As we write this letter, India is recovering from a devastating second wave that has claimed countless lives across the country and preparing for the imminent possibility of future waves. The various vaccines developed through rigorous research and clinical trials around the world have effectively shown to reduce both the risk of hospitalizations and the severity of the disease due to the SARS-CoV-2 novel coronavirus virus. India is known as the vaccine capital of the world and had assumed a leadership role in dispatching more than 664 lakh doses to 95 countries. With just 9.4% of the population receiving both the doses of the vaccine and 23% partly vaccinated against COVID-19, India is in a tight spot with a large number of vulnerable individuals potentially susceptible to infection with the third wave looming over us. India began vaccinating its citizens above 60 years of age earlier from March 1, 2021, followed by the inclusion of citizens above 45 years of age from April 1, 2021, and 18–45 years from April 28, 2021. One of the most important factors that affected the vaccine uptake in the population was the non-availability of the vaccines and other factors such as literacy status and the influence of misinformation. We are reporting an analysis of a follow-up survey performed 3 months since the initial survey in patients aged 45 years and above diagnosed with an ocular surface disease related to auto-immune pathophysiology such as Sjogren’s syndrome, Stevens–Johnson syndrome (SJS), ocular cicatricial pemphigoid (OCP), and cicatrizing conjunctivitis to assess the current vaccination status in those who did not receive the vaccine initially. A total of 183 patients were identified using these inclusion criteria and we were able to elicit a response in 133 of them leading to a response rate of 72.67%. The survey contained five questions and was completed through a phone call after obtaining informed consent from the patients. The answers were documented through a Google Form sheet and the responses were analyzed on Microsoft Excel®. Descriptive statistics using mean ± standard deviation and median with inter-quartile range (IQR) were used to elucidate the demographic data.
COVID-19 vaccine uptake
Overall, 133 respondents responded to the survey. There were 94 (70.68%) female patients and 39 (29.32%) male patients. The average age of the patients was 57.73 ± 9.34 years. The median age was 57 years (IQR 50.5–62) with a mode of 46 years. There were 66 (49.62%) patients with a diagnosis of Sjogren’s syndrome, 38 (28.57%) patients with SJS, 14 (10.53%) patients OCP and 15 (11.28%) patients with cicatrizing conjunctivitis. Surprisingly, more than half of the respondents with 77 (57.89%) patients had still not received the vaccine. In the 56 (42.11%) patients who received the vaccine, the majority received Covishield in 44 (33.08%) patients, a minority received Covaxin in 11 (8.27%) patients and Sputnik in 1 (0.75%) patient. Less than a third of the patients received both doses in 15 (26.79%) patients and the majority received only a single dose in 41 (73.21%) patients. A minority of the patients who received the vaccine complained of side effects in 7 (5.26%) patients. Lower vaccination uptake rates were seen among patients with OCP (78.57%) and cicatrizing conjunctivitis (60%). Over half of the patients (56.25%) above 60 years of age and a similar number (47.85%) between 45 and 59 years of age had not received the vaccine since the initial survey. Among the 77 (57.89%) patients who did not receive the vaccine, the most common reasons cited were concerned about their systemic disease (diabetes mellitus, hypertension, cardiac disease, and others) status (45.45%), non-availability of the vaccine stock (16.88%), fear of the taking the vaccine (12.9%), and fear of drug allergy (2.6%). The respondents in 8 (10.39%) calls informed us about the demise of the patients.
The follow-up survey in the patients who did not receive the vaccine has surprisingly shown that more than half of the respondents still did not receive the vaccine. The non-availability of the vaccine due to the shortage in India was reported as the most common cause (49.18%) in the initial survey which was lesser (16.88%) in the follow-up survey indicating increased access to vaccination. There still is a concern of patients receiving the vaccine due to the status of their systemic diseases such as diabetes mellitus, hypertension, cardiac disease, and others. The challenges posed due to the lockdown restrictions had led to the loss of follow-up care and uncontrolled systemic status of non-communicable diseases (NCD). There should be a holistic approach to the management of patients as the systemic control of NCDs is crucial for fitness in the event of the need for surgical interventions. There is still a need to critically understand the burden posed due to the combined effect of the COVID-19 pandemic and NCDs due to the increased risk of mortality in these vulnerable groups. While the developed world is already publishing guidelines for the third booster dose of the vaccine, only 1.4% of the population in low-income countries have received at least one dose of vaccine against COVID-19 and many other countries turning out into vaccine deserts with no access to the same. The glocal landscape of vaccinations is constantly changing due to regulations enforced by decisions based on science and government mandates. There is a critical need for us all to encourage vaccinations in our patients to ensure their safety and also that of the healthcare providers. It is a moral responsibility of everyone to be a part of the solution! The end goal of breaking the chain of transmission of the COVID-19 virus starts with each individual being empowered with the vaccine. Get the vaccine, protect yourself, and protect others!
Financial support and sponsorship
Hyderabad Eye Research Foundation, Hyderabad, India.
Conflicts of interest
There are no conflicts of interest.
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