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]
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