA vaccine in the world are imminent. The pharma authority approved Bharat Biotech's domestically made Covaxin for children above the age of 12 for emergency usage.

Omicron's heightened transmissibility has raised illness risk, despite the fact that youngsters have been spared the pandemic's worst impacts so far.

According to a government statement:

"This was done in consideration of the amount of time spent by frontline workers and health care professionals serving COVID patients. In India, this is referred to as a 'precaution dosage' rather than a 'booster dose'. The precautionary dosage decision will instil more trust in healthcare and frontline personnel."

While vigorous talks about Omicron continued, scientists in India evaluated local data from 11 months of immunisation in the country, while also carefully monitoring global experiences, which differed by country. The study took into account the effect of vaccination on the elderly, individuals with co-morbidities, and vaccine response in terms of dosage gaps.

Additionally, researchers analysed data on re-infections and new infections in India and around the world. The decision to implement a 'precaution dosage' and to immunise youngsters will bolster the battle against COVID-19 and contribute to the normalisation of education in schools.

What exactly is the precautionary dose?

A 'precautionary' vaccination might be a different dose. The country's highest technical advisory committee on COVID immunisation has reached a preliminary agreement that the third dosage should be a vaccine based on a different platform than the first two doses.

As per sources:

"There is some clarification that if a recipient receives a further dosage, it cannot be the same vaccination, at least not in the case of inactive whole virus or adenovirus vector COVID-19 vaccine. As a result, the early agreement is that a recipient cannot get more than three doses of Covishield or Covaxin."

According to sources, the precautionary dosage will very certainly be a different platform vaccination. Numerous solutions will very certainly become available in the next months. The first is Biological E's Corbevax, a protein subunit COVID-19 vaccine developed in Hyderabad.

This differs from inactivated whole-cell vaccines in that it contains just the virus's antigenic components, which induce a protective immune response. Bio E's vaccine candidate is based on an antigen discovered by Texas Children's Hospital's Center for Vaccine Development and is licenced from Baylor College of Medicine's integrated commercialization team, BCM Ventures.

Possible choice of vaccine for the third dosage

1. The Centre has already paid a Rs 1,500 crore advance payment to reserve 30 crore pills of Corbevax. Corbevax is anticipated to get Emergency Use Authorisation within the next two weeks, according to sources.
2. The second possible contender for a third dosage is Covovax from the Serum Institute of India. This is a COVID-19 vaccination based on recombinant nanoparticle protein. Novavax and SII, both located in the United States, have previously acquired EUA approval for this vaccination in the Philippines.
3. A third possible choice for a third dosage is Bharat Biotech's intranasal vaccine. According to sources, this vaccination is likely to be available in the second part of January.
4. The fourth contender for a potential third dosage is India's first m-RNA COVID-19 vaccine, which was produced by Gennova Biopharmaceuticals Ltd. in Pune.
5. Previously, the government said that Gennova's mRNA vaccines will yield 6 crore doses. Significantly, unlike Pfizer and Moderna's mRNA vaccines, this one meets India's cold storage criteria for its vaccination push (2-8 degrees Celsius).
6. mRNA vaccinations are being recommended as booster doses by experts worldwide. In September, after a review of data on booster responses to various COVID-19 vaccination combinations, the UK expert committee became the first to recommend that Pfizer's mRNA vaccine be administered as the third booster dose regardless of whatever product was used in the initial schedule.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.