| Unnecessary drive: Hepatitis B vaccination |
Speculations whether foreign health data
were wrongly used to build up a scare in India and promote the
interests of hepatitis B vaccine producers now turn to deep suspicions.
Correspondence between medical experts, including letters published
last week in the international journal Health Economics,
bolster the claim of some doctors that India is being coaxed into
introducing a vaccine that the public-funded health system may not need
and cannot really afford.
The correspondence, specifically, hints
that the drive to introduce the hepatitis B vaccine into the nation’s
universal immunisation programme may have been fuelled by an
exaggerated estimate of the deaths caused by the hepatitis B virus in
In letters to the journal, Dr Jacob
Puliyel, head of paediatrics at the St Stephen’s Hospital in New Delhi,
has reiterated his concerns that data from Taiwan were, without
justification, used to exaggerate the risk from hepatitis B in India.
Suggestions to introduce the hepatitis B
vaccine in the immunisation programme hinged on a figure of 250,000
deaths each year from an infection of the virus in India. Dr Mark
Miller, director of international epidemiology and population studies
at the National Institutes of Health in the US, had claimed that the
figure was arrived at through a complicated model.
But when asked by Puliyel to reveal the
assumptions used in the model to derive the figure, Miller conceded
that “there are major limitations from extrapolations from the limited
available studies at the time on hepatitis mortality in developing
countries.” He has also said that “countries should conduct their own
analyses to formulate their own conclusions”.
The correspondence may come as a
vindication for Indian doctors — and Puliyel is at the vanguard of this
group which has long been campaigning for rational decisions in public
The figure of 250,000 emerges from the
inappropriate extrapolation of Taiwanese data on India. Data available
with the Indian Council of Medical Research (ICMR) suggest that the
figure may be closer to 5,000. In other words, the policy on hepatitis
B vaccine was influenced by a figure blown up 50-fold.
The correspondence not only hints at a
conspiracy to push vaccines into the public health programmes of poor
countries, but also puts a big question mark on the process of
policy-making here. Are assertions from foreign medical experts or
international funding organisations more credible than words of caution
from local experts?
Any proven and safe vaccine should be
available to those who can afford it. But public-funded programmes
often involve hard decisions. Policy-makers should conduct cost-benefit
analyses before they divert scarce resources from other health
programmes into a new vaccine.
A cost-benefit analysis based on an exaggerated estimate only means that the policy-makers have been taken for a ride.