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Thalassemia Patients Group call for the inclusion of patients in policy making at APPIS 2021

New Delhi: Thalassemia Patients Advocacy Group (TPAG) stressed the importance of involving patients in the policy-making at the ongoing Asia Pacific Patient Innovation Summit (APPIS), a unique collaborative partnership initiated to address the evolving capability needs of patient organizations across Asia Pacific and beyond. The 3 days virtual summit “Co-creating patient advocacy of the future”, scheduled between 2nd and 4th March 2021 has been organized to support patient organizations to be better equipped and have their voices amplified in the healthcare system. The APPIS initiative has been brought together by five patient organizations for the betterment of people dealing with rare cancers, disabilities among others. Targeting patient communities across Asia Pacific, the Summit aims to set out a valuable blueprint for the future of patient engagement, encompassing strategic aspects of patient organization capabilities, such as funding, stakeholder partnership, and clinical trials engagement. “We should replicate and institutionalize such collaborations for effective policy formulation and implementation in the healthcare sector”, said Anubha Taneja Mukherjee, Member Secretary, Thalassemia Patients Advocacy Group. “When it comes to policymaking for patients, I strongly feel that decision-makers may not be experts in every subject or issue and it would therefore be pertinent to include a patient representative who understands the trials and tribulations involving the relevant condition. For instance, the decision-makers could invite thalassemia patients to be a part of the policymaking while devising a new policy on thalassemia as patients are the ones who undergo the hardship of a particular disease. Patient Advocacy Group (PAG) are well known for their role and achievements in establishing better health services for patients in several countries of the world. India should replicate this,” She added. “Policymaking is a consultative process and involves a huge gamut especially in India and there is a possibility that sometimes, certain issues don’t come into the eyes of policymakers as they should as the challenges involving certain disease conditions may not be evident to them. In such a scenario, we do see a significant role of civil society groups and NGOs coming forward and highlight these issues in the healthcare space. There is more role for patient advocacy groups and patients themselves to actually engage on relevant forums to educate the people in the system by sharing the human aspect of the challenges and suffering,” Said Dr. Urvashi Prasad, Senior Public Policy Specialist, NITI Aayog.

6th March, 2021

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Vaccination target fixed for hospitals in Kerala to avoid crowds

THIRUVANANTHAPURAM: Even on the fourth day, there was no respite from the complaints raised by senior citizens over the vaccine registration process. The beneficiaries, mainly senior citizens, are facing an inordinate delay at vaccine centres and have to stand in long queues. To ease their difficulties, government has come out with a new advisory for vaccination. To reduce crowding, vaccine centres will implement token system for spot registration and further split the spot registration to 50% before noon and 50% later. Abeneficiary, who has taken an online appointment, will not be asked to take further token at the hospital. Each hospital has been given a target for a session. District hospital will have a minimum target of 300 vaccinations/day, while it is 200 in taluk hospitals and100 at community and primary health centres. All districts should ensure that private facilities are also creating sessions well in advance and vaccines may be given to them once they are on board. “Vaccine eagerness resulted in overcrowding in many Covid vaccination centres. This can be counterproductive and also hamper Covid control measures taken by the state. People are unaware of the sessions that are being conducted on a particular day in their district. Online slots are not available for booking in most districts,” said state mission director of National Health Mission Ratan Kelkar, who is also the nodal officer for Covid vaccination. Hence it has been decided to increase the number of vaccination centres in a phased manner keeping in mind the need for new sites as the number of vaccinations/day will be doubled from March 29 with the addition of persons due for the second dose. It has been directed to plan the sessions well in advance and create sessions for the next 75 days in CoWiN. Districts must also ensure that details regarding sessions are disseminated among the public through print and social media on a daily basis, said the new advisory. Till date, 30,061 people aged over 60 years were vaccinated in state. Centre has informed the state that 21 lakh vaccines will be sent to the state by March 9.

6th March, 2021

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‘Medical care requires personal touch, distance is testing doctors’

Bengaluru: As the pandemic unfolded, medical oncologist Dr Niti Raizada worried about patients who had received a cancer diagnosis months ago and were delaying treatment over virus concerns. Obstetrician-gynaecologist Dr Hema Divakar deliberated on the tricky logistics of bringing expectant mothers to the hospital because, as she niftily puts it, you cannot lock down a pregnancy. Doctors across specialities have witnessed an intense reversal of normal times, wrestling with questions not just about Covid-19 but about the entire healthcare process. Is it safe to call a patient for a check-up or a procedure; should a problem be allowed to fester to avoid possibly bigger complications the virus may cause; are video consultations helpful; how to protect and reassure stressed-out and stretched staff? These are some of the urgent concerns. Medical professionals have had to rethink their approach as counselling or treatment for conditions other than Covid-19 cannot be deferred indefinitely. Eminent women doctors, some of whom are part of national healthcare discussions, spoke to TOI about the new changes and challenges. “We had to completely reorganise our services, from patient admissions to staff shifts,” says Dr Pratima Murthy, head of psychiatry at the National Institute of Mental Health and Neuro-Sciences, or Nimhans, in Bengaluru. “We have special wards with long-time patients, who are old or have other illnesses. An infection would be dangerous here, so we reverse-quarantined the older patients. New admissions are also nursed separately. Everyone is tested.” A limited number of personnel are allowed inside wards, and preventing burnout is a key concern. “People management is crucial. People make up the system and their health, physical and mental, and functionality determine how well it runs. We had to balance their and the hospital’s requirements,” says Dr Murthy. “As a healthcare worker, your biggest fear is you will carry the infection home to your family. We ease anxieties and ensure staff safety and patient care don’t suffer.” A big ask for doctors has been to broaden their focus from treatment to organisational protocols, revamps and webinars while simultaneously creating safe access, and peace of mind, for everyone. “We made arrangements that were not limited to patient care. In the early months of Covid-19, we retrained staff and shifted our emergency unit. A lot of liaising inside and outside the institution, especially when an employee or a patient tests positive,” she says. “Figuring out how to extend support to patients wary of coming to the hospital was also very important. Telehealth helped us continue our communication.” Changing guidelines are an irritant for most medical professionals. “They change while you are setting up a new system... Protocols are mostly set now, and we have held things together by working collectively and adapting,” says Dr Murthy. According to Dr Hema Divakar, medical director of Divakars Speciality Hospital in Bengaluru, the pandemic-induced distance is testing doctors. “In India, more than systems, it’s the specialist’s personal touch and relationship that reassure patients. We are personally invested in ensuring our patients’ health. The distance created by Covid, where in-person consultations cannot happen regularly, is challenging for us,” she says. “The standard way of practice, which we followed for decades, has changed. New protocols require a complete change in behaviour with numerous precautions. But we are also learning that some ground can be covered through video consultations.” Uncertainty is a stressor for both care seekers and givers. “Some procedures can be put off, but the question troubling everyone is: what next and when? Childbirth, for instance, cannot be postponed. Thousands of deliveries will happen in the coming months. Thankfully, pregnant women take great care of themselves and stay safe,” she says. Medical professionals are expected to have the right answers, but the pandemic has left them with many questions. “When patients pose queries now, especially on complications caused by Covid, we don’t have definitive answers as the understanding about the virus is still evolving. Every day, there’s new information. Being unsure is not a position any doctor likes to be in,” Dr Divakar says. Managing facilities amid staff shortages and creating the right conditions for patients to make a hospital trek take up a large part of the day. “We have to screen everyone. Missing an ailing person, whether they are entering or leaving the premises, is not an option. Many patients don’t want to use public transport or cabs, so we have to arrange transport to get them here,” Dr Divakar says. “Retraining staff and making them confident is so important because they are the first point of contact. They must constantly remind everyone to follow distancing and wear a mask. It’s tough as people don’t always understand. For instance, childbirth is a joyous moment and relatives naturally want to see the baby at the hospital and celebrate. This is not advisable right now.” Many hospitals are under a strain even as they support government efforts. “People expect the medical fraternity to be kind and compassionate, and waive charges. We don’t consider our work as a business, but there are realities: we need to pay the staff, we need to pay for the consumables. No one is giving us things for free,” she says. Dr Murthy and Dr Divakar highlighted the challenging situation of veteran doctors, who are advised to stay off active hospital work as their age or pre-existing health condition puts them at a risk. “There’s been a general advisory for some time now that doctors aged above 60 should get into digital consultations and let juniors take over at the hospital. But senior doctors are not particularly comfortable with e-consultations and junior doctors lack the expertise to attend to patients. There’s a disconnect between what’s expected and what can be done on ground,” says Dr Divakar. “In many places, senior doctors are the only help available, so they continue to work despite the risks.” According to Dr Murthy, experienced medical professionals who cannot help people in a healthcare setting right now are in anguish. “It’s hard to suddenly stop doing the work you have known for years. Patient contact is a very important aspect of the work, and doctors are solely missing being able to help patients,” she says. Dr Radha S Murthy, co-founder and managing trustee of the Nightingales Medical Trust, which focuses on eldercare, welfare and dementia, says providing regular mental support to patients is crucial now. “Most of my patients are elders, who are prone to multiple health issues. Covid has forced them into extreme confinement, and this has affected them physically and emotionally. As a doctor who pioneered home medical care in 1996, I am in touch with many elderly patients; every day, I attend several calls. More than medicines, aged patients need interactions, eye-to-eye contact and empathy,” she says. Despite risks to her health — a new reality for all medical professionals — she personally sees patients. “I could have managed them over the phone, but knowing their psychology, I decided to be in the field. Patients feel better this way and their caregivers, who toil 24/7, are motivated. Though telemedicine is promoted widely, it cannot be the ultimate solution to the health concerns of elders” she says. “We have developed new systems, made modifications to infrastructure and constituted a core group to monitor the situation (at our centres).” She is actively involved in the care of more than 140 people with dementia and 55 elderly destitute women. “In our setups, physical distancing and making patients wear masks won’t always won’t work as dementia patients need physical help for all their daily activities. It’s a huge challenge to take care of them during a pandemic. With strict safety protocols, we have kept Covid at bay from our residential care centres,” she says. Dr Niti Raizada, director of medical oncology and hemato-oncology and transplant physician at Fortis Hospital, Bannerghatta Road, notes Covid-19 has complicated the straightforward dimension of treatment. “In cancer care, regularity of treatment is critical. The pandemic has disrupted this frequency. Since March, people have been avoiding hospitals. It takes time to persuade them and explain that medical attention is high priority. When they finally come in, they are very sick and in severe pain,” she says. “Suppose, a diagnosis was made in February and you visit the doctor again only in September. You have allowed a lot of time for things to go wrong.” To read the whole article, click on the link below: https://health.economictimes.indiatimes.com/news/industry/medical-care-requires-personal-touch-distance-is-testing-doctors/78099374

5th March, 2021

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Time to watch your weight: Obesity can increase risk of Covid fatality

LONDON: The majority of global Covid-19 deaths have been in countries where many people are obese, with coronavirus fatality rates 10 times higher in nations where at least 50% of adults are overweight, a global study found on Thursday. The report, which described a "dramatic" correlation between countries' Covid-19 death and obesity rates, found that 90% or 2.2 million of the 2.5 million deaths from the pandemic disease so far were in countries with high levels of obesity. The study analysed the Covid-19 death figures from Johns Hopkins University in the United States and the World Health Organization's Global Health Observatory data on obesity. Strikingly, the authors said, there is no example of a country where people are generally not overweight or obese having high Covid-19 death rates. "Look at countries like Japan and South Korea, where they have very low levels of Covid-19 deaths as well as very low levels of adult obesity," said Tim Lobstein, an expert advisor to the World Obesity Federation and visiting professor at Australia's Sydney University who co-led the report. "They have prioritised public health across a range of measures, including population weight, and it has paid off in the pandemic." By contrast, the report found that in the United States and Britain, for example, both Covid-19 death rates and obesity levels were among the highest. The United Kingdom has the world's third-highest coronavirus death rate and the fourth-highest obesity rate - 184 Covid-19 deaths per 100,000 and 63.7% of adults overweight, according to WHO data - followed by the United States, with 152.49 Covid-19 deaths per 100,000 and 67.9% of adults overweight. John Wilding, a professor of medicine at Britain's University of Liverpool and president of the World Obesity Federation, said obesity should be recognised as a key Covid-19 health risk and taken into account in vaccination plans. "It's really important that we recognise that obesity ... increases the risk," he said in a statement about the report's findings. "Therefore, like other diseases such as diabetes and cardiovascular disease, people with obesity should be considered for early priority in vaccination programs across the world."

5th March, 2021

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How Johnson & Johnson’s vaccine differs from Pfizer’s and Moderna’s

A third effective weapon was added to America’s arsenal against the coronavirus Saturday when the Food and Drug Administration granted emergency use authorization for a vaccine developed by Johnson & Johnson. The company said it would start shipping millions of doses early this week and would provide the United States with 100 million doses by the end of June. Together with 600 million doses of the nation’s first two authorized vaccines, made by Pfizer-BioNTech and Moderna, that are due to be delivered over the next four months, that ought to be enough to cover every American adult who wants to be vaccinated. The new vaccine differs markedly from the two already in use in the United States. Here is how they compare. One Shot Instead of Two The Johnson & Johnson vaccine is administered in a single shot, while the Pfizer-BioNTech and Moderna vaccines are given in two shots several weeks apart. The Way It Works The Johnson & Johnson vaccine uses a different method to prime the body to fight off COVID-19: a viral vector called Ad26. Viral vectors are common viruses that have been genetically altered so that they do not cause illness but can still cause the immune system to build up its defenses. The Pfizer-BioNTech and Moderna vaccines use messenger RNA to do that. How Well It Works The Johnson & Johnson vaccine is rated as highly effective at preventing serious illness and death, as the Pfizer-BioNTech and Moderna vaccines are. It is also very effective at preventing milder illness, though a bit less so than those two. It appears to do well against the highly contagious B.1.351 variant, first identified in South Africa, that has given at least one other vaccine candidate trouble. Storage and Handling The Johnson & Johnson vaccine does not have to be stored at extremely low temperatures like the Pfizer-BioNTech vaccine. It can safely be kept in an ordinary refrigerator for three months, much longer than the Moderna vaccine, which spoils after a month if not kept frozen. Side Effects The Johnson & Johnson vaccine appears to be less prone than the Pfizer-BioNTech and Moderna vaccines to trigger the kinds of side effects that require monitoring after the injection, which may make it more suitable for use at drive-thru vaccination sites. There have been reports that side effects tend to be felt more strongly after second doses, which the Johnson & Johnson vaccine does not require.

5th March, 2021

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Explained: What Covaxin’s 81% interim vaccine efficacy means?

New Delhi: Bharat Biotech on Wednesday announced its Covid-19 vaccine candidate BBV152 Covaxin demonstrated 81% interim vaccine efficacy in its Phase 3 clinical trial. While the results are very encouraging and expected to boost confidence in the indigenously developed vaccine, however, it is important to understand that these are the first interim results based on 43 cases infected with the Covid-19 virus and the final results will determine the actual efficacy. Interim results from clinical trials help to analyze and predict the outcomes of a clinical trial. According to the Bharat Biotech, of the 43 cases around 36 cases of Covid-19 were observed in the placebo group versus 7 cases observed in the Covaxin group, resulting in a point estimate of vaccine efficacy of 80.6%. The data is yet to be peer-reviewed. An additional interim analysis is awaited for 87 cases, and the final analysis is planned for 130 covid positive cases to analyse the actual efficacy data. To understand the vaccine efficacy, the study needs to continue till the predecided number of trial participants report Covid-19 infection. In the case of Covaxin, there have to be 130 trial participants who get infected with the Covid virus, and after studying how many were from the placebo arm versus BBV152 COVAXIN arm can the final efficacy be found. The Hyderabad-based vaccine manufacturer in partnership with the Indian Council of Medical Research began the phase 3 study of Covaxin in November 2020 across 25 study sites and was conducted on a total of 25,800 participants between 18-98 years of age, including 2,433 over the age of 60 and 4,500 with comorbidities. The results are crucial as this is the largest ever clinical trial for Covid-19 in India and would provide data on how well the vaccine protects the younger and older age groups and also those with comorbidities. Covaxin Phase 1 and Phase 2 clinical trials conducted in 755 participants demonstrated high safety profile of the candidate vaccine with seroconversion rates of 98.3% and 81.1% on day 56 and 104 respectively. The vaccine is stable at 2-8 degrees Celsius has also shown efficacy against the UK strain of the virus. The interim result is expected to reduce the hesitancy and doubts in people that cropped after the vaccine was granted approval in January 2020 without the phase 3 efficacy data. Currently, Covaxin and Covishield are the two vaccine candidates that are being administered to people in India as part of the nationwide Covid-19 vaccination drive which began on January 16. On March 1, India began the second phase of vaccination for people above 60 years of age and people above 45 years with comorbidities.

4th March, 2021

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Pune: Health experts demand free inoculation at private hospitals

Pune: Public health experts have questioned the Union government’s move to cap the Covid vaccine cost at Rs250 at private hospitals and demanded that the vaccines be provided for free, considering the gravity of the situation. The country’s foremost vaccine expert and professor of microbiology at the Christian Medical College in Vellore, Dr Gagandeep Kang, told TOI that as far as she was aware, India was the first country to charge for the vaccination at private hospitals. “Since the vaccines are not yet licensed, but approved for restricted use, I am not sure about the basis of the government’s move,” she said. Kang said in other countries, where the vaccines have been given emergency use authorisation, the governments were providing them free of cost even at private facilities. “One way to think about this is that the government is not charging for the vaccine but for services of purchasing it and providing it to private facility,” she reasoned. K Srinath Reddy, president of, Public Health Foundation of India, said the cost of the vaccine must be borne by the government. “Even if private hospitals are administering it, the overhead charges may be levied by the private facilities to the patients opting for the vaccine but the supply should be the responsibility of the government. “Vaccination in an epidemic is a public good and must be financed from government revenues,” he said. Reddy said the central and state governments should work out their share of the vaccine cost, but the principle should be applied across the country.

4th March, 2021

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World's 1st hybrid freezer for vax rolls out

Hyderabad: Rockwell Industries, a pioneering commercial cold chain appliances manufacturer, on Thursday launched Chillermill, the world's first chiller/freezer powered by hybrid (solar and wind) renewable energy, that would be ideal for storing vaccines including Covid-19 vaccines at the desired temperature. The company also rolled out their new Covid-19 vaccine freezer series. World Health Organization PQS certified freezer series, will be manufactured at Rockwell's state-of-the-art manufacturing facility in Medchal, Hyderabad. The entire system is certified by the National Institute of Pharmaceutical Education & Research (NIPER) Hyderabad. Jayesh Ranjan, Principal Secretary, Government of Telangana for the Industries & Commerce (I&C) and Information Technology (IT), formally launched the new range of Covid-19 vaccines chillers, a simple plug and play standalone unit, powered by SolarMill, a hybrid (wind & solar) energy solution, manufactured by WindStream Energy Technologies ideal for remote areas where availability of electricity is not stable. The Hybrid Renewable System comprising Savonius vertical axis wind turbines, along with a solar module enables the refrigerator to run 24/7 on power stored in batteries. SolarMills are also being used in powering critical applications of defence forces, Railways and Telecom domain. Commending Rockwell for its need of the hour technological innovation, and its new Covid-19 vaccine focussed hybrid renewable energy-driven Chillermill and the WHO certified new Covid-19 Freezer series, Jayesh Ranjan said government's and immunization programmes rely on a complicated cold chain of freezers and temperature-controlled conditions and Rockwell has developed the much-needed refrigeration technology to address these challenges to preserve vaccine, healthcare products, and other deep-freezing applications. "There are places especially, many rural hospitals and immunization sites that can't depend on the unreliable power supply. With our new renewable energy-supported freezers/chillers, we are in a position to help the health sector overcome these challenges. Technologically they meet the strictest biosafety, biomedical needs and solve the pain points in the cold chain," said Ashok Gupta, Managing Director, Rockwell Industries. The company is in active discussion with leading vaccine players nationally and internationally to supply Chillermill. "We expect to close in orders worth Rs 25 crore this year and hope to achieve Rs 50 crore by the end of 2022," Ashok added Rockwell, which has a size of over Rs 125 crore in the segment, may touch Rs 350 crore in the next few years, Ashok Gupta, revealed. Rockwell's fully operational plants in Medchal, Hyderabad, can produce over 400,000 units per annum. Further, the company has earmarked an investment of Rs 50 crore towards R&D, new capacities and adding a new marketing network to its existing network of over 500 outlets. The company plans to participate in several tenders of Central and state governments, public and private enterprises for refrigerators and freezers. Rockwell has the widest range of commercial and medical refrigeration appliances in the industry ideal for use in diverse environments and energy conditions, it sells about 100,000 units of its range of products to customers in India and different parts of the world. In an initiative to increase their green footprint, Rockwell has partnered with WindStream Energy Technologies for providing unique hybrid (solar wind) Renewable energy solutions for the power needs of refrigerators and chillers/freezers. Rockwell's Chillermill and the new Covid-19 vaccine freezer series meet the temperature protocols of currently available vaccines for Covid-19 including India's Covaxin, AstraZeneca-Oxford vaccine, Moderna, and the Sputnik Vaccine temperature requirement of storage temperature between 2 to 8 degrees Celsius. The new Chillermill can also meet the minus 40 degrees Celsius requirement. With the nationwide coronavirus vaccination drive getting far bigger for the second phase covering 50 plus age groups, the demand and need for commercial refrigeration to ensure a sustainable supply chain is growing across the globe. Further, as vaccines begin to receive commercial licensure, Rockwell anticipates the requirement for its products is bound to grow even more, from major healthcare manufacturers, R&D facilities, and rising healthcare expenditure. According to the data from the WHO, due to the lack of temperature control or continuous cold chain during vaccine transportation, 5-20 percent of vaccine loses its potency. A recent market research report published early this year by Meticulous Research mentioned the vaccine storage equipment market is expected to grow at a CAGR of 10.6 percent from 2020 to reach $1.83 billion by 2027. The demand for cold storage solutions from pharma and other segments is expected to post a 17 percent growth in 2021 to Rs 1.7 trillion, according to market research firm IMARC Services. In addition to the demand for cold storage to house Covid-19 vaccines, there is a rush in demand from pharma and allied sectors for cold chain products.

4th March, 2021

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