NEW DELHI: Surprised that obesity has failed to make it to the list of 20 comorbidities that would determine the eligibility for Covid-19 vaccination for those between 45-59 years, experts say it should have been included as it was one of the common underlying conditions found in hospitalised patients. Overall, the categories of underlying conditions for vaccination released by the Union health ministry on Saturday has divided the medical community with some calling it exhaustive, while others have found it too restrictive.
Doctors also pointed out that diabetes and hypertension have been clubbed with other ailments or tied to complications, or duration for which a person has been on medication. One of the criteria reads ‘having diabetes for more than 10 years or with complications and hypertension on treatment’. “Diabetics have to be on medication for more than 10 years and if they have hypertension as well, they will qualify,” said physician Dr Gautam Bhansali.
Bariatric surgeon Dr Muffazal Lakdawala, who had created the city’s first jumbo centre at NSCI Worli, said dropping obesity from the list was a “glaring exception”. “World over, it has been considered a risk factor. In Mumbai too, we found obese patients had a 60% higher chance of complications and an over 30% higher risk of dying from the infection,” he said, adding those with a BMI of over 40 should have been taken into consideration. “Just as diabetes and hypertension have been clubbed with other ailments, they could have added obesity too to the list,” he said. Diabetologist Dr Rajiv Kovil said metabolic issues in the 135 million obese people in India drives the epidemic of diabetes and heart diseases. “Obesity should have been included,” he added.
In the US, BMI-based vaccine eligibility has been a topic of discussion since several states listed it as a criterion for getting priority vaccination based on the Centre for Disease Control’s recommendation to include the obese and morbidly obese. Dr Lakdawala said statistics show that 80% of diabetics would also be obese. A senior doctor from BYL Nair Hospital said at least 35% of their ICU patients had a higher body weight. “Their lungs were compressed and putting them on a ventilator did pose an additional challenge,” the doctor added.
The list of 20 comorbidities includes heart failure with hospitalisation in the past one year, post-heart transplant, coronary heart disease with a history of bypass, chronic kidney disease, liver and stem cell transplant recipient or on waitlist, among others. The list also includes those with severe respiratory disease, blood cancers, solid cancers diagnosed on or after July 1, 2020 or people currently on any cancer therapy. A medical practitioner would have to certify a person as eligible for vaccination based on his/her previous medical reports. Apart from obesity, another point of contention has been the inclusion criteria for diabetics, which states they should have been on treatment for more than 10 years or have complications. The criterion for BP patients is ‘pulmonary artery hypertension and hypertension/diabetes (for more than 10 years or with complications) and hypertension on treatment’.
According to Dr Naveen Thacker, a former civil society representative on the Global Vaccine Alliance (Gavi) board, people with diabetes and hypertension should have been included irrespective of the duration they have been on medication. “Obesity was found to be a big factor for severe disease, even in younger people. The inclusion for diabetes and hypertension is extremely restrictive. Wonder what data was relied upon to exclude obesity or to make these expectations?” he said. A total of 70% of Covid victims in Mumbai had a comorbidity with diabetes and hypertension being the predominant ones. Dr Thacker also said since certification is a must for those in the 45-59 age category, a price should be fixed on how much doctors can charge for it. A senior BMC official admitted they are yet to think of “prescription misuse”.
Infectious disease expert Dr Tanu Singhal, however, found the list exhaustive. “Perhaps calculating BMI could have been a challenge at the community level, but as vaccination becomes more flexible, we may see a modification,” she said.