Shalini on the national scale-up of the pentavalent vaccine in India

shaliniThe pentavalent vaccine has been recommended for national scale-up in India. It was first introduced in two states, Kerala and Tamil Nadu, in 2011 as part of the national vaccination programme. The vaccine has so far made its way to seven more states.

India has the highest infant and child under 5 mortality rate in the world. The pentavalent vaccine provides protection against five killer diseases—Diphtheria, Pertussis, Tetanus, Hepatitis B, and Hib infections. India’s traditional defence against the first three diseases has been the DPT vaccine. But the pentavalent vaccine promises to save more lives.

The decision to push the vaccine nationally also comes after a significant report in September 2013 from the National AEFI committee, which monitors the adverse events following immunization (AEFI) in the country. It clarified that the 18 deaths reported in Kerala in the last year, after due investigation, were found as not related to the pentavalent vaccine. It provided much awaited clarity for public health experts, the health ministry, and even journalists in India. The vaccine has already been much debated.

Despite that, the experts in India seem “divided” on the cause. There are many sceptics in the country, who, to put it simply, say the vaccine endangers lives. There is in fact a Supreme Court public interest litigation pending. And while a controversy is easier to believe, especially for the media and the public in general, there are some very important questions to be examined in this argument.

Firstly, the initial controversy around the pentavalent vaccine said that the vaccine was withdrawn in many countries following safety concerns, as in Sri Lanka and Bhutan. But the latest reports tell us that these countries are still using the vaccine. In fact, 170 countries worldwide are. But why would so many countries use a vaccine on its children, when its safety is in question? And why have the vaccine sceptics now suddenly dropped that argument?

Secondly, there were similar questions raised about the polio vaccine, a few years ago. The increasing number of AEFIs was a concern. Yes. But is heightened surveillance a bad thing? No. (Any healthcare professional would know that reporting an AEFI doesn’t necessarily mean that the vaccine caused the problem. But any adverse outcome observed up to a month after the immunization is recorded as an AEFI and followed up). There were also arguments made as to how the Indian government should invest in providing clean water and improving hygiene conditions instead of focusing on the vaccine as a solution. While agreeing it is a shame that the powers that be (like the ministries for water, irrigation, and rural development) haven’t woken up to see good reason, should the health ministry simply shift blame and refuse to vaccinate the children while it can, against crippling and killer diseases? When perfectly good vaccines are available and used worldwide? With a birth cohort of two million babies each year, I shudder to think of such possibilities.

And finally, what about the cost efficiency? Let’s not forget that the pentavalent vaccine is not new in India. It has been licensed and in use for the past nine years. It was being sold for up to 6000 rupees per child, for the three doses. It is only new to the government programme (which usually slashes prices drastically in the long run). It is also no secret that pneumonia is the biggest killer of children in India. The Hib component in the vaccine can save up to a third of those pneumonia deaths that is at least a lakh (100 000) babies each year. For a country that cannot boast of excellent solutions for healthcare, since when did prevention become a bad idea?

Competing interests: I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Shalini is a television health journalist from India, working with one of the national news channels in India, CNN-IBN (Indian affiliate of CNN International). She has been covering disease outbreaks, medical breakthroughs, and has been extensively reporting on public health epidemics for the last eight years.