Dr. Jacob John writes that with regard to the Indian Academy of Pediatrics Immunization Programme, the Academy welcomes voices of dissention and that it help the Academy to reexamine its policies(1). I would therefore, like to call into question the 'ethical and scientific ground' of the official policy to 'immunize with Hepatitis B all infants whose parents can afford it'.

Hepatitis B is particularly a problem among the poor and disadvantaged. It is the poor who go to clinics which do not use disposable needles. It is they who are more likely to be given blood transfusions with blood not screened for Hepatitis B. It is they who form the bulk of the high carrier rate referred to by Dr. Jacob John. A policy to vaccinate the well-to-do who are less likely to be infected and less likely to spread the infection does not address the problem. It is reminiscent of a person seen looking under a street lamp for a coin that he knew he had dropped elsewhere-just because there was more light under the lamp. Instead we should, like the WHO try and mobilize our efforts for universal immunization which would help the vaccine . prices to come down to Rs. 30/-.

With regard to H. influenzae b vaccination, the Academy has left it to the pediatricians to decide. To help this decision making the Academy states that the vaccine is safe and incidence of the disease, now re- ported as low, may be an underestimation due to poor microbiological isolation. On what basis would the pediatricians decide to use the vaccine? Would they again follow the policy of looking at the paying capacity of the patient? It is probably the first time that an immunization has been advised without defining the magnitude of the problem on the specious grounds that a vaccine is available and is reported safe.

Is it a coincidence that in Delhi and its surroundings there is an explosive upsurge in the incidence of paralytic polio while pediatricians are frittering away their energies on finding people who can afford Hepatitis Band Hib vaccinations. It probably is a coincidence but at present our dream of universal protection with the EPI by the year 2000 seems shattered. The Academy needs to state its priorities clearly.

 

Jacob M. Puliyel,
Head,
Departments of Pediatrics and Neonatology,
St. Stephen's Hospital,
Tis Hazari,
Delhi 110 054, India.