The possibility of a vaccine becoming a reality to counter the coronavirus pandemic appears bleak at least for the time being, according to seasoned  medical practitioners in India and abroad. Dr Venugopal Reddy,

Kansas-USA  based physician who keeps track of the progress of the researchers in developing a vaccine for covid has some unpleasant questions to ask.

“They have been trying for the last four decades to develop a vaccine for AIDS, a disease caused by another virus.  Have they succeeded in it? What about the publicity regarding the vaccines developed for swine flu, birds flu and SARS? They have not reached anywhere. What is the guarantee that they would succeed this time?” asked Dr Reddy while speaking to The Pioneer from Kansas.

Even if pharma companies succeed in developing a vaccine for covid pandemic, it takes years for this drug to get the trust of general practitioners, pointed out Dr C V Krishnaswamy, Chennai based diabetologist and physician.  He said there was strong objection from medical doctors in Britain when they were asked to prescribe oseltamivir (Tamiflu) for the swine flu pandemic in 2015.

“Don’t be bullied into prescribing Tamiflu,” demanded Dr Margaret McCartney, a Glasgow based general practitioner in a communication to British Medical Journal.

“Now we have guidelines, hundreds of them. Good guidelines would distil evidence cautiously, making clear what we know and where the gaps are. They would say how many people would get what benefit from a treatment while identifying the cost in terms of harm.

But guidelines are not always applicable to our patients and they are meant to guide practice; rarely should they dictate it,” Dr McCartney wrote in the message which was published by the BMJ as a coup de grace.

She took strong objection to the communique issued by the National Health Service, the publicly funded health care system in England, in which the authorities had stated that “there is an expectation defined in the General Medical Council’s Good Medical Practice that a doctor will respond to an organization advising on public health”.

But Dr McCartney stated that the NHC directive read like a veiled threat. “If General Practitioners decide not to prescribe Tamiflu for all patients in a nursing home, lawyers and the GMC could dust down their robes and eviscerate the doctor for  not following orders,” she said. Dr McCartney a widely respected GP, who is a strong advocate for evidence-based  medicine, said  doctors had enough reasons not to accept the diktat from the GMC and the NHS.

“Doctors hesitate to prescribe the medicines dictated by the GMC and the NHS because 33 people have to be treated prophylactically to prevent one cause of flu. One in 20 will vomit and one in 100 will have neuropsychiatric side effects. Or may be its because the National Institute for Health and Care Excellence (NICE) didn’t include a negative trial in its calculations,”   said Dr McCartney who took strong objections to the disregard shown by the authorities towards multimorbid persons in nursing homes.

She also says that architects of mass public health intervention still don’t grasp that populations are made up of individual patients. “Each person offered antivirals needs not just an assessment of dose but also a discussion of risk and harm. Doctors must question what they are told to do, speak up and point out flaws in arguments when asked to prescribe drugs of questionable benefit. Prescribing because of fear is toxic to patient care and safety,” said Dr McCartney.

According to Dr Krishnaswamy, the apprehension shown by Dr McCartney is applicable to doctors all over the world including India at this critical juncture.