Saleema Bibi from Murree reached the Covid-19 vaccine center last week along with her brother. Belonging to a poor family, she wanted to be part of the ongoing Covid-19 vaccine trial going on at Shifa International, a private health facility in Islamabad.

“My brother has brought me here to get vaccinated as the vaccine is free. Also, the company is paying me some money for this,” she tells The News on Sunday. Her husband is sick and has been without work for the past several months. Her brother, also without a job, heard about these trials from someone else. “I read about these trials on the banner outside the hospital and decided to volunteer myself,” Zafar Abbas, in his late 20s and a low-grade government servant says, adding, “I volunteered myself for this trial because at this point the vaccine is free. I thought I would get this dose and this will save me the price they will set on it when it becomes available in the market.”

Pakistan started the trial of the vaccine produced by a Chinese company, Cansinobio, in collaboration with the National Institute of Health and AJM Pharma at five places in three major cities – Lahore, Karachi and Islamabad in the last quarter of 2020. They are: Sir Aga Khan Hospital and Indus Hospital in Karachi; University of Health Sciences and Shaukat Khanum Cancer Research Hospital in Lahore; and Shifa International Hospital in Islamabad. Initially, the plan was to recruit 10,000 volunteers. However, this number has been increased to 18,000 after the second wave of the pandemic hit the country. It is for the first time that Pakistan has become part of such mass-scale testing. There are various logistic, scientific, professional and social challenges associated with it.

“This is unique in the sense that never has such a trial taken place in Pakistan before,” says Dr Ejaz Ahmad Khan, the chairman of Infectious Diseases Control Committee and Principal Site Officer of the corona-vaccine trial project. “Sor far, this health facility has recruited almost 50 per cent of the volunteers across the country. This was only made possible because of an energetic marketing campaign to attract volunteers. So far, there have been no serious adverse events (SAEs).”

The recruits, he says, are mostly from the lower middle class or are living below the poverty line. “Some people are getting the vaccine for the Rs 3,000 travel allowance and a small sum of money after a year of follow-up. Obviously, there have been many challenges. Initially, it was not an easy job to get volunteers. It was also a challenge to form a team of trained staff and equip them. Also, we have to educate those who come and address their concerns,” he says, adding,” No doubt, there is always misinformation about such vaccines and campaigns. Some of the apprehensions will remain. However, we have tried to address them by educating people.”

Such apprehensions and misconceptions are not just limited to Pakistan. “Mostly, people fear that the vaccine will cause infertility, or that a chip is being installed. A segment of the society will always remain opposed to it. Many still do not believe that the disease is lethal. We should continue to give people the correct information to change such behaviours. This is a difficult task,” he says.

Initially, the plan was to recruit 10,000 volunteers. However, the target has been raised to 18,000 after the second wave of the pandemic in the country. This is the first time Pakistan has become part of such large trials of a frontline vaccine.

“During the trials, we tried to educate the volunteers. Sometimes, there were conflicts among family members. Some people came here but left the place without getting the vaccine. Educated people were few and far between. Even doctors and nurses had some reservations,” he adds.

However, Dr Khan says, the number of volunteers has risen with the second wave of the virus. “People have even started calling us to get recruited. In-fact, the second wave of this pandemic has proved beneficial for the vaccine trial in Pakistan,” he says.

“People are getting more mature in their response and they are volunteering for this trial now,” says Dr Shehnoor Azhar, co-principal investigator in the trials at the University of Health Sciences (UHS), Lahore. He thinks there is a better understanding now of the challenges posed by the pandemic. Even educated people are participating in the trials in Lahore. The UHS, till now, has vaccinated nearly 3,000 volunteers. Training the workforce for these trials was a challenge, he says.

The organisers had to run a huge advertisement campaign. Marketing teams of the health institutes have also been approaching poor neighborhoods to recruit volunteers. “One day, around 30 people from a marginalized community reached the hospital at the same time to get vaccinated. The family, from a slum in Islamabad, received a total of Rs 90,000,” a marketing team member says.

“The average number of volunteers coming to Shifa Hospital last week went up to 100 per day. This number was only about 20 in the first month of the trial,” Qaiser Suhail of the AJ Pharma, a partner in the vaccine trial, says, adding: “This is the first cohort. After its completion, there will be two more cohorts requiring new recruitment. Now, educated people are also joining the trial,” he says.

Last week, some senior public office holders, including Punjab Governor Chaudhry Sarwar and Interior Minister Ijaz Shah, also volunteered for the trial to motivate the public.

Dr Khan says China agreed to make Pakistan a partner in the vaccine trial on account of strong bilateral ties. “We have close ties with China. There have been collaborations in the past too. China wanted to conduct this trial in seven countries. However, it is now taking place only in Pakistan, Mexico, Russia, Argentina and Chile.”

The trial data from Pakistan is being sent to China and Canada where the global principal investigator will analyse it.

Trials in other countries and of other vaccines have been going on for the past few months. Experts say there will be several vaccines for Covid-19 in future. At the moment, around 200 vaccines are going through different stages. Among those, 40 are in the human trial stage and a dozen in phase three.

Only four of these 200 vaccines have been approved till now. Every vaccine is being made using a different technique. The vaccines have different storage requirements and doses. Trial strategies might change as well, the experts say.

“This will open a new window of opportunity to bring large scale medicine trials to Pakistan. We are hopeful that this trial will be successful. Pakistan will definitely benefit from this vaccine. As compared to other countries, we might get the vaccine sooner and at cheaper rates,” Dr Khan says. He thinks Pakistan will have to depend on Chinese vaccines as other approved vaccines are destined for other countries.

“It is quite clear that the vaccine will be prioritized for select populations – very old people first and then healthcare workers. It will not be given to the whole population of 220 million,” he says.

The author is a staff reporter. He can be reached at vaqargillani@gmail.com