A BRIEF TIMELINE TO COVID-19 VACCINATION

INTRODUCTION TO THE VIRUS

• The coronavirus disease (COVID-19) emerged in Wuhan, China in December 2019. Back in December 2019, it all started in a patient with pneumonia of unknown etiology in Wuhan, China and since has spread to over 180 countries.
• It was ascertained that novel corona virus was of a zoonotic origin was the causative agent that jumped from a bat, acting as its reservoir via an intermediate host which most likely could be pangolins
• Initially WHO called it 2019-nCoV which was subsequently named SARS-CoV-2 by International Committee on Taxonomy of Viruses (ICTV).
• This contagious virus gets transmitted from an infected person via droplets and fomites. However, in several cases, the shedding of viral RNA has been found in feces which raise concern over community spread of COVID 19 through contaminated water. The recent claims by WHO has claimed it to be an airborne disease.
• Several countries are trying to find the vaccination for this deadly novel corona virus. But how is the blueprint taking place?

BEGINNING FOR SOLUTIONS

• The current COVID-19 pandemic is unprecedented, but the global response draws on the lessons learned from other disease outbreaks over the past several decades.
• As part of WHO’s response, the discussions were activated to accelerate diagnostics, vaccines and therapeutics for this novel coronavirus.
• The Blueprint aims to improve coordination between scientists and global health professionals, accelerate the research and development process, and develop new norms and standards to learn from and improve upon the global response.
• On 30 January 2020, following the recommendations of the Emergency Committee, the WHO Director-General declared that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).
• World scientists on COVID-19 met at the World Health Organization’s Geneva headquarters on 11–12 February 2020 to assess the current level of knowledge about the new virus, agree on critical research questions that need to be answered urgently, and to find ways to work together to accelerate and fund priority research to curtail this outbreak and prepare for those in the future.
• The discussion led to an agreement on two main goals.
  •  The first was to accelerate innovative research to help contain the spread of the epidemic and facilitate care for those affected.
  • The second was to support research priorities that contribute to global research platforms in hopes of learning from the current pandemic response to better prepare for the next unforeseen epidemic.
• Building on the response to recent outbreaks of Ebola virus disease, SARS-CoV and MERS-CoV, the R&D Blueprint has facilitated a coordinated and accelerated response to COVID-19, including an unprecedented program to develop a vaccine, research into potential pharmaceutical treatments and strengthened channels for information sharing between countries.

SARS-CoV CHALLENGE

• The urgency of the current pandemic gives substantial weight to challenge studies.
• As of 17 May 2020, more than 4.5 million COVID-19 cases and more than 307,000 deaths have been reported globally.
• Those numbers are on a continuous rise, and there is great uncertainty concerning how many more cases, hospitalizations and deaths will eventually occur and how long the pandemic will last.
•  The pandemic is expected to trigger a prolonged global recession that will further negatively impact the health and well-being of individuals worldwide.
• SARS-CoV-2 challenge studies could enable three things: studying clinical progression, developing effective vaccines and testing candidate therapies.
•  The process of testing candidate therapies is less imperative, as therapeutic trials are already taking place in existing patients.
• To study clinical progression, volunteers challenged with standardized virus doses would be observed to find out what proportion develop symptoms, how much virus it takes to cause disease, how long it takes for infected individuals to develop symptoms, how long individuals are infectious for, and what biomarkers are associated with more severe disease or more effective immune responses.
• The observations could help answer currently unresolved questions and aid policy decisions, such as whether quarantine durations are adequate, what criteria should be used to ensure that discharged patients are not infectious, the extent to which truly asymptomatically infected individuals are infectious, or whether recovered patients can later be re-infected.
• Additionally, candidate vaccines that have satisfied phase I safety and phase IIa. Dosage trials could be administered to volunteers who are subsequently challenged with the virus as part of a phase IIb trial to see how well the vaccine protects them as compared with a placebo or suitable alternative.
•  Promising vaccines must eventually undergo large-scale testing in at-risk communities, but the process of assessing candidate vaccines prior to large phase III trials could be substantially accelerated by challenge studies.
• It is difficult to give a precise estimate concerning how much time could be saved in vaccine development through a challenge study.
•  It is already very uncertain whether the US’s goal of developing a vaccine within 18 months is feasible, given numerous logistical difficulties and the fact that most candidate vaccines will fail.
•  And challenge studies themselves will take some time to establish, including production of a version of the virus that can be deployed in such a study.
• But just as uncertainty about the feasibility of developing a vaccine within 18 months should not preclude extraordinary efforts already underway, it is worthwhile to now begin the process of preparing for a SARS-CoV-2 challenge study.
•  Like other vaccine efforts, it is possible a challenge study would not result in an effective intervention.
• Nevertheless, making a vaccine available even a few weeks sooner than otherwise possible via a challenge study would save many lives and relieve pressure on strained health systems, and would have global social benefits, by allowing countries and economies to resume normal activity that much earlier.
• A difficulty with obtaining adequately informed consent is that much information about COVID-19, including actual mortality risk and infectiousness after recovery, is still highly uncertain, and models have been rapidly adjusting since the early days of the pandemic.
•  Uncertainty does not preclude adequate informed consent; phase I safety trials, for instance, by definition have an uncertain risk profile.
• Advances in community testing and subsequent modelling of COVID-19 will help reduce this uncertainty and improve upon the informed consent process for a potential challenge study.
•  But as long as the probable range of risks is acceptable, uncertainty does not preclude the provision of adequate informed consent.

STAKES ARE HIGH

• The stakes of a SARS-CoV-2 challenge study are high due to the risks of harm to participants.
• There may be devastating repercussions for all other human challenge studies if one or more volunteer participants were to experience significant adverse outcomes or even death from intentional exposure to COVID-19.
• A SARS-CoV-2 challenge study should not just be well-designed with appropriate safeguards to minimize risk, but its inherent risks and its justification – seeking to more quickly reduce the human toll of the pandemic as a global good – should be communicated to the public to minimize potential fallouts.
•  We have argued that challenge studies could be ethically conducted without lowering of scientific and ethical standards—they merit serious consideration as the human toll of the COVID-19 pandemic continues to grow.

A HUNT FOR EFFECTIVE TREATMENTS

• Drug development is sometimes described as a pipeline, with compounds moving from early laboratory development to laboratory and animal testing to clinical trials in people.
• It can take a decade or more for a new compound to go from initial discovery to the marketplace. Many compounds never even make it that far.
• That’s why many medications being eyed as potential treatments for COVID-19 are drugs that already exist.
• In a review in the British Journal of Pharmacology, scientists from the United Kingdom called for wider screening of existing drugs to see if they might work against the new coronavirus.
• The scientists identified three stages of infection at which the virus could be targeted: keeping the virus from entering our cells, preventing it from replicating inside the cells, and minimizing the damage that the virus does to the organs.
• Many of the drugs being developed or tested for COVID-19 are antivirals. These would target the virus in people who already have an infection.
• Lee says antivirals work better if you administer them sooner, “before the virus has a chance to multiply significantly.” And also before the virus has caused significant damage to the body, such as to the lungs or other tissues.
• Dr. Robert Amler, dean of the School of Health Sciences and Practice at New York Medical College and a former chief medical officer at the Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry (ATSDR), says both antivirals and vaccines will be valuable tools in combating COVID-19.
• However, Dr. Amler told Healthline that “antivirals are likely to be developed and approved before a vaccine, which typically takes longer.”

Top of Form

ANTIVIRALS

Remdesivir

• This drug failed in clinical trials against Ebola in 2014. But it was found to be generally safe in people. Research with MERS, a disease caused by a different coronavirus, showed that the drug blocked the virus from replicating.
• The drug is being tested in many COVID-19 clinical trials around the world and includes studies in which remdesivir is being administered alongside other drugs, such as the anti-inflammatory drug baricitinibTrusted Source.
• The drug is also being tested in children with moderate to severe COVID-19.
• In late April, the drug’s manufacturer, Gilead Sciences, announced one of its trials had been “terminated” due to low enrollment. Gilead officials said the results of that trial had been “inconclusive” when it was ended.
• A few days later, the company announced that preliminary data from another trial of remdesivir overseen by the National Institute of Allergy and Infectious Diseases (NIAID) had “met its primary endpoint.”
• Dr. Anthony FauciTrusted Source, the institute’s director, told reporters the trial produced a “clear cut positive effect in diminishing time to recover.” He said people taking the drug recovered from COVID-19 in 11 days compared with 15 days for people who didn’t take remdesivir.
• More details will be released after the trial is peer reviewed.
• Gary Schwitzer, founder of HealthNewsReview.org, though, said the researchers changed the primary endpoint 2 weeks before Fauci’s announcement.
• Schwitzer compared that to moving football goalposts closer to make it easier to get a touchdown.
• Participants in a clinical trial who took remdesivir showed no benefits compared to people who took a placebo.
• Despite the conflicting results, the FDA issued an order on May 1 for the emergency use of remdesivir.
• In early June, federal officials announced their supply of remdesivir will run out by the end of June. Gilead is ramping up production, but it’s unclear how much of the drug will be available this summer.
• In mid-July, Gilead officials announced results from an ongoing phase III trial of remdesivir. They said the drug was “associated with an improvement in clinical recovery and a 62 percent reduction in the risk of mortality compared with standard of care.” They called it an “important finding that requires confirmation in prospective clinical trials.”

Arbidol

• This antiviral was tested along with the drug lopinavir/ritonavir as a treatment for COVID-19.
• Researchers reported in mid-April that the two drugs didn’t improve the clinical outcomes for people hospitalized with mild to moderate cases of COVID-19.

EIDD-2801

• This drug was created by scientists at a nonprofit biotech company owned by Emory University.
• Research in mice has shown that it can reduce replication of multiple coronaviruses, including SARS-CoV-2.
• Pharmaceutical company Merck and Ridgeback Biotherapeutics LP signed an agreement in May to develop this drug. It’s already being tested in a clinical trial in the United Kingdom.
• Unlike remdesivir, EIDD-2801 can be taken orally, which would make it available to a larger number of people.

Favipiravir

• This drug is approved in some countries outside the United States to treat influenza.
• Some reports from China suggest it may work as a treatment for COVID-19.
• Japan, where the medication is made, is sending the drug to 43 countries for clinical trial testing in people with mild or moderate COVID-19.
•  Canadian researchers are testing to see whether the drug can help fight outbreaks in long-term care homes.

Kaletra

• This is a combination of two drugs — lopinavir and ritonavir — that work against HIV.
• Clinical trials are being done to see whether it also works against SARS-CoV-2.
• One small study published May 4 found that lopinavir/ritonavir didn’t improve outcomes in people with mild or moderate COVID-19 compared to those receiving standard care.
• Another study, published May 7 found that the drug combination wasn’t effective for people with severe COVID-19.
• But another study found that people who were given lopinavir/ritonavir along with two other drugs — ribavirin and interferon beta-1b — took less time to clear the virus from their body.

Merimepodib (VX-497)

• This drug developed by ViralClear Pharmaceuticals Inc. has been shown previously to have antiviral and immune-suppressing effects. It was tested against hepatitis C but had only modest effects.
• The company is running a phase II trial of this drug.
• People with advanced COVID-19 will be randomized to receive either merimepodib with remdesivir, or remdesivir plus a placebo.

Monoclonal antibodies

• These drugs trigger the immune system to attack the virus. Like antibodies made by the body’s immune system, these laboratory-made molecules target a specific invader, such as SARS-CoV-2.
• The small biotech company Sorrento Therapeutics announced it has an antibody drug that has been effective in early testing in blocking SARS-CoV-2.
• The company say the drug could potentially be used to treat people with COVID-19 as well as help prevent infection.
• AbCellera has isolated 500 unique antibodies from a person who recovered from COVID-19 and is set to start testing them.
• Regeneron Pharmaceuticals Inc. is testing a two-antibody combination in four groups: people hospitalized with COVID-19; people with symptoms of the disease but not hospitalized; healthy people at high risk of getting sick with COVID-19; and healthy people who have had close contact with someone with COVID-19.
• Vir Biotechnology has isolated antibodies from people who survived SARS, another disease caused by a coronavirus. The company is working with Chinese firm WuXi Biologics to test them as a treatment for COVID-19.

Convalescent plasma

• Along the same lines, the FDA has announced a process for medical facilities to conduct trials on an experimental treatment that uses blood plasma from people who have recovered from COVID-19.
• The theory is that their plasma contains antibodies that will attack this particular coronavirus.
• In late May, researchers reported that 19 of 25 people with COVID-19 who were treated with convalescent plasma transfusions at Houston Methodist Hospital in Texas had improved. Eleven of those patients have been released from the hospital.
• In late March, the New York Blood Center began collecting plasma from people who have recovered from COVID-19.
• The Mayo Clinic and Michigan State University are also leading convalescent plasma programs.

Immune modulators

• In some people with COVID-19, the immune system goes into overdrive, releasing large amounts of small proteins called cytokines.
• Scientists think this “cytokine storm” may be the reason certain people with severe COVID-19 develop acute respiratory distress syndrome (ARDS) and need to be put on a ventilator.
• Several immune suppressants are being tested in clinical trials to see whether the drugs can quell the cytokine storm and reduce the severity of ARDS.
• In mid-June, U.K. researchers announced that the inexpensive corticosteroid dexamethasone reduced deaths by about a third in people with severe COVID-19 who were on ventilators, and by a fifth in those who needed oxygen support.
• . The drug, though, is already approved for other conditions and can be given orally or intravenously.
• Other drugs being tested include baricitinib, a drug for rheumatoid arthritis; CM4620-IE, a drug for pancreatic cancer; and IL-6 inhibitors.
• The FDA has also approved a device that filters cytokines out of the blood of patients with COVID-19.

Stem cells

• Athersys Inc. began a phase II/III clinical trial that will examine whether the company’s stem cell treatment could potentially benefit people with ARDS.
• Mesoblast has also developed a potential stem cell treatment for ARDS. The company is enrolling people with moderate to severe ARDS into a phase II/III clinical trial in the United States.

Hydroxychloroquine and chloroquine

• These drugs received emergency use authorization from the FDA at the end of March.
• On June 15, the FDA revoked that authorization, citing studies that indicated hydroxychloroquine didn’t significantly help people with COVID-19 and may have caused serious health risks.
• At the time of the FDA authorization in March, manufacturer Novartis donated about 30 million doses of hydroxychloroquine and 1 million doses of chloroquine to the nation’s existing Strategic National Stockpile.
• The United States is now left with 63 million doses of hydroxychloroquine and 2 million doses of chloroquine in its emergency stockpile.
• Clinical results for the drugs have been mixed. Studies published in May  showed that the drugs didn’t help people with COVID-19.
• In late May, the World Health Organization announced it was halting its clinical trials of hydroxychloroquine due to safety concerns.
• In mid-June, the National Institutes of Health halted its clinical trial of hydroxychloroquine after data showed that the drug was no better than an inactive placebo.
• In late June, British officials announced they would restart a global clinical trial on hydroxychloroquine and chloroquine.

Next steps for treatments

• While a lot of the focus is on developing new treatments for COVID-19, improvements in how doctors care for patients using existing technology are also crucial.
• The things that the people have to worry about with the novel coronavirus is that it can cause pneumonia and acute respiratory distress syndrome. There are ways of treating those things that can reduce the effects, so doctors are trying to use those as well.
• No company has offered a timeline for when its drug might be used more widely to treat COVID-19. This isn’t an easy thing to estimate.
• After laboratory and animal testing, drugs have to pass through several clinical trial stages before they can be approved for widespread use in people.
• It’s also difficult to speed things up, because scientists have to enroll enough people in each stage to have useful results. They also have to wait long enough to see whether there are harmful side effects of the drug.
• However, drugs can sometimes be given to people outside a clinical trial through the FDA’s “compassionate use” program. For this to happen, people must have an “immediately life-threatening condition or serious disease or condition.”
• Doctors at the University of California, Davis were able to secure this type of approval for a woman with severe COVID-19 to receive remdesivir. They reported she was doing well.
• Many will take this as a sign that the drug works. But because the drug was given outside of a clinical trial to just one person, it’s not possible to know for certain. Also, other people may not have the same response to the drug.
• Improvements in testing can also reduce COVID-19 deaths by slowing the spread of the virus. As cities and states lift stay-at-home and physical distancing orders, increased testing will be needed to prevent large spikes in infections.
• The FDA has granted emergency use authorizations for many diagnostic tests. Companies and universities around the world also continue to develop new ones.
• On May 8, the FDA announced the authorization of the first at-home saliva-based COVID-19 diagnostic test.
• The test, which was designed by Rutgers Clinical Genomics Laboratory, allows people to spit in a tube at home and mail it back to the Rutgers lab for testing.
• This is the first at-home test approved involving saliva collection — all other approved at-home tests are conducted via a nasal swab.
• The Rutgers test will hopefully expand access to people unable to easily make it to a clinic or drive-thru testing facility. The test is currently only available by prescription.
• New guidelines were posted by the FDA in early May designed to expedite the development and approval of more at-home self-collection kits to further expand access to testing.
• Under the new guidance, test developers are encouraged to reach out to the FDA to ensure their kits and shipping methods are in compliance with the most up-to-date regulations.
• One commercially available test developed by scientists in Europe can show in 15 minutes whether someone has an infection. The test uses a sample collected with a nasopharyngeal swab inserted into the nose.
• A real-world analysis found that the test could detect 6 out of 10 people with an infection. It performed much better at identifying when an infection wasn’t present.
• While the test isn’t 100 percent effective, it doesn’t require special reagents or trained laboratory staff to run.
• This would make it ideal for health clinics or in low- and middle-income countries with few clinical laboratories.

Vaccines.

• Many groups are working on potential COVID-19 vaccines, with several backed by the nonprofit Coalition for Epidemic Preparedness Innovations (CEPI).
• There are more than 100 projects around the world centered on the development of a COVID-19 vaccine. As of May 11, eight candidate vaccines were being tested in clinical trials in people.
• An official at the National Institutes of Health said in mid-May that large-scale testing could begin in July, with a vaccine potentially available by January.
• Here’s a look at some of the projects:

• Moderna. In March, the company began testing its messenger RNA (mRNA) vaccine in a phase I clinical trial in Seattle, Washington. In mid-May, the company announced the vaccine had produced antibodies in all 45 trial participants in this initial clinical phase. The study included 45 healthy volunteers, ages 18 to 55, who are getting two shots 28 days apart. The company has developed other mRNA vaccines before. Those earlier studies showed that their platform is safe, which allowed the company to skip certain animal testing for this specific vaccine. In early May, the company received permission from the FDA to start a phase II study of its vaccine. The company expects to begin a phase III clinical trial in July. The FDA also agreed to fast-track regulatory review of this vaccine if it succeeds in a phase III clinical trial.
• University of Oxford in England. A clinical trial with more than 500 participants began in late April. Oxford officials said the potential vaccine has an 80 percent chance for success and could be available as early as September. The vaccine uses a modified virus to trigger the immune system. The university has partnered with pharmaceutical company AstraZeneca. The company reported in mid-May the vaccine was effective against COVID-19 after it was given to six rhesus macaque monkeys. The company expects to begin a late-stage clinical trial by the June. Officials said in mid-May that if the clinical trial is successful, they could deliver 30 million doses by September.

• Advances in genetic sequencing and other technological developments have sped up some of the earlier laboratory work for vaccine development.
• Even if a vaccine is developed and distributed, it’s unlikely to be completely effective. The measles, mumps and rubella vaccine is effective 97 percent of the time while the seasonal flu vaccine tops out at 60 percent.
• Still, even a less-effective vaccine may reduce the severity of disease if someone gets COVID-19.

Speeding up vaccine development

• Some scientists argue that a “human challenge trial” could speed up the vaccine clinical trials — potentially shaving months off the timeline.
• In this type of trial, healthy volunteers are given a potential vaccine and then intentionally infected with the virus.
•  Nearly 30,000 people in more than 140 countries have signed up to take part.
• There’s still a lot we don’t know about this virus and disease, including who will get seriously ill or die from COVID-19.
• That means people can’t really know the risks of participating in the study, so they wouldn’t be able to give high-quality informed consent. This is an essential part of modern clinical trials.
• In preparation for this, the World Health Organization recently released ethical guidelines to navigate these tricky waters.
• Meanwhile, some clinical trials are underway in Israel, the Netherlands, and Australia to see whether existing vaccines for tuberculosis might also protect against SARS-CoV-2.
• The polio vaccine is another possible option. Scientists think these vaccines might boost the immune system just enough to fight off the new coronavirus, although there’s no evidence yet to confirm this theory.
• Like drugs, potential vaccines have to pass through the same clinical trial stages. This is especially important when it comes to safety, even during a pandemic.

Clinical trial stages

• Phase I. The drug is given to a small number of healthy people and people with a disease to look for side effects and figure out the best dose.
• Phase II. The drug is given to several hundred people who have the disease, looking to see whether it works and if there are any side effects that weren’t caught during the initial testing.
• Phase III. In this large-scale trial, the drug is given to several hundred or even up to 3,000 people. A similar group of people take a placebo, or inactive compound. The trial is usually randomized and can take 1 to 4 years. This stage provides the best evidence of how the drug works and the most common side effects.
• Phase IV. Drugs that are approved for use undergo continued monitoring to make sure there are no other side effects, especially serious or long-term ones.

INDIA’S ROLE

• The Indian Council of Medical Research (ICMR), on Wednesday, wrote to 12 hospitals, including the All India Institute of Medical Sciences (AIIMS), Delhi, to fast-track clinical trial of the Covid-19 vaccine candidate BBV152, developed by Bharat Biotech International Limited, a Hyderabad-based vaccine manufacturer.
• ICMR has set a deadline of July 7 for recruitment for the trial, stating that a launch for public health use is being targeted by August 15.
• ICMR envisages a 5-6 week period for the completion of the trial of Covaxin.
• This is a significantly shorter timer-frame from WHO’s projection that a vaccine may only be available in the next 12-18 months.
• Covid 19 vaccine developers AstraZeneca, which is working with the University of Oxford, is already in Phase 3 of human trial — where a drug/vaccine is observed for therapeutic effect and adverse effects over a longer period than the previous phases — for its vaccine candidate.
• US-based Moderna started Phase 2 trials for its candidate in June. Clinical trials for both candidates had started in late-March/April of 2020.
• Both developers have announced that their products could hit the market in the December 2020.
• When Moderna had announced its trial in March, it had spoken of a two-dose schedule 28 days apart, with the vaccine’s efficacy and safety observed over 12 months from the second dose.
• Even with regulatory easing, the vaccine would take 7-8 months from the commencement of trial to hit the market.
• Bharat Biotech’s application with the Clinical Trial Registry of India (CTRI) shows that it will be conducting Phase 1 and 2 trials involving 1,125 participants over 30 days.
• As of 16 July, the CTRI website showed that the trial had received ethics committee approval from six of the 12 hospitals.
• ICMR has warned the hospitals where the trials will be conducted that the vaccine is one of the “top priority projects which is being monitored at the topmost level of the government”, and “non-compliance will be viewed very seriously”.

BCG VACCINATION IN INDIA

• A Timeline BCG vaccine was introduced in India as early as 1948 and was implemented with the help of the International Tuberculosis Campaign (ITC).
• In 1951, ITC withdrew its support and WHO took over the functioning. In the same year Government of India called a conference endorsing to expand the campaign across the country.
•  However, no state could commit financially and it took 3 years between 1951 and mid-1954 to persuade them.
•  The campaign was aimed to cover susceptible age groups 1-25 in urban, suburban and accessible rural areas by the end of 1959.
• Interestingly, according to Census of India 2011, about 70% of the Indian population still lives in rural setting.
• In 1962, BCG vaccination became part of the National Tuberculosis Control Programme (NTCP) and was followed by a fifteen year long trail between 1968 and 1987 in Tamil Nadu which led to a revision in the BCG vaccination policy of India.
• It was then recommended to be administered within a year after birth.
• To cover 80% of infants, the Expanded Programme of Immunization was launched in 1978 and included BCG, OPV, DPT and typhoidparatyphoid vaccine.
• However, it remained largely confined to urban areas. Aiming to cover all districts in a phased manner by 1990, a Universal Immunization Programme was launched on November 19th , 1985 and the measles vaccine was added to 3  P a g e the list of vaccines.
• It became a part of the Child Survival and Safe Motherhood programme in 1992.

 FUTURE PROSPECTS

• India has only 7.47% of its population who are aged 60 years and above.
• Interestingly as per official reports, on April 04th, 2020, 42% of cases of COVID-19 in India belong to 21-40 years of age group with only 17% accounting to those 60 years and above.
•  9% belong to the 0-9 age group and 31% to the patient between 41 and 60 years.
•   42% of COVID19 patients were born between 1979 and 1999.
• The BCG vaccination timeline of India suggests that after 1992 almost all newborns should have received BCG vaccination.
• It is imperative that urban areas would have better medical facilities and hence a better vaccination coverage.
• However, it also true that a lot of migration takes place from rural areas to Tier 1 cities for a variety of factor including employment.
• The population thus becomes very heterogeneous.
• For Indian population, it is thus proposed that the further study of the effect of BCG vaccination on COVID-19 infection needs to be done on individuals born after 1992, that is, the 0 to 28 years age bracket.
• This study will yield a clearer picture.
• BGC vaccination is shown to have no major side-effects; however, it is contraindicated in immune-compromised and pregnant individuals.

In the lack of effective therapeutics and vaccine, BCG re/vaccination should be given to everyone in the high-risk group including healthcare providers, volunteers taking care of suspected cases, and essential service provider. With effectiveness against COVID-19 still in question, BCG vaccination could certainly prevent some opportunistic bacterial infection thus reducing comorbidities.