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Wrong Cure: WHO
promotes an Ineffective Pneumonia Vaccine
By
Sumana Narayanan
Who
will benefit from globally promoted pneumonia vaccine?
The pneumonia vaccine that the Global Alliance for
Vaccines and Immunization, a public-private coalition, and who
are promoting in developing countries is expensive, inefficient and causes
serious side-effects, contends a letter published in a public health journal.
In a letter to the Bulletin of the World Health Organization
published online, paediatricians Jacob Puliyel and Sona Chowdhary of St.
Stephen’s Hospital, Delhi, said the vaccine was not effective against the
common form of pneumonia in India, clinical pneumonia. Seven-valent
pneumococcal conjugate vaccine or pcv 7 combats
seven strains of pneumonia-causing bacteria and is known to work for uncommon
radiological pneumonia. Clinical pneumonia cannot be diagnosed through X-rays
but symptoms such as cough, while radiological pneumonia shows on X-rays.
“Radiological pneumonia is so rare that 1,000 children must be vaccinated to
prevent 3.6 cases of pneumonia,” said Puliyel. His letter is a comment on a
paper published earlier in the same journal by experts from who
and the un’s Children’s Fund (unicef).
The authors of the original paper in their rejoinder to Puliyel’s letter
agree that the vaccine is not effective against clinical pneumonia but
continue to project it as a way of reducing deaths due to pneumonia in
children. who’s position paper on pneumonia,
however, states that the vaccine covers 80 per cent of the strains occurring
in the us, but covers less than 50 per cent of the
strains in India and other developing nations.
Asthma instead
pcv
7 can cause asthma. Data from clinical trials in Colombia, Chile, Gambia,
Brazil, South Africa, Bangladesh, Indonesia and the Philippines shows that for
every 3.6 cases of pneumonia which are prevented, 1.3 children will get
asthma. Asthma is a lifelong condition unlike pneumonia.
“The data on pneumonia in India is inadequate. We need more information
before introducing this vaccine (in universal immunization programmes),”
says Ajay Gambhir, member of the National Technical Advisory Group on
Immunization set up by the health and family welfare ministry.
The paper published in the who bulletin
extrapolates the Indian scenario from a study in Bangladesh on the
effectiveness of another vaccine—Hib conjugate vaccine, which is for
meningitis but also combats pneumonia—in preventing radiological pneumonia.
Cost factor
The
cost of the vaccine is also high. A child needs three doses of pcv
7, with each dose costing nearly Rs 4,000. So to prevent about four cases of
pneumonia, the government will be spending Rs 1.2 crore. The who-recommended
treatment of pneumonia using antibiotic Septran costs Rs 10. The Global
Alliance for Vaccines and Immunization was offering a reduced price of Rs 50
per child as an introductory offer on the pneumonia vaccine, said Puliyel.
Even at this price, the cost of saving four lives would be Rs 50,000, he
added.
who considers pneumonia vaccines to be a priority
for inclusion in governments’ immunization programmes. Pneumonia kills 1.6
million people every year, of which over half are children less than five
years old. In its position paper on pcv, who
states, “Despite the absence of some serotypes that are important causes of
pneumococcal disease in developing countries, pcv 7
can prevent substantial mortality and morbidity in these countries.”
Gambhir, however, said, India should wait till a pcv
which covers Indian strains is developed. “I wouldn’t introduce pcv
7. The problem is that even if we vaccinate children, new strains will appear
and so we need continuous monitoring. Currently, India does not have a
monitoring mechanism in place,” he added.
An official from the health and family welfare ministry also said the
government was not considering adding pcv 7 to the
universal immunization programme at present. “We are struggling with the
hepatitis B vaccine introduction, so we are not looking at pcv
right now,” he said.
Manufacturer Wyeth Pharmaceuticals has already introduced the vaccine in the
private market. Vaccines for hepatitis and meningitis (Hib) also entered the
private market before becoming part of the government’s immunization
programme. “Perhaps in another four years pcv
will be in the programme if there is at least 70 per cent coverage of strains
in India,” said R K Agarwal, president, Indian Association of Paediatricians.
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