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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______REASSESS, REORGANIZE & paper analyzes the adopted strategy of REALIGN VISION FOR EFFECTIVE drive during the COVID : A HOLISTIC pandemic, understands its complexities and REVIEW OF SARS COVID-19 dynamics. It focuses upon existing VACCINATION DRIVE IN infrastructural and technological integration during the drive; its directives towards By Neha Verma vaccinating socio-demographic and From University of Delhi economic minorities, defining short and long-term goals, and keeping it in pace with the production supply. It aims to give a Abstract holistic view of the adopted tactics of the Indian Government for improving the With the advent of SARS-COVID 19 or efficacy of the vaccination drive. coronavirus pandemic in 2020, have become the sword and might towards Fair Use Act Disclaimer defeating and subduing the rage of the pandemic on the world population. India has This research paper is for educational followed the global outcry for vaccines and purpose only. has a vaccination drive commenced from January 2021 with a certain priority attached Fair use to each section of the population. Effective Copyright disclaimer under section 107 of implementation of Drive essentially the Copyright Act of 1976, allowance is defines the global outlook and strength of the made for “fair use” for purpose such as Indian Government towards protecting the criticism, comment, news reporting, population and promoting the economic teaching, scholarship, education and activity to resolve back to pre-pandemic research. normalcy. India has integrated the vaccine drive in a COWIN portal allowing the Fair use is a use permitted by copyright statue Government to determine the coverage of that might otherwise be infringing. vaccination, assess the drive efficacy, and plan out future strategies to overcome the 1. Introduction challenges put forward in a dynamic COVID With the advent of the SARS COVID-19 or environment. Real-time analysis has helped the coronavirus pandemic in 2020, which to reassess the implemented plan of action, started as an undefined endemic disease with re-organize and realign the vision of effective pneumococcal characteristics in the last inoculation. With the initiation of free quarter of 2019 in the Wuhan province of inoculation of all above 18 years of age from China, the whole world has been caught in May 1, 2021, the Indian Government has so the web of isolations and quarantines to curb far completely inoculated 3.5% of the the spread of the virus and save as many lives population with the weekly average reaching as possible. Till June 2021, 182 million above 3 million doses in June 2021, and has people worldwide have contracted adopted a dynamic strategy towards coronavirus with about 3.96 million losing inoculating other sections of society. This their lives with a lot of excess death going

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______unaccounted for. In India, about 30.5 million billion doses of the vaccines all over the people have contracted the virus and about world under its Maitri Initiative and mirrors 0.4 million people have lost their lives with the global objectives of donating such to many states under-counting the excess death developing countries like South Africa. to a factor of 0.42 in Kerala to 23.8 in Madhya Pradesh. 2. Available Vaccines in India Utilizing its research and development The best policy to curb the spread as adopted capabilities, India had initiated researches by the GoI, and has been stressed on every into efficacious vaccine development on occasion, appears to be to ensure that the multiple fronts. SII had signed an agreement is mild in most people, and that in with the Oxford-AstraZeneca1, Novavax2 and those in whom the disease might be more Codagenix3 to manufacture the international severe, it can be pushed towards a milder vaccines in India. It plans to manufacture form by vaccination. Therefore, it was an about 2 million Vaccines a year for imperative to vaccinate as many as people as (ChAd0x1 - Original International name) possible. Global Analysis for developing Covidshield (developed by the AstraZeneca- immunity and preventing more loss of life Oxford and domestically manufactured by has necessitated the efficacious vaccines and ) and has applied for their inoculation. Many institutes and EUA with DCGI and ICMR. organizations’ efforts have resulted in multiple vaccines being developed and Covaxin4 is India's first indigenous vaccine administered all over the world like developed by “ International Corminaty by Pfizer and Vaxzevria by Limited” in collaboration with “National AstraZeneca-Oxford. India has been Institute of Virology of ICMR”. It is one of administering the vaccines Covidshield and the two domestic vaccines and has recently since January 2021. Certain published the Phase III results highlighting international variants of vaccines have also 77.8% efficacy against symptomatic Covid- begun their inoculation in multiple parts of 19 and 93.4% efficacy against the severe the country like Sputnik V in Bangalore and diseases. Production for Covaxin is planned other vaccines are in process for obtaining to be increased to 7-fold during the July- EUA - Emergency Use Authorization by August 2021 and follow-on to reaching DCGI. nearly 10 Crore Vaccines a month in September. India utilizing its robust and dynamic vaccination program capabilities has ZyCoV-D5 by (Zydus promised to develop, donate and deliver a Cadila) is the other indigenous vaccine

1 World Health Organization. 2021. The 4Pharmaceutical Technology, Verdict. July 05 2021. Oxford/AstraZeneca COVID-19 vaccine: what you Bharat Biotech’s COVAXIN shows 77.8% efficacy need to know. [Accessed: July 14 2021] against Covid-19. [Accessed: July 14 2021] 2 Zimlich, R. 2021. An Overview of the Novavax 5 Economic Times. Updated: July 14 2021. Zydus COVID-19 Vaccine. [Accessed: July 14 2021] Cadila seeks approval for its needle-free COVID 3 Zoe Magee. 2021. Inhaling away the virus: Is the vaccine ZyCOV-D; here's how it works. [Accessed: next generation of COVID vaccines on its way? July 14 2021] [Accessed: July 14 2021] ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______developed in India. It is based on plasmid 19 (NEGVAC)8 with the aim of guiding, DNA technology not licensed for public providing advice & recommendations, and usage which delivers the DNA encoding to strategizing the vaccine administration all the target antigens in the recipient and is used over India. The group, chaired by NITI as a vaccine vector to allow the antigens to be Aayog, co-chaired by Secretary of Mohfw, produced by the human cells. Compiling the India and Member (Health), had prioritized phase two trial results, the company is the sections of Indian society for vaccine focusing on executing the trial III inoculation. The priority list9 is as follows: examinations. (a) health & front-line workers; (b) people above 60 years of age with essential Corbevax6 by Biological E Limited is a inoculation of people with comorbidities in protein similar to the this section; (c) people below 60 years with vaccines developed by the Novavax and comorbidities and people above 45 years of Sanofi-GSK. The phase 2/3 trials began on age; (d) people with age between 18-45 years. June 7 2021 and even before the conclusive Each of these sections had been inoculated in results, Government of India had signed an a progressive manner with each lower agreement for delivery of 300 million of prioritized section getting a later date for the with Biological E. start than the higher-prioritized ones with priority (a) section getting vaccines from 3. COVID-19 Vaccination January 1. GoI had allowed the vaccination Strategy in India to be inoculated to all people above the 18 Marking March 22 2021 as the Lockdown years of age from May 1 2021 to build upon 1.07 enforced by the Government of India, the the herd immunity and vaccinate as many society has witnessed the release of new people as possible. As per another expert guidelines and methods each week to protect group of doctors and medical scientists, personal life and curb the further spread of people with comorbidities were prioritized in virus. The “Ministry of Health & Family the clinic trials as well as in the program Welfare (MOHFW)” and ICMR under the given the life-threatening situations arising if guidance of the PM of India had issued such in case of Covid-19. guidelines and had been robust in structuring out the policies and process on saving the With the start of inoculation10 from January infected in hospitals as well. 16 2021, after 2 dry runs, majority of the health and front-line workers given the risk The GoI has instituted a National Expert of contraction were vaccinated with both Group of Vaccine Administration of COVID- Covidshield and Covaxin. Covidshield and

6 Raghavan, P. June 10 2021. Explained: How is deliberates on strategy to ensure COVID-19 Biological E’s Corbevax different? [Accessed July 14 vaccines’ availability and its delivery mechanism. 2021] [Accessed: July 14 2021] 7 Economic Times Bureau. April 14 2020. Lockdown 9 Ministry of Health and Family Welfare. Updated: 1.0: Some success in . [Accessed: Dec 28 2020. COVID-19 Vaccine Operational July 14 2021] Guidelines: (10-11, 61-64) 8 Press Interest Bureau. Ministry of Health and 10 Zee News Bureau. Jan 09 2021. COVID-19 Family Welfare. Aug 12 2020. National Expert vaccination drive to kick off on January 16: Centre. Group on Vaccine Administration for COVID-19 [Accessed: July 14 2021] ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______Covaxin had to be given in 2 doses as per the Reddy’s Laboratories. As per the ‘New ICMR and Mohfw separated by a month Drugs and Rules 2019,’ each apart and each person had been allowed a batch of the imported vaccines had to pass walk-in at the centers to get vaccinated if through the local clinical trials while other verified with a proof of work and Aadhaar rules were scrapped to allow the import of card. ICMR and Mohfw had started the vaccines. During the second wave of the distribution of Vaccinated certificates being COVID-19, the local trials were removed to issued to the recipient's mobile number and fast-track the import and utilization of the the government had started the process of imported well-renowned vaccines accepted integration of the technology with the by the majority of the countries. vaccination program to ease up the process and streamline the inoculation. Initially the India had faced a major challenge of logistics government had policed for obtaining to transport and store the covid vaccines in vaccines from the manufacturers at a the temperature ranges of 2-8 degree Celsius subsidized rate and administering them to the to rural and urban vaccination centers. These whole population free of cost. The policies vaccines could only survive for about 4-5 have been altered multiple times but future hours once the vial had opened and the changes are yet to be seen. During the first government had to fast-track the safe passage drive, Covaxin could only be administered in of each dose. Vaccine manufacturers airlifted the clinical mode as without the data of the vials from the production site to four immunogenicity after the phase 2/3 trials. major depots - Kolkata, Chennai, Mumbai, However, Bharat Biotech released the data of and Karnal - where they were stored in the immunogenicity on March 3, 2021 and walk-in cold storages. These depots worked highlighted the 77.8%11 efficacy of Covaxin as the storage centers from where vaccines against the COVID-19. were transported to the designated 41 transport centers in neighboring 37 states and Other international vaccine manufacturers UTs. Further from these 41 centers, the vials like Pfizer and Moderna had initiated the are transported to the district level centers request for its inoculation to the Indian and further to distribution/inoculation citizens, but given the sensitivity of centers. In all the logistics, they were indemnity clause12 in the contract between transported in ice-packed cold storages to Pfizer & Moderna and Government of maintain the temperatures. There had been a India13, the grant for EUA has been stalled for real-time monitoring of each vial using the a certain amount of time. Sputnik V was the Co-WIN14 vaccine delivery Management first imported vaccine given the restricted System developed by the Government of EUA by the DCGI on May 13 2021 and is India. The initial doses were administered being administered in private hospitals by Dr. using the “Universal Program

11 Chandna, H. June 22 2021. Covaxin phase 3 trial 13 Sharma, M. July 13 2021. Talks with vaccine data showing ‘77.8% efficacy’ reviewed by expert makers Moderna, Pfizer stuck on indemnity clause: panel. Over to DCGI. [Accessed: July 14 2021] Sources. [Accessed: July 14 2021] 12 India Today Web desk. June 03 2021. India may 14 Ministry of Health and Family Welfare. Updated: grant indemnity to Pfizer, Moderna for their Covid Dec 28 2020. COVID-19 Vaccine Operational vaccines. But what does it mean? [Accessed: July 14 Guidelines: (45-59) 2021] ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______(UIP)” already operational in India and it was Co-WIN system will be linked to existing boosted with the recruitment of the Cold- UIP programs and it will meticulously storage operators. monitor and follow upon the immunized individuals. Ever since the easing of rules Government of India had asked the states to beyond the May 1 2021 when all people train the frontline workers using the proper above 18 years of age were allowed to covid protocols for inoculating the recipients vaccinate, the vaccination availability had using the “Integrated Govt. Online been hit the most. Co-WIN portal had training’(iGOT)15 portal on the Ministry of witnessed a major surge in numbers with Human Resources and Development people above 3 million being vaccinated each (HRD)’s Digital Infrastructure for day but soon the number had crumbled down Knowledge Sharing (DIKSHA)” platform for to 1-1.5 million a day. A certain reason had the capacity building of frontline workers on been substituted to the vaccination strategy COVID-19. This has been influential in by the GoI. training the additional personnel for the inoculation drive and management using the 4. Reassessment & COWIN portal. India had utilized the Reorganization and potential of the ASHA (Accredited Social Realignment Health Workers) and midwives (ANM), who With majority of people in the priority (a), (b) have a far greater reach in the rural sector, for and (c) still in line for vaccination, the inoculating in such areas and were included government notification for renewing the as the front-line workers. eligibility for vaccine inoculation to include citizens above 18 years16 of age increased the The initial inoculation had been highly queue for the vaccination as people above 18 effective under the strict management of the being a tech savvy swarmed the Co-win GoI where the state governments were portals to register for vaccines, which closely following the steps followed. Each resulted in the poral experiencing multiple inoculation had been closely followed using crashes17. Certain sections of the society, the Co-WIN application which allowed the especially the senior citizens in rural India users to book their slots for vaccines citing were still wishing for the vaccine and this the availability in their areas. When the notification further shredded the desire to COVID-19 vaccine was introduces twenty protect their lives. Each day, people had three ministries/departments and several flooded to fill in the vaccination slots on the developmental partners were involved. Their Co-WIN portal and technology advanced roles have been described in the operational millennials utilized the ability of booking guidelines issued by the Ministry of Health quickly than their aged counterparts in less and Family Welfare, Government of India19. advanced areas; this further widened the

15 Press Information Bureau, Delhi. Ministry of 16 Koshy, J. April 19 2021. Vaccines for all above 18 Education. Apr 09 2020. Government of India from May 1; States can buy directly. [Accessed: July launches a training module for management of 14 2021] COVID-19 named ‘Integrated Government Online 17 ZeeBiz Web team. Apr 28 2021. COVID-19 training’ (iGOT) portal on DIKSHA platform of vaccine registration: Co-WIN portal crashes, users MHRD. unable to register for vaccine. [Accessed: July 14 2021] ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______vaccination gap. GoI had extensively focused proper primary health care, the inability to on the technological integration with the acquire the basic essentials for protecting vaccination drive; though this made the themselves as required by the guidelines and process smooth and easy to management, a high-risk nature for covid contraction, these major section had been wanting to get the sections need to prioritized in the 18-44 vaccination. These developments group. During each pandemic, there had been withstanding the complex and multiple accounts for under-counting of the comprehensive stature of Indian society affected and the dead people. Like during the seems to contrast the practical challenges of smallpox pandemic in 1920, women mass vaccination in India. accounted for about 60% of the deaths and yet, majority went under-counted. Similar is In the purview of the priority list, there is a the case of every endemic, women constitute dire need to understand the socio- the majorly affected and dead population. demographic impact of the COVID-19 and GoI needs to reorganize the priority list of 18- need for injection of the sub-priority list in 44 to vaccinate the women, especially the the priority list (d) section. With majority of pregnant ones (clinical trials are already vaccination centers being located in the urban being conducted under a close areas the rural section has been left to the supervision)18, followed by the Adivasi market forces and on the god’s will for communities and rural population and other protecting the life; the increasing hesitancy people who constitute urban slums residing among the population has further deteriorated in the outskirts of the cities. the chances for the curbing the spread. In this section resides the major chunk of the Indian The whole vaccination drive had crumbled population. A recent change to include down during the second wave of COVID-19 ASHA workers and midwives much higher in when India had to brace the tantamount of reaching the depth of such areas, reducing the deaths and cases which had exponentially hesitancy and increasing the reach of the risen too far greater heights in a short span of vaccines is laudable. The ASHA workers and 1-2 weeks. India had reported about 3-4 Midwives already having the experience for Million cases daily1920 during the second handling the vaccination drive of polio wave. Vaccine availability had decreased to a vaccines and other inoculation drives as well mere inoculation of 1-1.5 million doses a day were trained using the iGOT portal and under and had caused nationwide outcry for the comprehensive guidelines had played an vaccines with state governments requesting important role in reducing the vaccination the central government for such; people gap between the rural and urban. The areas aggressively booked the slots to protect the of Adivasi community, urban slums and poor personal life and liberty granted a people have been left out of the focus from fundamental right by the Constitution of the drive; given the unavailability of the India. GoI had taken a comprehensive

18 Ministry of Health and Family Welfare. second wave hammers country. [Accessed: July 14 Operational Guidance for COVID-19 Vaccination of 2021] Pregnant Women. [Accessed: July 14 2021] 20 One India. Coronavirus Cases: Statistics and Charts 19 Choudhury, S. R. May 07 2021. India reports over [Accessed: July 06 2021] 400,000 daily cases for the third time in a week as ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______account of the current condition and process given the sensitivity of the nature of understanding the shortfall in the vaccines vaccines and dire need for it.22 accessibility, realigned the policy towards partial-privatization21 of the vaccine We are able to highlight the majority of - allowed 25% of the vaccines to points where the government, building upon be captured by the private hospitals at a pre- a robust and dynamic program response determined rate leaving room for further mechanism, had proved to bridge the negotiations - and rest 25% to be gathered by shortcomings of the vaccination program in states on their own expenses, dropping the rail and aim to improve upon it while we themselves the role of intermediary to could highlight the sections, where a certain provide vaccines to each section of strategy. involvement and huge investment could Leaving the to market improve the current situation given the need forces is neither ethical nor practical. The for such. With each response to the change in GoI had been robust in understanding the the dynamics of the environment of need of the situation and agreeability of the coronavirus inoculation and increasing shortcomings and reverted back to the former sensitivity of the topic, NEGVAC has been policy for free vaccination to all. robust to release the new operation guidelines Reassessment of the guidelines had been the and each guideline catered to the demands of center policy for structing the response to the the Indian populace as well the increasing pandemic and vaccination drive by the GoI. unrest of the state governments and judicial systems. The vaccination does play an With a major focus on the development and important role with being the only weapon to research of the vaccines all over the world, protect the lives and more important is the each country has given them undue respect role of the population to understand and and had a standing ovation for their hard follow the operational guidelines and work. Major world initiatives had taken place measures to guard against the wrath of at during such times to fund each initiative for coronavirus. vaccine and each country’s government did it for their population. However, even in such 5. Conclusion scenario, Indian Government had not issued In a country as complex and comprehensive any draft or policy for helping the Indian as India, vaccine development and Vaccine Initiatives until November 2020. administration would be a major hurdle to Given high investment in the R&D for the conquer. The purpose of this perspective was vaccine by private partners, the national to highlight the robust and dynamic nature of funding could have necessitated the the vaccination program and strategies improvement in the supply chain, utilized it adopted and followed by the Indian to advance the national supply chain for Government highlighting some of the areas vaccines. GoI had to realign their thought where a certain intervention could have a far- fetched response and improve the current

21 First Post Staff. April 19 2021. Centre allows states 22 Sharma, E. K. April 14 2021. Where did the govt’s to buy COVID-19 vaccines directly from makers, Rs 900 crore R&D grant for COVID vaccine opens direct import for private players; key changes development go? [Accessed: July 14 2021] from 1 May. [Accessed: July 14 2021] ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______conditions. The Indian government had adopted the strategy for reassessment, reorganization and realignment of the vision to understand the dynamics of the Indian Society and structure a response to the new changes after close consideration with the expert groups. The current COVID-19 pandemic has triggered emergency use authorization, unprecedented collaborative efforts from various stakeholders and rapid development. Questions are still raised although vaccination might be cost-effective strategy for survival and quality of life will be better for people as well as India’s economy will get a revival. Owing the barriers and gaps existing for the vaccine administering, our understanding about the effect of the vaccines and its utility in protecting the loss of life, it is imperative for the government to maintain a close follow-up on the recipients in the long term. The experience of India’s strategies in immunization for COVID-19 gives great tips for similar strategy preparation which is not only limited to countries with similar economic strength and health facilities but also on a global range.

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______7. References  Mandal S, Arinaminpathy N,  Bhuyan, A. India begins COVID-19 Bhargava B, Panda S. India's vaccination amid trial allegations. pragmatic vaccination strategy Lancet397, P264 (2021) against COVID-19: a mathematical  Chakraborty, C., Sharma AR, modelling-based analysis. BMJ Bhattacharya, M., Agoramoorthy, G., Open. 2021 Jul 2;11(7): e048874. Lee S-S. Asian-Origin Approved  Mandal S, Arinaminpathy N, COVID-19 Vaccines and Current Bhargava B, Panda S. Responsive and Status of COVID-19 Vaccination agile vaccination strategies against Program in Asia: A Critical Analysis. COVID-19 in India. Lancet Glob Vaccines. 2021; 9(6):600. Health. 2021 Jul 1: S2214-109X  DNA Web Desk. Sputnik V vaccine's (21)00284-9. first shot administered in India; here's  Ministry of Health and Family how much it will cost (accessed on 6 Welfare (2020) COVID-19 Vaccine July 2021) Operational Guide-lines. Ministry of  Foy, B.H., Wahl B, Mehta, K., Shet, Health and Family Welfare, A., Menon, G.I., Britto, C. Government of India. 28 December Comparing COVID-19 vaccine 2020. allocation strategies in India: A [Accessed: July 06 2021] mathematical modelling study. Int J  News18. National Vaccine Day 2021: Infect Dis. 2021 Feb; 103:431-438. A Timeline of India's Massive  Gupta, I. & Baru, R. Economics & Vaccination Exercise [Accessed: July ethics of the COVID-19 vaccine: how 06 2021] prepared are we? Indian J. Med.  One India. Coronavirus Cases: Res.152, 153–155 (2020). Statistics and Charts [Accessed: July  Kang, Gagandeep., Thomas, George., 06 2021] Muliyil, Jayaprakash. The basics of  Praveen SV, Ittamalla R, Deepak G. an effective vaccine policy Analyzing the attitude of Indian [Accessed: July 06 2021] citizens towards COVID-19 vaccine -  Kang, Gagandeep., Thomas, George., A text analytics study. Diabetes Muliyil, Jayaprakash. What needs to Metab Syndr. 2021;15(2):595-599. be done with vaccines [Accessed:  Sharma, P., Pardeshi, G. Rollout of July 06 2021] COVID-19 Vaccination in India: A  Kumar, V.M., Pandi-Perumal, S.R., SWOT Analysis [published online Trakht, I. et al. Strategy for COVID- ahead of print, 2021 Apr 6]. Disaster 19 vaccination in India: the country Med Public Health Prep. 2021;1-4. with the second highest population doi:10.1017/dmp.2021.111 and number of cases. npj Vaccines 6,  Umakanthan S, Chattu VK, Ranade 60 AV, Das D, Basavarajegowda A,  Kumar, V Rishi. 2021. Biological E, Bukelo M. A rapid review of recent Providence Therapeutics tie up for advances in diagnosis, treatment and mRNA vaccine, to run trials in India, vaccination for COVID-19. AIMS seek EUA. [Accessed: July 06 2021] Public Health. 2021;8(1):137-153. ______PIF 6.242 www.supremoamicus.org

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VOLUME 25 | JULY, 2021 ISSN 2456-9704 ______Published 2021 Feb 1. doi:10.3934/publichealth.2021011  Vignesh, R., Shankar, E. M., Vijayakumar, V. & Thyagarajan, S. P. Is Herd Immunity against SAR- CoV2 a silver lining? Front. Immunol.11, 586781 (2020).  Sashank, Y. 2021. Protein Subunit Vaccines Come In From The Cold To Offer India A Ray Of Hope. [Accessed: July 06 2021]

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