Immunisation is an important vehicle for health promotion and therefore is a true national investment. The ministry of health brings out policies that determine the type of vaccines that need to be made available in this country.
Earlier the Universal Immunisation Programme (UIP) was introduced in India during 1985-86 with the objective to cover at least 85 per cent of all infants against the six vaccine preventable diseases which include diphtheria, pertussis (whooping cough), tetanus, polio, measles and tuberculosis. Of these six, the first three are given together as injections, popularly known as DPT or triple injection.
Now, the recent national vaccine policy draft, submitted by the government of India, strongly favours inclusion of new vaccines in the UIP of the country without doing a cost-benefit analysis and substantiating it with proper scientific evidence to suggest the prevalence of the diseases. The new vaccine that is being promoted is the pentavalent (a combination of five vaccines in one shot) vaccine to protect children against hepatitis B and haemophilus influenza type B (Hib) in addition to diphtheria, pertussis and tetanus (DPT), which are already covered under the UIP.
Costly for poor people
The government’s policy on vaccine insists that the pentavalent vaccine must be introduced in the national UIP for ‘its pragmatic convenience’ as only three shots of injections would be needed instead of nine which will need to be given to a child to fight DPT, Hib and hepatitis B. But this statement of the government has come under severe criticism from several public health experts and practicing child specialists.
The major arguments against the initiation of pentavalent vaccine are that: DPT cannot be given at child birth, while hepatitis B vaccination should be given at birth so as to prevent mother-to-child transmission. Cost is another factor. The pentavalent vaccine costs Rs 525 per child as against the total cost of vaccines for six basic diseases included in the UIP which costs around Rs 30 per child. And thirdly the new vaccines do not find adequate scientific ground.
Besides, combining of hepatitis B vaccine with DPT is most illogical as the ideal time schedule for the two is very different because while hepatitis B vaccine is best given at birth followed by 1 month and 6 months of age. If first dose of hepatitis B is not given at birth, then it will fail to prevent mother-to-child transmission which may be responsible for 30-50 per cent of chronic carriers.
Also if the third dose of hepatitis B is given earlier than four months of age then the antibodies (antibodies are proteins that are produced in our body as a result of the vaccination and in turn they assault the invading organisms and prevent them from attacking us) reached are very inadequate and hence may be ineffective over long period of time. Hence giving hepatitis B at 6, 10 and 14 weeks of age along with DPT is largely a waste of money. Again while given separately hepatitis B vaccine costs hardly Rs 10, but combining it as pantavalent would costs Rs 525.
The other vaccine Hib has never been a big public health problem to warrant a national immunisation programme. No study has ever been able to show it and in fact most studies have demonstrated a very low prevalence. So we need to address these questions squarely before suggesting inclusion of these vaccines into our national programme.
Global Alliance for Vaccines and Immunisation (GAVI), a global health partnership of public and private sectors, has committed $165 million grant for the phased introduction of pentavalent vaccine in India and provides a subsidy of Rs 145 per injection for five years. But after that the government will have to pay the total cost of the vaccines.
This is despite the fact that overall immunisation coverage is on the decline in India; there is irregular vaccination or no vaccination in most parts of the country.
The Bill Melinda Gates Foundation (BMGF) is a founding partner of the GAVI Alliance. Its initial grant helped establish GAVI and it continues to support its work. Some of the pharmaceutical companies have affiliation with BMGF to manufacture the vaccine. For instance, BMGF has $0.12 billion shares in Sanofi-Aventis, which owns Shantha Biotech, a pentavalent vaccine manufacturer in Hyderabad. BMGF also has links with Merck, another pentavalent vaccine manufacturer.
Several such details of BMGF’s investments in vaccine manufacturing companies and other corporations are revealed in a study by David Stuckler of Harvard University in the US. The study titled ‘Global Health Philanthropy and Institutional Relationships: How should conflicts of Interest be addressed’ was published in ‘Public Library of Sciences’ in April. It is a clear case of conflict of interest because Gates is promoting vaccines manufactured by pharmaceutical companies in which he hold shares, Stuckler says.
Vaccines no doubt are useful tools of public health to prevent morbidity and mortality. But the dominating market forces do not seem to let it happen.