Monday, May 11, 2020

CMAAO CORONA FACTS and MYTH BUSTER 91: Vaccine, Collateral harms vs benefits

CMAAO CORONA FACTS and MYTH BUSTER 91: Vaccine, Collateral harms vs benefits

Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania, HCFI, Past National President IMA, Chief Editor Medtalks
With inputs from Dr Monica Vasudev

833:   CMAAO Weekly Update and Vaccine development status in CMAAO countries

9th May, 2020, Saturday


Member NMAs

Dr KK Aggarwal, President CMAAO
Dr Yeh Woei Chong, Singapore Chair CMAAO
Dr Rajan Sharma, National President IMA
Dr Marthanda Pillai, Member World Medical Council
Dr Ravi Naidu, Past President CMAAO, Malaysia
Dr N Ganabaskaran, Past President Malaysian Medical Association
Dr Thirunavukarasu Rajoo, Hon. General Secretary, Malaysian Medical Association
Dr Marie Uzawa Urabe, Japan
Dr Sajjad Qaisar, Pakistan
Dr Anil Karki, Nepal


Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia
Dr KK Kalra, Former CEO NABH
Dr Sanchita Sharma, Editor IJCP Group

  • The World Medical Association (WMA) is of the view that the funding to WHO should not be stopped by USA as it will hamper its working. CMAAO has supported the WMA in this endeavour. On behalf of CMAAO, the letter of support was signed by Dr KK Aggarwal, President CMAAO.
  • The world is eagerly awaiting the vaccine against Covid-19. The earliest the vaccine is anticipated in September; it may take more than a year. What will be the cost of the vaccine is an issue that needs particular attention?
  • The vaccine can be a killed/inactivated virus or live attenuated. Vaccine can be from spike (S) protein, membrane (M) protein, envelope (E) protein and the nucleocapsid (N) protein (SMEN). There can be a hybrid vaccine, which uses the influenza or parainfluenza vaccine.
  • India too is working on a multiple protein vaccine against spike, membrane and envelope. There are two potential coronavirus vaccines in Australia.
  • Advisories and guidelines issued by the governments are changing every day; there is a lack of clarity.
  • A resolution was passed that NMAs of Asian countries and CMAAO countries should write to their governments that instead of copyright, we should talk about “copyleft”, share our knowledge, collaborate with each other, and conduct joint research on drugs/vaccine. The virus is here to stay and so CMAAO countries should work to develop common protocols and guidelines that are acceptable to all countries. We should jointly develop a vaccine not for commercial purposes but for the humanity. It is time to forget difference between countries.
  • Dr KK Aggarwal suggested launching a new campaign “CMAAO Copyleft on Covid-19”, where innovations and ideas can be shared between CMAAO countries. A Face Book page can be created to this purpose.

834: Round Table Meeting on COVID-19: Collateral losses and benefits
9th May, 2020, Saturday, 11am-12pm
Dr Mahesh Verma: Chair
Dr KK Aggarwal, Dr AK Agarwal, Dr Suneela Garg, Dr Anil Kumar, Dr Atul M Kochhar, Dr Ashok Gupta, Dr Girdhar Gyani, Dr Alok Roy, Mr Bejon Misra, Mrs Upasana Arora, Dr K Kalra, Ms Ira Gupta, Mrs Geeta Anand, Mrs Aruna Tyagi, Dr Sanchita Sharma


  • The Covid-19 pandemic has caused considerable morbidity and mortality directly due to the infection; there are some collateral losses as well.
  • While it is difficult to talk about benefits of Covid-19 with all its attendant suffering and hardships, deaths and sickness of thousands, there are some collateral benefits associated with the pandemic.
  • Lessons learnt during the pandemic should be converted to collateral benefits.
  • The collateral benefits must be enumerated and presented to the society so that we can adopt a lifestyle with a change.
  • India has a large population of asymptomatic cases, which may pose a risk to the older generation.
  • There is an apprehension of a second wave in China, but we are yet to think about it in India.
  • Only when 20-30% of population is infected, can we say that peak has been reached.
  • Social distancing is the only answer to Covid-19. If the population density is >1000/ sq km, the average number of cases is more than 2000; if the density is 200-300/ sq km, the average number of cases is 35.
  • We must come out with a strategy to control TB similar to efforts to contain Covid-19: Isolate a patient with open TB till he is negative; test all close contacts of the TB patient and develop an Arogya Setu App also for TB for notification.
  • Ayush is now coming to the forefront as a good and robust alternative to people; a center of excellence is being created at BHU, Varanasi. A 9-point declaration will be soon revealed as a road map along with an action plan for 12 months.
  • Covid-19 has become a vertical program, which is likely to take away the gains; other persons should be employed so that other national health programs do not suffer.

  • Patients are not able to reach hospitals
  • Education of staff and patients is a challenge.
  • Immunization coverage is decreasing.
  • Health management Information systems are not being monitored.
  • Economy: The largest impact of the pandemic has been on the economy, both global and local (India). The implementation of unprecedented lockdown has led to a sudden global stop in economic activity. A baseline global pandemic scenario sees GDP of the world fall by 2% below the baseline, of developing countries by 2.5% and of industrial countries by 1.8%. In India, the first phase of lockdown has been estimated to cost nearly $4.5 billion every single day. India’s GDP growth for the current fiscal is expected to slow down to 4.8%.
  • Tourism and hospitality industry: The impact of Coronavirus on tourism and hospitality has been of a considerable magnitude. A large percentage of total tourism business activity of India, which is estimated at $28 billion-plus in Forex and upwards of Rs 2 lakh crore in domestic tourism activity will be at economic risk through the year. 96% destinations of all worldwide destinations have introduced travel restrictions in response to the pandemic. Around 90 destinations have completely or partially closed their borders to tourists, while a further 44 are closed to certain tourists depending on country of origin.
  • Distress deaths: As on 20th April, 2020, the total number of recorded deaths associated with Covid-19 pandemic in India was 515. Of these, 334 were deaths due to infection, while 181 were distress deaths. The most significant cause of distress deaths is the fear of the disease or stigma associated with Covid-19. A large number of people suspected of having Covid-19 committed suicide, died in attempts to escape from miserable conditions in which they were quarantined or killed somebody in an attempt to escape.
  • Collateral damage of Covid-19 affecting persons with disabilities
  • Patients on dialysis or thalassemic patients are not able to visit hospitals due to either lack of transport or facility not available
  • Schools have been closed for almost three months (and are likely to remain closed for two or more months) due to lockdown, this could have detrimental social and health consequences for children living in poverty as schools are not only a place for learning but also for eating healthily (mid day meals). As a result, the nutrition of children is likely to suffer.
  • Increased violence incidence in field as well as in HCFs, gender related violence
  • Labor migration issue
  • HCWs stigmatized – denied entry to their houses/locality
  • Across India, workers complained that employers used lockdown to defraud them of wages they are owed.
  • Likelihood of crime may increase as convicts are being freed


  • Enhanced public awareness regarding infectious disease prevention
  • Improved hygiene and sanitation have reduced the incidence of food and water-borne diseases like typhoid, jaundice, summer diarrhea (though the diarrhoea peak is yet to come).
  • Restricting visitors to hospitals will reduce hospital-acquired infections (HAIs)
  • Decrease in pollution: Clearer rivers, cleaner air, more birds and wildlife around us, reduced emissions of global warming gases, rock bottom demand of fossil fuels, quieter surroundings, view of Himalayan mountains from Jalandhar, Saharanpur, more flamingoes in Mumbai, reduced road accidents, to name a few. There has been 70% decline in PM10 and PM2.5 levels all over the country. At some places, we have been able to achieve PM2.5 levels less than 20. This has decreased asthma episodes and other allergic diseases.
  • Fewer trauma cases; cases of hand injuries, tendon injuries, and domestic burns have disappeared, there are fewer industrial accidents.
  • Improved interpersonal relationship: People are learning to live with their families.
  • New lifestyle norm: Work from home, online school/college teaching
  • Greater opportunity for Make in India
  • Learning to develop pandemic-friendly infrastructure to fight against future epidemics/pandemics
  • One stop clinics’: with lab, point of care tests, pharmacy tie ups, speciality tie ups

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