Health

Phonological problems: Why the name of a COVID-19 vaccine matters

The issue of nomenclature and confusion due to sound-alike and name-alike vaccines doesn’t find any mention in Covid-19 vaccination strategy; however, it is a simple but sensitive issue of science communication

 
By Kumar Gandharv Mishra
Published: Monday 18 April 2022

India’s vaccination drive against COVID-19 started with ‘Covishield’ in January 2021. Soon, the first indigenous COVID-19 vaccine ‘Covaxin’ also accelerated the vaccination drive. 2021 ended with the news of two more vaccines: Corbevax and Covovax. 

Now, Corbevax is to be administered for the age group of 12-14 years. In January 2022, India crossed a successful landmark of 1.5 billion vaccine doses. Beneficiaries have to be administered with double doses of the same vaccine, according to vaccination protocols.

However in the midst of the vaccination drive, there also came reports of ‘mixed vaccination’ (or vaccination errors) in some parts of the country — a case where a beneficiary took the first dose of Vaccine A and then Vaccine B as the second dose.

Some news reports highlighted such cases: Twenty persons in Siddarthanagar of Uttar Pradesh got vaccinated with Covishield followed by Covaxin; the final vaccination certificate of a beneficiary in Ujjain represented two different vaccines.

In January 2022, two students of Bihar Sharif (Bihar) in the age group of 15-18 got vaccinated with Covishield. This age group has to be vaccinated with Covaxin according to the Drug Controller General of India.

But why did such errors take place? Was it because of the person who handled the vaccine registration at the vaccination centre? Was it because of the lack of the awareness about the vaccine’s name by the beneficiary?

News reports did not mention any reason behind such errors. But in the first instance, the error does appear to be a case of misunderstanding due to the inability to explicitly differentiate between the two similar names — Covishield and Covaxin (similar sounding names). 

This can be worse in the case of beneficiaries belonging to poor and illiterate backgrounds as they don’t have enough knowledge to speak or double check the vaccine name at the vaccination centre.

Usually, the registrant at the vaccination centre writes the name of vaccine in cursive style on the copy of the identity card of the beneficiary and directs the beneficiary to go to a particular spot where the health worker is supposed to vaccinate him/her.

Writing the name in cursive style may make it difficult to differentiate, as the names of both the vaccines start from ‘COV’ though these have been developed by different companies. The names ‘Covishield’ and ‘Covaxin’ could be easily differentiated by an educated Indian, but not by people coming from poor and illiterate backgrounds.

The two new vaccines — Covovax (by Serum Institute of India Pvt Ltd, Pune) and Corbevax (Biological E Ltd, Hyderabad) — also have similar-sounding names. In fact, their names are much more similar sounding than Covishield and Covaxin.

The names of vaccines developed by Moderna Inc, Pfizer Inc and Johnson & Johnson are clearly distinguishable in sharp contrast to this. These are neither similar sounding or similarly-named.

The World Health Organization published a report in 2007 on drug name confusion and highlighted LASA (look-alike and sound-alike) medication error as a matter of concern.

In fact, similar drug names, either written or spoken, account for approximately 15 per cent of all reports to the USP Medication Errors Reporting Program (published in the Food and Drug Administration consumer magazine, 2005).

One out of four medication errors voluntarily reported in the United States involved drug name confusion, according to a study on orthographical and phonological similarity of drug names (2001) published in Social Science & Medicine.

Levenshtein distance

One of the tools used to keep a check on sound-alike and name-alike confusion is the Levenshtein distance. A shorter Levenshtein distance between two drugs makes the names more similar and it is problematic.

Calculating Levenshtein distance is a complex process based on matrix, but in simple words it may be treated as an edit distance ie to count the number of edits done to differentiate the name.

The Levenshtein distance (or L-distance, used here in the text) between COVAXIN and COVISHIELD appears to be 7. A total of 7 changes in letters are there to differentiate

 

Similarly, from one perspective, the L-distance between CORBEVAX and COVOVAX appears to be six (a total of six edits); it also appears to be two if read and pronounced from another perspective (if BE is considered a single unit on the basis of pronunciation).

A study published in 2007 in International Journal of Risk and Safety in Medicine by Indian researchers (doctors) conducted in a hospital in Delhi reported that the brand names usually associated with medication errors had a Levenshtein distance of more than five; still, confusion occurred.

The L-distance (which is 2 from one perspective) between COVOVAX and CORBEVAX should be a matter of concern. Irrespective of the L-distance, these names should be easily distinguishable by common people.

Even graduates may get confused with similar names like COVOVAX and CORBEVAX. However, the issue of nomenclature and confusion due to sound-alike and name-alike vaccines doesn’t find any mention in Covid-19 vaccination strategy (2020) by the Union health ministry.

This is a simple but sensitive issue of science communication. Our policy makers involved in vaccination strategy and vaccine developers have done a tremendous job in vaccination drive during the COVID-19 pandemic, but they should also prioritise issues of vaccine nomenclature during mass level vaccination which is unlike prescribing medicines to an individual.

At the end, I am also left with few questions: The nomenclature lies in the hands of vaccine companies, but did they think of such medication errors during the pandemic? Is the nomenclature of vaccine outside the health ministry’s purview during a pandemic?

Why can’t vaccines be named distinguishably? Is it a trend to name the vaccine closer to the name of the disease or pandemic in the era of competition?

Kumar Gandharv Mishra is an independent researcher who works in the area of science and mathematics education

Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth

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