This vaccine needs a booster shot

| | in Oped

While we should continue to be vigilant to ensure the safety of our children, it is equally important to move forward and embrace newer technologies in our health system that can help save lives, writes Naveen Thacker

The issue of childhood diseases has long eluded public consciousness — which is a grave injustice to India’s children. Every year, the world loses about seven million children less than five years of age. Nearly one-fourth of these deaths (24 per cent) are from India. Tragically, a majority of these deaths occur from easily preventable diseases, such as pneumonia and diarrhoea. Pneumonia is one of the leading causes of death of children aged under five in the country. The disease claimed over 3,97,000 lives in 2010 alone.

What is especially tragic is that pneumonia can be easily averted and treated with existing child-survival interventions. Precautionary measures such as frequent washing of hands and general cleanliness help reduce the transmission of micro-organisms and exclusive breast-feeding for the first six months is vital to ensure that the child gets adequate nutrition and builds natural immunity against infections. Vaccines are particularly important preventive strategies in populations that do not have access to care and treatment. A comprehensive approach to the prevention of pneumonia, including access to new and available vaccines, is needed to combat this deadly disease.

The National Technical Advisory Group on Immunisation, in 2008, recommended that vaccines for Hib (Haemophilus influenza type B), the pathogen that causes pneumonia and meningitis, should be included in the Universal Immunisation Programme of India. The Government of India introduced the vaccine for Hib in the form of the Pentavalent vaccine, which provides protection against five life-threatening diseases: Diphtheria, pertussis, tetanus, Hepatitis B and Hib. The DPT (diphtheria, pertussis, tetanus) and Hepatitis B vaccines were already part of the national routine immunisation programme. Protection against Hib is a new addition.

Currently, nine States across India — Tamil Nadu, Kerala, Jammu & Kashmir, Haryana, Karnataka, Gujarat, Delhi, Goa and Puducherry — have included this vaccine in their immunisation programme, and many other States have shown interest. Introducing a vaccine in the immunisation programme enables public health programmes to use this preventive technology to reach remote, inaccessible and poorer sections of the society who would otherwise not have access to this life-saving intervention.

India has demonstrated in its polio eradication and vaccination programmes that dedicated efforts can reach the most vulnerable populations and ensure encouraging results.

Vaccines are safe and the most effective preventive tools. In some cases vaccines may have a few mild side-effects such as pain, redness, and swelling at the injection site, irritability and increased crying or fever. Pentavalent vaccines have been demonstrated to be efficacious and effective in numerous studies and are widely supported by global and Indian health communities. Hib-containing vaccines have been introduced and are currently employed in more than 180 countries with tens of millions of children having received the pentavalent vaccine across the world.

Recently, a few critics of the vaccine expressed concern about the safety of Pentavalent due to serious adverse events including death, reported after vaccination in India and neighbouring countries. India, like many countries, trained its health workers and strengthened the system for reporting of any adverse events, before the vaccine was introduced into the immunisation programmes of selected States, starting in 2011.

These reports of adverse events and deaths following immunisation were thoroughly investigated by national authorities and international experts. Other countries too did the same. In Bhutan, Sri Lanka and Vietnam there were reports of deaths around the time of immunisation, and as a precaution, there was a temporary suspension of the vaccine during the investigations of these adverse events. However, the investigations in India and other countries did not show evidence that the vaccines had caused the deaths.

Since then, all three countries have reintroduced the Pentavalent vaccine, and Bhutan now boasts of 97 per cent coverage, according to the World Health Organisation. Although the apprehension about the serious side-effects of the vaccine is understandable, the knee-jerk reaction of calling to withhold a valuable public health tool is dangerous to say the least. We need to keep in perspective that although there are risks with all medical interventions, including vaccines, the fact that the public health benefits almost tens of thousands of Indian infants, is substantial.

We should continue to be vigilant to ensure the safety of our children, but it is equally important that we move forward, embrace and incorporate newer technologies in our own system that can help save lives. Just like the vaccine for small pox eradicated the disease from our memories and the oral polio vaccine has helped India achieve over two-and-a-half years of polio-free status, it is time we accept the benefits of this life-saving tool and ensure its access to all of India’s children.

(The writer is president-elect of the Asia Pacific Paediatric Association)

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