Pneumonia keeps killing children,vaccine caught in debate

Pakistan has become the first South Asian country to introduce a new vaccine for children against pneumonia

Written by Pritha Chatterjee | New Delhi | Published:October 18, 2012 3:02 am

Pakistan has become the first South Asian country to introduce a new vaccine for children against pneumonia. India,in contrast,has only partially introduced one of two available vaccines under a national programme,though it is available in the market. This is despite WHO having attributed India with the highest child mortality rate from pneumonia. The government is going slow in the wake of litigation over the vaccines.

The Global Alliance for Vaccines and Immunisation,with WHO and UNICEF support,is supplying both available variants to India,Pakistan,and 16 other developing countries for a minimum of five years. The variant newly introduced,the pneumococcal vaccine,protects against at least 13 strains. The other variant,pentavalent haemophilus influenza type B (Hib) vaccine,which India has rolled out in Kerala and Tamil Nadu so far,combines the existing DPT vaccine — for diphtheria,whooping cough and tetanus — with those for hepatitis B and the Hib bacteria,which causes meningitis and pneumonia.

Health ministry officials and experts of the Indian Council of Medical Research have stressed a rollout. Said Dr N K Ganguly,chairperson of ICMR’s task force on pneumonia and a former ICMR director general,“Most of the developed world and now even the developing world have introduced both vaccines. We must understand that most of the pneumonia deaths occur among the poorest of the poor who cannot afford the vaccine at market prices. If it is available in the market,why should it not be made available to these people through a national programme?”

The National Technical Advisory Group on Immunisation had first given the green signal to the vaccines,but then advised a cautionary approach after health activists filed a PIL in the Delhi High Court in 2009. In a 2010 report,NTAGI said,“As the vaccine has not been introduced there is not enough data on vaccine safety; therefore the vaccine should be initially used in the states with better adverse effects following immunisation (AEFI) management and surveillance system to monitor the vaccine safety”. It added,“data may be reviewed after one year of introduction (in Tamil Nadu and Kerala) before expanding the vaccine to other states.”

The PIL says the government’s hurry to introduce the vaccine was based on international market and WHO pressure,without proper research on safety and efficacy. Said Dr Jacob Puliyel,one of the petitioners,himself an NTAGI member,and head of the paediatrics department at Delhi’s St Stephen Hospital,“In the last one year,not only has there been no monitoring of AEFI,but seven reported deaths are not being recorded. The government is also dismissing reports of deaths in Sri Lanka and Bhutan within 48 hours of the vaccine being administered.”

Dr Ajay Khera,deputy commissioner (child heath & immunisation) in the health ministry,denied these claims. “The deaths are not due to the vaccine… It is a safe vaccine. Besides the two states where it has been introduced,we are in the process of finalising its launch in six other states.”

According to WHO,India accounts for half the world’s global pneumonia deaths,with 3,70,000 children dying due to the disease every year. A pneumonia progress report,released jointly by the International Access Vaccine Centre and John Hopkins Bloomberg School of Public Health in 2011,said India recorded the highest pneumonia deaths among 15 developing countries. Pakistan was in fifth position with about 80,000 child deaths recorded annually.

Critics maintain India should not “blindly” follow Pakistan when no comprehensive data is available on the prevalent serological strains of pneumonia in the country. “There has not been any proper data collection on the numbers affected. These inflated figures are based on ridiculous extrapolation. Without proper data on existing strains,how do we know if any of the existing vaccines will actually be helpful in protecting our children?” said Dr Puliyel. Dr Ganguly of the ministry countered that studies have shown 80 per cent of the strains in India are covered by the pneumococcal vaccine. “There is also evidence of hard immunity. Even if 30 per cent of the population is vaccinated,the immunity percolates to many others.”

Dr N K Arora,director of The INCLEN Trust International,which has been promoting the vaccine,said an 11-centre ICMR study is under way while previous studies “ give a sense” of prevalent strains. “The Invasive Bacterial Infection Surveillance Group study published in The Lancet in 1997 had given us nationwide data on pneumococcal serotypes. It is true than only 50 per cent of the pneumonia strains respond to antibiotics,but considering the morbidity and mortality rates of penumonia,I think there is sufficient evidence of the efficacy of the vaccines.”

Doctors say an evidence-based approach should ideally be followed before introducing the pneumococcal vaccine,a practice that was not followed for the Hib vaccine. According to Dr Arora,“We have more data than Pakistan,so there is no question of blindly following them. But we should introduce a pilot project in some districts to evaluate the latest pneumonia vaccines in a focused manner to evaluate the morbidity and mortality rates,particularly now since many Indian companies have started manufacturing the product. Based on the evidence,a decision on the national programme can be taken.”

Variants & variatons

3,70,000

Child deaths in India annually due to pneumonia,according to WHO. India accounts for half the world’s global pneumonia deaths

Vaccine status Partially introduced older variant,going slow because of PIL against it.

80,000

Child deaths in Pakistan annually due to pneumonia,according to International Access Vaccine Centre and John Hopkins Bloomberg School of Public Health. Fifth among 15 developing countries

Vaccine status Rolled out newer variant,which protects against at least 13 strains

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