A sure shot

Hepatitis B vaccine should not be administered to all children

By Vibha Varshney
Published: Friday 15 August 2003

a recent study may intensify the ongoing controversy about the inclusion of hepatitis b vaccine in India's universal immunisation programme (uip). The study shows that vaccinating only children born to hepatitis b-positive mothers is 19 times cheaper than immunising all kids. Since the main mode of transmission of the hepatitis b virus is from mother to child, the inclusion of the vaccine in uip is quite redundant, the study goes on to assert.

Around three to seven per cent of India's total population is affected by the disease, which damages the liver. According to the New Delhi-based Indian Council of Medical Research, 5,000 people die annually due to liver cancer caused by the hepatitis b virus. The authorities are, therefore, contemplating about vaccinating all six-week-old children against hepatitis b under the uip.

Some experts say the vaccine is effective only if administered during the first 48 hours of birth; but in India this is not possible as 65 per cent of babies born each year are delivered at home. Therefore, the inclusion of the vaccine in uip will not work wonders. The new study lends force to the argument. It was conducted in the Sangam Vihar area of New Delhi by Plan India, a non-governmental organisation based in the city.

A total of 1,100 deliveries took place in the locality during the study period of one year. Out of the 987 mothers tested prior to their deliveries, 22 were found to be hepatitis b-positive. The researchers vaccinated their children as soon as they were born. The rest of the children were not immunised.

To find out how cost-effective their approach is, the researchers simulated the expenditure of their method as well as that of vaccinating all the 1,100 children. While doing so, they assumed their method was being adhered to for a long time; therefore out of the 987 mothers who took part in the study, only 250 needed to be screened, as they were expecting their first child. The rest would have been tested when they had their first child.

The researchers' calculations show that if the cost of testing the mothers is Rs 30 and the price of the hepatitis b vaccine is Rs 70 per dose, then protecting a community of 65,000 people through selective immunisation will mean incurring an expense of Rs 12,120, but for universal vaccination the expenditure will be Rs 231,000. Selective vaccination is cost effective even when overheads such as cost of refrigeration, needles and syringes are considered.

The group further estimates that the cost of lives saved through selective vaccination would be Rs 309,800 per individual as compared to Rs 968,000 per person through universal vaccination.

To take a final decision about the inclusion, the government is waiting for the results of a pilot project, whereby the vaccine has been included in the uip of a few areas. However, funds to make it a part of uip have already been allocated under the 10th five-year plan.

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