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Vaccine Debate- Posted by K Ramachandran in the Context of a Debate With Dr B Ekbal

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Vaccine Debate
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  GsX¶nepw hmIvkns\Xncmbn Bsc¶nepw kwibßfp∂bn®m¬, AØcw kwibßsf AtX]Sn X≈n° f bpI am{X a√ AsXms° Nh¿' BsW∂pw aX Xo {h hm Zn I fpsS a\ n ep Zn® Bi b' am sW∂pw hnh c t°Sm'sW∂pw Hs° DS≥ Btcm ]n °m≥ \ΩpsS tUmIvS¿am cn¬ ]ecpw Bthiw Im´p ∂Xv hnNn {X ambHcp {]h WX Xs∂ bmWv. tUm. CIv_m¬, tUm. Ac hnµ≥ XpS ßnb tUmIv¿am¿ t]mepw CXn¬ \n∂pwhyXykvX c√ F∂p ImWp ∂Xv AXy [nIw sR´¬ Df hm °p ∂p.kz¥w A\p `h ß fn¬ \nt∂m ]T \ ß fn¬ \nt∂m BWv Bfp Iƒ GsX ¶nepw Hcp hmIvkn s\ Xn cmb\ne ]mSv kzoI cn °p ∂ Xv. AXns\ A∏msS Aimk{Xobw F∂pw auen I hmZw F∂pw Akw _ ‘ sa∂pwHs° Ffp ∏ Øn¬ ap{Z IpØn X≈n ° f bp ∂Xv F¥v imkv{Xo b X bpsS ]n≥_ e Øn emWv? sshZy im kv{X Øns‚ kwc £ I cm bn cn t°≠ tUmIvS¿am¿°v imkv{X t_m[w D≠m bn cn°pw F∂ kmam \y [m c WsbCXv IS ]p g °p ∂p. F{Xtbm hmIvkn \p Iƒ A] I S I c amb ]m¿iz ^ e ߃ D≈ hbpw A] cn lm cy ambsshI ey ߃°pw P\n XI XI cm dp Iƒ°pw CS \¬Ip ∂ h bp am sW∂v ]T \ ߃ h∂Xv sshZy im kv{X K th j I cn¬ \n∂v Xs∂ bm Wv. ]e cmPy ß fnepw ]e hmIvkn \p Ifpw \ntcm [n ®Xpw AXp sIm ≠p X s∂.B[p \n I im kv{X Øns‚ coXn Iƒ Xs∂ bmWv Cu Kth j Icpw ]n¥p S cp ∂ Xv. Nne hmIvkn \p Iƒ AXy¥wA] I S I c am sW∂v GsX ¶nepw Hcp shfn ® ∏mSv shfn ]m Sn eqsS Is≠ Ønb Imcy sam ∂p a√ kmd ∑mtc!Cu Kth j I¿ {]tbm P \ s∏ Sp Øp∂ imkv{X Øns‚ am¿ K a√ icn F∂pw GsX ¶nepw Huj [ hm Ivkn≥Iº \n Iƒ Ah cpsS em`Xm¬]cyw am{Xw ]cn K Wn ®p sIm≠v ]S ®p Iq ´p∂ imkv{Xm `m k amWv icn F∂pwhmZn °m≥ t{]cn ∏n °p∂ LSIw GXm bmepw ip≤ amb imkv{X kvt\ l am hm≥ hgn bn √; P\ ß fpsS Btcm Ky Øn ep≈ bYm¿∞ DXvIWvT Bhm\pw hgn bn √. i‡ amb tIm¿] td‰v apX em fnØw F√m \n¿Wm b I Xo cp am \ ß fp sa SpØv P\ ß fpsS ta¬ ASn t®¬]n °p∂ Hcp BtKm f km l N cy Øn¬ Huj [ ° º \n I fpsS em`Øn \p th≠n Ah¿ \S Øp∂ {]N c W ß sf bmtWm AtXm At\ Im bncw Bfp Iƒ°v ac WhpwsshI ey ßfpw Zpcn X hp amWv ]e hmIvkn \p Iƒ sIm≠p ap ≠m bn ´p ≈ sX∂ Kth j W ^ e ß sf bmtWmimkv{Xo b ambn ]cn K Wn t° ≠Xv? Hcp A‘ hn izmkw t]mse imkv{XsØ \mw IÆ S®v hniz kn °tWm?F¶n¬ GXp Xcw imkv{XsØ? imkv{Xw F∂Xv aqey \n c t] £ amb H∂mtWm? F¥pw tNmZyw sNøp I bpw ho ≠pw ho≠pw hne bn cp Øp Ibpw sX‰p Iƒ Xncp Øp Ibpw At\z j W _p≤n I¿° i a mbn \ne \n¿Øp Ibpw sNøp∂ hna¿i \m fl I kz `m h amWv imkv{X Øn \p ≈Xv F∂mWv Rm≥ a\n em °p ∂ Xv. Cu coXn bn ep≈ At\z jWw XpS cp I bmtWm th≠Xv; vA√, \ne hn ep≈ {]_ e im Ty ߃s° Xn cmbn Fs¥ ¶nepwA`n {]mbw ]d bp ∂ hsc apgp h≥ AS ®m t£ ]n °p Ibpw iIm cn °p Ibpw NoØ hnfn °p I bp amtWm? h¿j ß fpsS Kth j W ^ e ߃ A\m bm tk\ \ncm I cn °p∂ hnh c t°Sv' F∂v tUmIvS¿ hnh cn °p∂ AtXkwK Xn X s∂ bt√ hmIvkns‚ Zpc ¥ ^ e ß sf °p dn ®p≈ Kth j W ^ e ßsf hmbn ®p t\m °m≥ t]mepwan\s°SmsX A∏msS XnckvIcn°m≥ ]e tUmIvS¿amcpw ImWn°p∂ AanXmthiØn\v ]n∂nepw {]h¿Øn°p ∂Xv?t_m[ys∏´ Nne Imcy߃ Xpd∂p]d™Xn\v tUm. JZoP apwXmkns\Xnsc C{Xb[nIw AklnjvWpXImWn°p∂sX¥n\v? Ahcpw AhscØnt®¿∂ Iq´mbva'bpw CsX√mw {]kn≤oIcn°p∂ ]{Xßfpw F√mwtami am sW∂ Hcp hn[n {] kvXmhw \S Øn s°m≠v Ip]n X \mb Hcp c£n Xm hn s‚ kzc Øn¬ imkn °p ∂XvF¥p imkv{Xt_m[Øns‚ ASnÿm\ØnemWv? [mcmfw KthjW{]_‘߃ (acp∂pIº\nItfm Huj[ hym ]m cn Itfm kvt]m¨k¿ sNbvX h b√; k¿h I em im e Ifpw kzX{¥ Kth j Icpw ]T\w \SØn {]kn ≤oIcn®h) hmIvkn\pIfpsS {]XnIqe^e߃s°Xncmb imkv{Xob sXfnhpIfmbn C∂v e`yamWv. IqSmsXdqs_ √, F®v. ]n. hn. XpS ßnb hmIvkn \p Iƒ bmsXm cp NnIn ’m [ m ¿an I X bp an √msX {]tbm Kn ® Xns‚ ^e ambn Bbn c ° W °n\v s]¨Ip ´n Iƒ KpP dm Ønepw B{‘m {] tZ inepw acn ®p t]m b Xn\pw/\nc h[n t]¿°vKpcp X c amb sshI ey ߃ _m[n ® Xn\pw \ΩpsS I¨ap ∂n ep ≠mb kao ] Ime A\p ` h ߃ km£n bm Wv. F®v. ]n. hn. bpsS Zpc ¥ sØ Øp S¿∂v Db¿∂p h∂ \nin X amb hna¿i \ ß fpsS shfn ® Øn¬ F®v. ]n. hn.hmIvkn≥ ]co £ Ww \ S Øn b Xnse A]m I X I sf °p dn®v ]Tn °m≥ C¥y bnse tI{µ BtcmKy IpSpw _ t£ a h Ip∏v \ntbm Kn® IΩn‰n 2013 HmKÃv 30\v ]m¿e sa‚n\v ka¿∏n® dnt∏m¿´v A‘ ambn hmIvkn≥kvXpXn ]mSp∂ am\yhy‡nIƒ Zbhmbn H∂v hmbn®pt\m°Ww F∂v At]£n°p∂p. hkvXpXIƒ sh®mWvX¿° ߃ Db tc ≠ Xv; hnImcw sh®p sIm ≠√. Cu dnt∏m¿´v C¥y bnse Hj [ K th j W Iu¨kn en s\bpw{UKv I¨t{SmfdpsS Hm^okns\bpw F√mw hmIvkns‚ ImcyØn¬ kzImcy°º\nItfmSv HØpIfn®Xn\pwC¥y bnse F{Xtbm Poh≥ hmIvkn≥ ]co £ W Øn eqsS \jvS s∏ Sp Øm≥ Ah kcw krjvSn ® Xn\pw {]Xn °q ´n em °p ∂p ≠v. thsdmcp P\m [n ] Xy cm Py Øn em sW ¶n¬ CØcw ÿm] \ ß fpsS ta[m hn Iƒ CXn \Iw  Xs∂ ISpØ in£ t\cntS≠nht∂s\! \clXybpsS DØchmZnØØØn¬ \n∂v Hgn™pamdm≥ Ah¿°vkm[y a √msX ht∂s\! ChnsS F¥p am hmw. AXn s\ sbms° imkv{X Øns‚ t]cn¬ t]mepw \ym bo I cn °m≥ kma¿∞y ap≈ hnZ Kv≤ cpw kvXp Xn ]m T I cp sa √m ap ≠v. `c W Iq S Øn\v P\ X bpsS ta¬ hmIvkn s‚ bpw a‰pw t]cv ] d™v F¥v IS ∂m {I a Whpw \S Øm \p≈ HØmi sNbvXp sIm Sp °m≥ Ch¿ ]›m Ø e hm bvØm cn Iƒ apg °n s°m ≠ncn °pw.C¥y bn¬ km¿h {Xn I Ip Øn hbv]v ]cn ]m Sn bn¬ hmIvkn \p Iƒ Dƒs∏ Sp Øp∂ {]{In b bnse ss\Xn I X sb °p dn®v aX Xo {h hm Zntbm ip≤ N h sd gp Xp ∂ Btfm A√mØ Hcmƒ [mcmfw ]T \ K th j W ^ e ߃]cm a¿in ®p sIm s≠ gp Xnb {it≤ b amb Hcp teJ \ Øn¬ \n∂p≈ GXm\pw D≤ c Wn Iƒ hmb \ °m cpsSAdn hn te °mbn ]I¿Øn s°m≠v Cu Ipdn∏v Ah km \n ∏n °mw. tImgn t°mSv saUn °¬ tImtf Pnse Iayq Wn‰n saUn kn≥ hn`m K Øn¬ Akn. s{]m^ kdpw {]apJ sshZy im kv{X K th j I \p amb tUm. Sn. Pb Ir jvW≥ C¥y≥ tPW¬ Hm^v saUn °¬ FXnIvkn¬ (thmfyw 10, 2013¬) Fgp Xnb National VaccinePolicy:Ethical Equity Issues  F∂ teJ \ Øn¬ \n∂mWv Ch FSp Øp tN¿°p ∂Xv (tUm. Pb Ir jvW\v \µn)]cn`m j bn eqsS A¿∞w H´pw tNm¿∂p t]m Im \n S h c cpXv F∂v IcpXn Cwão jn¬ Xs∂ tN¿°p∂p: The criteria for selection of vaccines for the introduction of new vaccines in the UIP touch upon diseaseepidemiologyonly to the extent of mentioning ìDisease burden (incidence/ prevalence, absolute number of morbidity / mortality,epidemic / pandemic potential)î and ìconsideration for pathogen, host and environmentalinteractions and long-termimpact of vaccination on disease epidemiology have simplygone missingî. Epidemiologicaldiscussions on guiding policy should also consider the burden of a particular disease compared to otherhealth problems, as well as the extent to which the disease can be controlled by vaccination and thepossibility of the development of more serious infection due to strain replacement, as happened withHaemophilus influenzae type b (HiB) infection in the West, or age-shifting due to subimmunisation,as inthe case of rubella One of the main stumbling blocks for an evidence-based vaccine policy in India is the lack of reliableepidemiological data. There are insufficient data on the actual prevalence and incidence of disease,pathogen strain/serotype variations, and immunity with and without vaccination among populations of different geographical regions/age groups The current level of disease surveillance inIndia is insufficient to support unequivocal scientificdecisions based on established principles of public health . These limitations severely affect the task of theNTAGI, on whichthe Union Government currently relies for all its vaccination policy decisions The introduction of more expensive vaccines sold by private manufactures in the public health systemrequires a transparent evaluation of the need for the vaccine and the health of the children in thecountry, and should not focus solely on the viability of the vaccine industry . The mere availability of a safe and efficacious /affordable vaccine cannot be a good enough justificationfor its universal use. Vaccines are not consumer goods and should not be advised unless the need forthem is proven on the basis of scientific principles of public health The aim of such a policy seems to be to not have a policy and to utilise vaccines indiscriminately, withepidemiology taking a back seat. The policy is increasingly determined by the supply ìpushî by thepharmaceutical companies than the ìpullî demand of proven public health needs The introduction of newer vaccines into the immunisation programmes in India has been the subject of heated debate in recent years. While a number of concerns have been identified, the one that receivesprecedence over the others is that the commercial interest of the vaccine manufacturing lobby oftenoverrides public health interest'' hmIvkn≥ {]iv\w Hcp auen I hm Z am ImsX AXn s\ °p dn®v imkv{Xo bhpw bp‡n k l hp amb Hcp Xpd∂kwhmZw kaq l Øn¬ \S t° ≠Xv ASn b ¥n c {]m [m \y ap≈ Hcp kwK Xn bm Wv. AXn\v t{]c I amhpw CuIpdn∏v F∂v {]Xym in °p ∂p.
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