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[e-drug] India cannot afford to use vaccines that are not cost-effective - Guardian

E-DRUG: India cannot afford to use vaccines that are not cost-effective - 
Guardian
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http://www.guardian.co.uk/commentisfree/2010/oct/27/india-vaccines-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 
possible
The Guardian, 27 October 2010
Jacob Puliyel,

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,
(http://www.guardian.co.uk/lifeandstyle/2010/oct/11/vaccination-fears-developing-world-deaths).
 [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 
usefulness.

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 
it�.

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 
context.

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
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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 
websites.

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]

-- 
http://novartisboycott.org/petition

Dr Gopal Dabade,
57, Tejaswinagar,
Dharwad 580 002
Tel 0836-2461722
Cell (0)9448862270
www.jagruti.org
http://aidanindia.wordpress.com/
www.daf-k.cjb.net

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