E-DRUG: WHO and vaccines
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MATTER OF TRUST
Is WHO promoting harmful vaccine for pneumonia?
23rd September 2008
www.deccanherald.com/Content/Sep232008/panorama2008092291533.asp
The WHO should be an honest broker between the needs of the public and vaccine manufacturers.
The term vaccine was coined by Edward Jenner, during 1796, when he observed that the milk-maid did not acquire small-pox as she was having protection and further he realised that milk-maids -- who had contact with cow-pox -- did not get small-pox. The process of distributing and administrating vaccines is thus referred to as 'vaccination'. Since Jenner's discovery, more than 200 years back, we have come a long way. Thanks to rapid development of biotechnology, we now have access to vaccines for other diseases.
But unfortunately, some of these developments are not in the right direction as is evident from the vaccine that the Union government is planning to introduce to prevent pneumonia. Pneumonia is infection of the lungs, often caused by bacteria. The disease is caused by a common bacterium known by its tongue twisting name as the pneumococcus, which can attack different parts of the body.
When bacteria invade the lungs, they cause the most common form of bacterial pneumonia; when bacteria invade the bloodstream, they cause bacteremia; and when they invade the covering of the brain, they cause meningitis. It can can be fatal, depending upon the immunity, nutritional status of the child and how quickly the baby gets medical treatment.
The pneumococcal conjugate vaccine (PCV) has been developed to prevent these forms of severe pneumococcal disease and specially pneumonia that harm and kill children below the age of five. The vaccine's protection lasts at least three years. The most serious pneumococcal infections happen during the first two years of life.
In India, 6.6 lakh pneumonia cases were recorded in 2007 and the deaths stood at 2,865. To prevent this morbidity and mortality the Union government, along with technical support from the World Health Organisation (WHO), initiated an ambitious plan during April 2008, to vaccinate children against pneumococcal bacterial infection.
But all this was short-lived as a revelation occurred in the WHO's own bulletin of Sept 1, 2008, that the pneumococcal vaccine that is being promoted by WHO, globally and in India, does not reduce pneumonia. It reduces a rare type of pneumonia -- so rare that 1,000 children need to be vaccinated to prevent four cases of the pneumonia! Still more alarming is the revelation that for every four children -- in whom pneumonia is prevented -- two children develop asthma because of the vaccine.
Pneumonia is a mild infection treated with antibacterial agent (Sulfamethoxazole / Trimethoprim) at less than $1 (Rs 43) per child, according to the WHO protocol. Asthma, on the other hand, is often permanent and needs repeated inhaled treatment with bronco-dilators and steroids. Asthma is a condition much worse than the one-off pneumonia, which is easily treated and cured.
It is anticipated that with this revelation, parents of children, from all over the globe, are going to ask embarrassing questions to WHO, as to how it continues to advocate the vaccine. So, can we expect that the vaccine will be voluntarily withdrawn from the market immediately because of this unacceptable risk?
But there are still fundamental questions which, the director-general of WHO needs to answer. One basic question is: how and on what basis did WHO take the decision to promote this vaccine? The world expects the WHO to be an honest broker between the needs of public health and vaccine manufacturers. This trust, it seems, has now been betrayed by the WHO by promoting a harmful vaccine.
The vaccine's ineffectiveness, as a public health tool, has been shown by earlier studies as well. The fact that the vaccine doubles the risk of asthma was known as early as 2003.
The other major barrier to cover the entire child population is the cost factor. Each dose of the vaccine costs Rs 4,500 and each child needs four doses at 6, 10, 14 weeks and later followed by a booster dose. The cost factor is extremely important in a developing country like India, where scarce resources have to be allotted to major public health problems.
Neither scientific evidence nor cost effectiveness make the pneumococcal vaccine useful in the Indian context as a tool for public health problems. It is necessary for policy-makers, both in the Indian and the WHO context, to stop being agents of profit-making vaccine manufacturers. Their first and foremost duty should be to serve the health of children.
(The writer is president, Drug Action Forum -- Karnataka)
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