Visiting private clinic for immunisation?

I am trained as a medical doctor. Few years ago, I was out of town when my wife had to take our elder daughter, who had developed a fever, to a paediatrician.

After examining her and prescribing medicine, the paediatrician, in this case a private practitioner, casually inquired with my wife, if she would like to postpone the onset of puberty for the daughter. He went on to describe the efficiency of an injectable drug, which postpones the onset of puberty. He said, “As a mother, you wouldn’t want to see the changes a girl has to go through at a young age”.

When I returned home, my wife asked me, annoyed “Tell me, you are also a doctor. Why would a doctor want me to do this to my daughter? Is it wrong to go through natural stages in life?” I had no answer but was amazed and shell-shocked. That said, I was not surprised; as a doctor trained in public health, we are aware of the dangers of rapid commercialisation of health care in an unregulated environment such as the Indian healthcare scenario. The resulting disregard of patients’ healthcare choices bothered me.

I was also suddenly aware of the vulnerability of the parents, even the educated and the middle-class ones, let alone those who are poor and illiterate. There is a certain powerlessness in healthcare encounters as opposed to an empowerment that one usually expects; heeding to the advice of healthcare professionals is not always questioned unless one has access and interest in finding out more about the various therapeutic tools being offered to patients.

However, there are “good” and empowering technological tools too. One of the wonders that modern technology has offered is that anyone can know whether vaccines are maintained in cold chain or not just by glancing on a square in comparison to circle. This is called as vaccine vial monitor (VVM), and is widely used in most vaccines supplied in the government health systems. Vaccines lose their efficacy if a certain temperature is not maintained right from their production to their use.

The World Health Organisation has mandated the governments to use VVM to indicate the status of cold chain maintenance. In the absence of cold chain, vaccines might be impotent and administering them can vaccinate your children but they may not be immunised. To be immunised, the vaccine has to be potent and initiate an antigen-antibody response in the immune system. I consider that, it is the duty of every parent (as well as their intention!) to know whether their children are immunised or not (not just vaccinated).

Several years back, during my previous work in the WHO, I had interacted with many paediatricians about the importance of cold chain maintenance of vaccines. Little did I know about the implementation of these best practices till we had second child recently.

Oral polio vaccine

Don’t be surprised to know that a lot of vaccines used in the private sector do not have vaccine vial monitors. I asked a learned paediatrician about how many vaccines have VVM and he answered, “Hmm, well sometimes we do see for oral polio vaccine, but we recommend killed vaccine (an injectable), so pretty much all others don’t have it”. That was a harsh welcome to reality for me! You might be shelling a bomb for vaccines at private facilities but in my opinion, their efficacy needs to be monitored.

The real question, however, is how do we ensure good quality vaccines irrespective of whether it is provided by the public or private sector. In the public sector, one can be sure of the use of VVM, but in the private sector, I am not so sure. As illustrated in the above example, why would the private practitioner adopt a technology? One argument is that modern medicines and technology as tools get promoted probably because they provide some financial incentives to the persons who prescribe them.

In the case of VVM, there is no added incentive and it increases the work for manufacturers. Often, several people endlessly criticise the government health system whenever there are debates concerning the quality or access. At least, the vaccine cold chain maintenance in the government is immaculate.

But, I wonder, as responsible partners, why not private system decree the manufacturers that they don’t accept the vaccines without VVM? If self-regulation among the medical profession is to work, then this is a great step in that direction. Until then, it might be worth asking whether going to private clinic for immunisation may be beneficial for your kid or not. If not, what choices do we really have?

(The writer is Associate Professor, Indian Institute of Public Health, Public Health Foundation of India, Bengaluru)