E-DRUG: India cannot afford to use vaccines that are not cost-effective -
India cannot afford to use vaccines that are not cost-effective
Developing countries must spend their budgets wisely to save as many lives as
The Guardian, 27 October 2010
Your article about anti-vaccination scares spilling over into the developing
world, where they are threatening to derail global vaccination programmes
failed to present a balanced view of the situation (Why fear of vaccination is
spelling disaster in the developing world, G2, 12 October,
[The article has been copied in below. Moderator]
The article states that "Indian lobbying groups, led by opposition politicians,
still claim that Hib [Haemophilus influenzae] vaccines are not only
unnecessary, but have caused a number of deaths" and that the Indian
government's decision to re-examine their usefulness is putting lives at risk.
I am a member of the Indian government's National Technical Advisory Group on
Immunisation, and I know of no politician in the opposition that is leading any
lobbying group against vaccines. For a vaccine to be introduced into the
national immunisation programme, it must reduce the disease burden sufficiently
to justify its costs.
Unfortunately, Hib does not fit that bill in Asia. Repeatedly, Asian studies
have shown there was no reduction in meningitis or pneumonia among those who
received the vaccine.
In particular, a vaccine effectiveness trial using Hib - conducted in Dhaka,
Bangladesh, in June 2007 and involving 68,000 infants under two - showed that
there was no significant reduction in clinically diagnosed pneumonia compared
with the control group. However, the Global Alliance for Vaccines and
Immunisation (Gavi) claimed the Bangladesh trial demonstrated the vaccine's
It is clear that the vaccine does not save many lives - it merely swallows up
funds that could have been used for genuine life-saving interventions, such as
the provision of clean potable water.
In the article, Lois Privor-Dumm of the Bloomberg School of Public Health is
quoted as saying �it would be wrong to characterise all opposition to vaccines
as cranky or anti-science. �There is often a grain of truth at the bottom of
An analysis in the Lancet showed how the pneumococcal vaccine reduces only four
cases of pneumonia per 1,000 children. According to Gavi's own figures, the
cost of vaccinating 1,000 children is $12,750.
Treating the four cases of pneumonia in India, using WHO protocol, would cost
$1. The pneumococcus strains prevalent in India are nearly all sensitive to
inexpensive antibiotics like penicillin. In the US, which has been using the
pneumococcal vaccine, there has been a strain shift - strains covered in the
vaccine are being replaced by more antibiotic resistant strains. Vaccine has
simply made the problem of pneumococcal disease worse. Yet this vaccine is
being pushed in Africa and Asia.
India is a country where 50% of the populations do not receive the six basic
vaccines against diphtheria, whooping cough, tetanus, polio, tuberculosis and
measles. The incremental cost of complete immunisation with these basic
vaccines is less than $0.75 (30 rupees) per child. This week I had the
heart-wrenching experience of explaining to a mother that her eight-year-old
daughter had died from diphtheria, which could have been prevented with the DPT
vaccine. The push to include expensive new vaccines must be viewed in this
Any vaccine introduced in developing countries needs to be weighed in relation
to its cost and benefit.
Many of the organisations that are pushing these vaccines have profit margins
to protect. To put it bluntly, for them, it is not about lives lost in poor
countries - it is all about the cash register.
For responses: http://jacob.puliyel.com/#paper_224
Why fear of vaccination is spelling disaster in the developing world
Anti-vaccination scares are as old as vaccination itself � but now they are
putting lives at risk in the developing world
Vivienne Parry, guardian.co.uk, Monday 11 October 2010
Rumours about vaccines are threatening to derail vital health programmes in the
developing world. Vaccine scares are nothing new. When Edward Jenner first
pioneered the use of the mild disease cow pox to inoculate against the deadly
small pox in the 18th century, satirists drew cartoons of vaccinated patients
sprouting cow's heads. Now, it seems, every country in the developed world has
their own type of scare. In France, protesters claim that the hepatitis B
vaccines cause multiple sclerosis, in the US, that the vaccine's mercury
additives are responsible for the rise in autism. In the UK, there was a furore
over whooping cough and then, famously, MMR. All have been exposed as
groundless fears, yet anti-vaccine feeling continues to reverberate on the
internet. Now doctors warn that such rumours from the UK, Europe and the US are
spilling over into the developing world, where they are threatening to derail
global vaccination programmes. Terrifyingly, this means putting the lives of
thousands of children at risk.
In South Africa, concerns about MMR, generated by coverage in the rest of the
English-speaking world � including the UK � have led to an unwillingness to
receive the vaccine, and there has been an outbreak of nearly 7,000 cases of
measles. For children with poor health and limited access to medical services,
this decision has been disastrous. There have already been hundreds of deaths.
Meanwhile, in India the government has recently overturned recommendations from
its own scientific advisers to include the Hib (shorthand for a bug called
Haemophilus influenzae) vaccine in its basic childhood programme, despite the
fact that the World Health Organisation says that 20% of the 400,000 childhood
deaths from pneumonias caused by Hib worldwide occur in India. In the UK,
childhood Hib vaccination has seen Hib-caused meningitis (the more common Hib
illness in the developed world) fall away to almost nothing. Yet Indian
lobbying groups, led by opposition politicians, still claim that Hib vaccines
are not only unnecessary, but have caused a number of deaths. The tactics of
the Indian anti-Hib groups draw directly on the work of UK and US anti-vaccine
Our anti-vaccine fears, and the groups set up to highlight them in the
developed world, may not directly cause these problems, but are "fuelling and
amplifying them", according to Dr Heidi Larson of the vaccine programme and
policy group at Imperial College London. Shockingly, just five minutes spent
looking at websites critical of vaccines increases your perceptions of the
risks, and reduces the perceptions of the risks of not being inoculated,
according to a recent paper from a German group published in the Journal of
Health Psychology. Rumours about vaccines quickly gain credence in the internet
hothouse, with sites feeding off each other. Many sites will tell you that four
girls in India died within 24 hours of receiving HPV vaccines. What they don't
say is that two died in road crashes, one from a snake bite, and one fell down
a well. Add this rumour to the feeling that vaccination is something that is
done to you by government, by global agencies or by big pharmaceutical
companies, and conspiracy theories are virtually guaranteed.
So what can be done? So far, campaigners have insisted on more information,
awareness and education. But this approach has failed. Instead, the idea of
each country taking ownership is being explored, along with advocacy and
immediate action to quell rumours.
In South America, which has astonishingly high rates of vaccination, ownership
clearly works. Brazil's rates are 98% of children across all of the childhood
vaccines. This is partly because campaigners such as Ciro de Quadros, the
legendary former director of the Pan American Health Organisation, have made
vaccination rates a matter of local pride. "Every mayor in Brazil can tell you
the vaccination rate in their town," he told me at the recent International
Paediatric Congress in Johannesburg. Grassroots advocacy has also been a
powerful counter force to rumour in countries such as Bolivia and Peru, which
are as poverty-stricken and with infrastructure as poor as some in Africa.
At the congress paediatricians from African countries with the poorest
vaccination rates, such as Ethiopia, Rwanda and the Democratic Republic of
Congo, were enrolled in workshops that told them how to develop that grassroots
advocacy at home, by linking up to women's groups and local chiefs.
Lois Privor-Dumm of the Bloomberg School of Public Health at Johns Hopkins
University is the strategy director of the Hib Inititative, which aims to get
Hib adopted more widely. She cautions that "it would be wrong to characterise
all opposition to vaccines as cranky or anti-science," because there can be
problems with vaccines. "There is often a grain of truth at the bottom of it,
and you need to listen."
Yet the risk they pose is so strong that Larson has now set up a vaccine trust
group to monitor rumours that threaten vaccination programmes. Part funded by
the Gates Foundation, the organisation's board includes De Quadros. "When we
look at vaccine scares, we see evidence that there was a problem flagged far in
advance," says Larson.
In the developed world, our children are well nourished and healthy and have
easy access to medical care. It's by no means a guarantee that they will not
die of infectious disease, but it helps enormously. How shaming is it that the
actions of those not threatened by infectious disease are now putting the lives
of those who are at risk?
guardian.co.uk � Guardian News and Media Limited 2010 [copied as fair use]
Dr Gopal Dabade,
Dharwad 580 002