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New Delhi, Aug 8: The Union Health Secretary Rajesh Bhushan on Friday directed the governments of four states -- Gujarat, Karnataka, Tamil Nadu, and Telangana, to analyse the factors driving the high COVID-19 mortality and devise ways and means to reduce the mortality.

Apart from the higher case mortality, these states account for 17 per cent of India's active cases, high daily new cases, low tests per million, and high confirmation percentage.

In a high-level virtual meeting, Bhushan advised state administrations to adhere to measures suggested by central advisories and guidelines to prevent and reduce mortality due to coronavirus infection.

According to the health ministry, 16 districts in these four states are reporting maximum virus fatalities. It includes -- Ahmedabad and Surat in Gujarat; Belagavi, Bengaluru urban, Kalaburagi and Udupi in Karnataka; Chennai, Kanchipuram, Ranipet, Theni, Thiruvallur, Tiruchirappalli, Tuticorin and Virudhnagar in Tamil Nadu; and Hyderabad and Medchal-Malkajgiri in Telangana respectively.

"The districts were advised to ensure that the advisories, guidelines and clinical treatment protocols issued by the Health Ministry are adopted and effectively implemented to reduce the mortality among COVID-19 patients and other preventable deaths among all sections of the people, particularly those with co-morbidities, pregnant women, the elderly and children," said the health ministry official.

"States were advised to ensure optimum capacity utilization of testing labs, increase tests per million population and reduce confirmation percentage, in addition to ensuring timely availability of ambulances with target zero refusal," the official further said.

"States were also advised to analyze availability and need for projected beds and oxygen, and plan in a timely manner. States and district administration have also been advised to ensure good infection prevention and control practices to control infection in the healthcare workers," said the official.

Principal Secretary (Health) and MD (NHM) from the four States along with district surveillance officers, district collectors, commissioners of the municipal corporation, Chief Medical Officers, and Medical Superintendent of Medical Colleges participated in the meeting.

The Drugs Controller General of India (DCGI) has given nod to the Serum Institute of India (SII) for conducting phase 2 and 3 human clinical trials of the Oxford University developed Covid-19 vaccine candidate in the country.

Government officials said that the approval for conducting phase 2 and 3 clinical trials by the SII was granted by DCGI Dr V G Somani late Sunday night after a thorough evaluation based on the recommendations of the Subject Expert Committee (SEC) on Covid-19.

"The firm has to submit safety data, evaluated by the Data Safety Monitoring Board (DSMB), to the CDSCO before proceeding to phase 3 clinical trials," a senior official said.

"As per the study design, each subject will be administered two doses four weeks apart (first dose on day one and second dose on day 29) following which the safety and immunogenicity will be assessed at predefined intervals," the official said.

As a rapid regulatory response, the expert panel at the Central Drugs Standard Control Organisation (CDSCO) on Friday, after a detailed deliberation and considering the data generated on the vaccine candidate in phase 1 and 2 of the Oxford University trial, had recommended granting permission for phase 2 and 3 clinical trials of the potential vaccine, 'Covishield', on healthy adults in India,  the officials said.

Currently, phase 2 and 3 clinical trials of the Oxford vaccine candidate is going on in the United Kingdom, phase 3 clinical trial in Brazil and phase 1 and 2 clinical trials in South Africa.

The officials said that the SII had submitted a revised proposal on Wednesday after the SEC on July 28, following deliberation over its application, had asked it to revise its protocol for the phase 2 and 3 clinical trials besides seeking some additional information.

The panel had also recommended that the clinical trial sites which have been proposed for the study be distributed across India.

According to the revised proposal by the SII, 1,600 people aged above 18 years will participate in the trials across 17 selected sites, including AIIMS-Delhi, B J Medical College in Pune, Rajendra Memorial Research Institute of Medical Sciences (RMRIMS) in Patna, Post Graduate Institute of Medical Education and Research in Chandigarh, AIIMS-Jodhpur, Nehru Hospital in Gorakhpur, Andhra Medical College in Visakhapatnam and JSS Academy of Higher Education and Research in Mysore.

"According to the application, it would conduct an observer-blind, randomised controlled study to determine the safety and immunogenicity of 'Covishield' on healthy Indian adults," the official said.

The SII, which has partnered with AstraZeneca, for manufacturing the Oxford vaccine candidate for Covid-19 had submitted its first application to the DCGI on July 25 seeking permission for conducting the phase 2 and 3 trials of the potential vaccine. 

Initial results of the first two-phases of trials of the vaccine conducted in five trial sites in the UK showed that it has an acceptable safety profile and homologous boosting increased antibody response, sources had said.

To introduce the vaccine, SII, the world's largest vaccine maker by number of doses produced and sold, has signed an agreement to manufacture the potential vaccine developed by the Jenner Institute (Oxford University) in collaboration with British-Swedish pharma company AstraZeneca.