Hepatitis B vaccination or clean water ?
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Source: e-drug@usa.healthnet.org (modified)
Dear everybody,
The WHO has suggested universal immunisation with Hepatitis B vaccine
in countries with intermediate prevalence. The Indian Academy of Paedi-
atrics has dutifully recommended it to paediatricians in the country
and to the government. Paediatricians have in turn been advising the
vaccine. The vaccine costs about Rupees 750 for 3 doses.
The India Development Report 1997 (Ed. Kirit S Parikh Oxford Press
Delhi 1997) suggests that a third of the population earn less than Ru-
pees 57 per capita per month. The major killers here are diarrhoea,
respiratory infections and malnutrition. Basic amenities like safe
drinking water are not available to the majority.
Does the WHO really want universal immunisation with Hepatitis B as a
priority over the provision of clean drinking water? At what stage of
infrastructure development in a country does Hepatitis B prevention by
vaccination take priority? Is there any study about this?
How does one compute the cost effectiveness of Hepatitis B vaccination.
One way to compute cost-effectiveness would be to look at the cost of a
liver transplant and the cost of vaccinating n number of people to pre-
vent the need for that transplant. If the cost of the latter is less
than the former it can be called a cost-effective intervention. But
surely the WHO is aware of the ground realities in developing coun-
tries.
Liver transplant is not an option for 99.99% of the population. For one
person dying of liver failure hundreds of others die of diarrhoea. The
interventions (like provision of clean drinking water) required to save
these hundreds would cost a fraction of what is required for Hepatitis
B vaccines.
Is it right that developing countries are advised to spend their meagre
resources on this expensive Programme of universal immunisation with
Hepatitis B vaccine?
The WHO is manned by the best brains in the world. There must be very
sound reasons for their recommendation. I am however curious to know
their reasoning. I put my question to them via e-mail. I have not heard
in reply. Probably the e-mail did not reach the right person.
I wonder if any one can help with the answers.
Jacob M. Puliyel
Head, Department of Paediatrics
St Stephens Hospital
Tis Hazari Delhi 110054, India
mailto:puliyel@ndf.vsnl.net.in
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