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For long, India’s vaccination programme had six vaccines for tuberculosis, diphtheria, pertussis, whooping cough, tetanus, polio and measles. The vaccines were cheap and protected children adequately. But in the last decade, the country has been under tremendous pressure from the pharmaceutical industry to include a variety of expensive vaccines in its immunisation programme.
The Global Alliance for Vaccines and Immunization (GAVI), a public private partnership that represents the industry worldwide, promotes "underutilised" vaccines and provides support to buy these otherwise expensive vaccines. It is under this support that India now has Hepatitis B vaccine in its universal immunisation programme. Efforts are on to include Hib vaccine (against Haemophilus influenza B) and the HPV (against human papiloma virus) vaccine.
But the efficacy of these vaccines is questionable. Last year, Kerala which has the best indicators for health in India, decided to use the pentavalent vaccine in its immunisation programme. The vaccine is widely used in private sector and so far there has been no report of adverse effects. But when it was distributed free across the state, four children died. A case was filed in the Kerala High Court at Ernakulam by Human Rights Law Network, a non-profit, on behalf of a child’s parents. The health department of the state recently filed an affidavit in the case. It said the child died due to reaction to paracetamol given to control fever due to vaccination.
The affidavit also said that two of the children had died due to “co-morbidities” while parents of one child did not allow post-mortem examination. Public health experts against the inclusion of pentavalent vaccines in the immunisation programme ask what these co–morbidities were.
Rajeev Sadanandan, health secretary of the state, in an email reply to Down To Earth revealed, “One child was a tribal in general malnourished condition and the other had a cardiac situation. Both were susceptible to pneumonia and were recommended Hib as a prophylactic (preventive) measure. They would have had to buy the vaccine from the market otherwise.”
This suggests that the vaccine should not be given to malnourished children or those who have a heart problem. But nearly half of the children in India are undernourished. Should we then, really consider including pentavalent vaccine in the universal immunisation programme? What will happen if the vaccine is given to the undernourished children in Uttar Pradesh and Bihar?
Sadanandan adds that it is surprising that the petitioners are asking that the pentavalent vaccine be stopped in the government sector where it is given free and not in private sector from where huge amounts are collected. The answer to this is that parents who can afford the vaccine would also ensure that the child is adequately nourished. Each dose costs Rs 2,000 and three doses are needed.
The affidavit also mentions that Goa has been using the pentavalent vaccine in the immunisation programme for years now. Once again, Goa is a rich state and has the highest per capita income in the country.
It would be better if the pilot projects to check whether the vaccine should be included in the immunisation programme are carried out in poor states like Uttar Pradesh and Bihar.