Thanks for providing an opportunity to discuss in detail the
issues related to conflict of interests.
No, you have not got everything wrong,
but partially yes! I would not outrightly accuse you of
possessing a prejudiced mindset considering the recent state
of affairs where industry goes all out to pressurize
academic bodies to get favorable recommendations. But
probably you have not thoroughly gone through the
recommendations which have many subtle and many not so
subtle indications pointing toward impending change in its
thinking and process of issuing recommendations. Conflict of
interests issue is indeed a very serious matter, especially
for the realm of vaccines and vaccination where
controversies are brewed every now and then. This committee
has two very specific topmost objectives, first, to settle
the issue of conflict of interests for committee’s members
and second, to initiate a new process of issuing
evidence-based recommendations.. We have devised a new ‘code
of conduct’ for every member, advisor, and office-bearer of
the committee which will be mandatory for everyone to sign
and follow before joining this committee. Each member and
even invitee will have to declare their conflicts of
interests before participating in any meeting of the
committee. A three-member committee appointed by the
executive board of the academy will decide whether a member
has got ‘significant’ conflicts and whether he/she should be
allowed to remain a part of the committee or of the decision
making body. All these forms will be brought in to public
domain very soon. So, we are not only for disclosing all the
conflicts but also for resolving them by taking appropriate
measures to ensure they do not affect the ultimate process
of decision making. The ‘evidence based process’ and
‘conflicts of interest’ issues are interlinked and the
former cannot be practiced without addressing the latter. As
stated in the consensus recommendations [1], the main focus
is on scientific evidence and transparency so that the
system can be reproducible and can also be reviewed by other
experts. The author probably has not visited IAPCOI website
(www.iapcoi.com) which is recently also acknowledged
by WHO as reliable source of obtaining information about
vaccines and included in its list of websites that adhere to
the credibility and content criteria of good information
practices [2]. Hence, maintaining transparency is another
agenda of current committee. Detailed proceedings of each
meeting including agenda, detailed minutes, participants,
presentations, etc are regularly posted to our website.
If we go by the author’s ‘yardstick’ of
measuring competing interests, no practicing academician
would be eligible for the membership of any decision making
body. We need to be specific and should have some specific
guidelines, codes, etc for dealing with specific issues.
Regarding the issue of industry’s
participation in the meeting, the author should know that
the vaccine industry forms an important ingredient of
practice of vaccine science today. They have become integral
part of the system that affects every aspect related to
vaccines, be it developing an antigen, planning and
conducting a vaccine clinical trial, approval by a national
regulatory authority, collaboration with experts, agencies,
governments, philanthropic societies, NGOs, academic bodies,
etc. The onus is on us how to best utilize this
‘unavoidable’ association without being influenced. The
industry people are also invited regularly by CDC/WHO in
their meetings whenever they need some brand-specific data
on certain specific aspects. We also invited them with
certain objectives. First, we wanted to gather information
on post-marketing surveillance (PMS) on newer vaccines. Once
a new vaccine is licensed in the country by the NRA (i.e.
DCGI in India), the vaccine companies usually start a
marketing blitzkrieg targeting different quarters but
usually fail to apprise them of the post-marketing
performance of these vaccines. Even NRA forgets to take
notice about what is happening at the community level, i.e.
the AEFI, the efficacy and effectiveness, the impact on
disease epidemiology, etc. The committee invited the
industry people and requested them to share their data on
PMS of some newer vaccines. They were also requested to
initiate PMS of the vaccines where it did not exist.
Secondly, we sought their help in developing a passive VPD
surveillance system in the country so that some useful data
can be gathered by the year end. IDSurv and the surveillance
subcommittee of IAP are the steps in this direction. Another
objective was to request them to cut the margins offered to
practitioners (i.e. to reduce the MRP) on the sales of newer
vaccines so that these vaccines could be made more
affordable for the parents. Further, this committee is
committed to support indigenous vaccine manufacturers in
order to address the gap of demand and supply of some
products, and also to make them affordable.
This is just a beginning. The committee
needs to be complimented for undertaking some new bold
initiatives rather than castigating based on false
presumptions and prejudices.
