Ever since India’s independence, the BCG campaign developed as the largest immunization campaign in the world. The objective was to reach all Indians below the age of 25 (estimated at 170 million people) by the end of the second five-year plan period in 1961. Facing stiff logistical challenges and powerful opposition, BCG was incorporated into the general immunization programme in 1978.

Community participation, is another pre-condition of any programme of mass immunization to be successful. The DOTS strategy (directly observed treatment, short course), promoted worldwide by the World Health Organization, is highly effective only where fully implemented; but in the event of non-compliance it gives rise to multi-drugresistant (MDR) strains, the instances of which are rising in several countries, including India.

An estimate puts MDR cases to be above 10 per cent of all tuberculosis cases and more than 50 million people are infected with MDR M. tuberculosis strains globally. If the administration is not enforced by health workers on a day-today basis, such a programme is bound to fail much in the same way as the advice to remain quarantined at home to people with travel histories from countries afflicted with COVID- 19 was flouted with disdain and impunity. It is a matter of speculation when all this will be a closed chapter.But the future is uncertain.

Even though the eradication of smallpox by vaccination was envisaged by Edward Jenner as early as 1802, it was not until WHO launched a determined global vaccination programme in 1966 that success was finally achieved in its eradication by massive and concerted worldwide effort in 1977.

Beginning with the intensified Smallpox Eradication Programme (SEP) in 1967 in India, home to some 30–40 per cent of all smallpox patients in the world, the final stage (1973-75) of the South Asia SEP that closed the chapter convinced the world of the need for globally coordinated action for eradicating a number of other diseases.

This led to the launch of WHO’s worldwide Expanded Programme of Immunization (EPI) in 1974, cited, in turn, to justify the launch of the global polio eradication programme in 1988. Though India constituted over 60 per cent of all global polio cases as recently as 2009, there was not a single case of wild polio virus since 2011. India, along with the rest of the Southeast Asia, was officially declared polio-free as late as in 2014. But the primordial pathogens keep visiting us.

Even today, cholera happens to be a disease of inequality that sickens and kills the poorest and most vulnerable, indeed those without access to clean water and sanitation. Even in the first decade of this century, countries in Africa (particularly the Democratic Republic of Congo, Liberia, Mozambique, Somalia and Uganda) accounted for 96 per cent of reported cases of cholera. In Yemen, from the start of the outbreak in October 2016 to June 2019, over 1.8 million potential cholera cases and 3,500 deaths have been reported.

It bears recall that the pneumonic plague ~ a more deadly strain of the bubonic plague, or “Black Death” that ravaged 14th century Europe ~ broke out in Surat in August 1994 immediately after a bubonic plague in Maharashtra’s Beed district. The outbreak of the disease led to more than 200,000 people ~ their faces wrapped in cloth to keep out the germs ~ fleeing the city, making it one of the largest post- Independence migrations in the country. The pneumonic plague quickly spread to five states and the national capital.

There were more than 1,000 suspected cases and the disease killed over 50 people across the country. Of the top ten major pandemics, there is actually no truly effective vaccine for almost half. The unpreventable five are typhus, HIV, malaria, tuberculosis and syphilis.

It is estimated that up to 1 per cent of the world’s population was killed ~ 25 million may have been killed in the first 25 weeks (compared to HIV/AIDS that killed 25 million in its first 25 years) ~ when the 1918-19 pandemic had struck. Still, there can be little incentive today for developing a vaccine for the virus H1N1 associated with the 1918 outbreak known as the Spanish flu because the worryingly potential modern H5N1 strain that causes a highly infectious, severe respiratory disease in birds called avian influenza is an entirely different strain against which there is no effective vaccine.

Certain diseases ~ Ebola or Creutzfeldt-Jakob Disease (CJD) for instance ~ are all the more dreadful for lack of any cure, any vaccine and ultimately no effective treatment. Is there a way out to tide over the recent crisis? According to a Newsweek report, Cuba has mobilized its medical corps around the world to distribute a new “wonder drug” ~ jointly developed by scientists from Cuba and China ~ called Interferon Alpha-2B Recombinant (IFNrec). Officials say it is capable of treating the new coronavirus despite the strict US sanctions.

Cuba first used advanced interferon techniques to treat dengue fever in the 1980s and later achieved success in using it to combat HIV, human papillomavirus, Hepatitis B, Hepatitis C and other diseases. But doubts persist as to whether we can fast-track our discovery of a vaccine given the uncertainty in the outcome of clinical or human trials. There are as many as 35 companies and academic institutions, according to The Guardian. They are trying to create a vaccine, and at least four are already testing it on animals.

The first of these ~ produced by the Boston-based biotech firm Moderna ~ will begin human trials soon. WHO, meanwhile, has announced a major study to compare treatment strategies in a streamlined clinical trial design calling doctors around the world to join.

At least 12 potential COVID-19 treatments are being tested, including drugs already in use for HIV and malaria, experimental compounds that work against an array of viruses in animal experiments, and antibody- rich plasma from people who have recovered from COVID-19.

The article in The Guardian examines why taking a vaccine candidate all the way for regulatory approval might take as long as a decade or more, and there can be no short-cut. After the smallpox vaccine, Emil von Behring’s and Shibasaburo Kitasato’s use of horse anti-serum for treating diphtheria and tetanus became the next major breakthrough in immunological research, a feat so important that it earned the German scientist the first ever Nobel Prize in Physiology or Medicine in 1901.

We are not certain about when another eureka moment will rid us from the threat that has brought the world to a grinding halt. India’s response to this catastrophic outbreak must not be based on heresies or superstition, or on the fatalism of its people.

In fact, as China and South Korea have shown, the response should be tempered by the people’s trust in science and medicine, their experience of pain and illness and their reaction to disability and death. Until we find a vaccine against the novel coronavirus, we will either have to scout for cover (which we actually cannot) or just bide time.

The people will have to brave the virus because lockdowns, in the long run, are unsustainable. The road to a vaccine might be long and tortuous and we must learn to struggle for it.

(Concluded)

(The writer is a Kolkata based commentator on politics, development and cultural issues)