Marie Antoinette's infamous declaration has been quoted at two places in December is- sue of Indian Pediatrics, which must be a unique record for the Journal(1,2). In both cases the context is inappropriate, as Dr Jacob John explains in the same issue(3).

No one can disagree with Dr. Mathew(1) that infectious and communicable disease need to be prevented by measures such as pro- vision of safe water and elimination of insects and animals responsible for their transmission. The realities of the situation in our country are, however, very depressing and preventable diseases are going to stay with us for a long time. Safe water for all of our one billion people will remain a distant dream. There is a tremendous shortage of water all over the country and in some regions (parts of Gujarat, Rajasthan) there is virtual water famine. In . most urban areas during summer water supply is restricted to 1-2 hours in a day. The conditions in underprivileged areas in big cities are quite appalling. It is common to see long lines before a solitary water tap, and arguments and fights are usual. The 'clamour' for water has been going on for years but a solution is not in sight. There are environmental activists willing to thwart governmental efforts and interstate differences over water sharing that linger on for years. Dr. Mathew talks of rabies and stray dogs. How does one achieve elimination of stray dogs (or stray cattle from the roads, which are a traffic hazard)? Champions of animal rights will not tolerate 'cruelty' to dogs (they are not concerned with cruelty to human beings). I will give one example. Every effort to get the campus of the All India Institute of Medical Sciences rid of stray dogs and monkeys has failed. Will the country ever be able to control mosquitoes and flies and other vectors? An astronomical increase in population, migration to urban areas and mass illiteracy and ignorance pose almost insurmountable hurdles in the control of preventable diseases. Given such a scenario we have little choice but to use effective and safe vaccines wherever possible. No doubt the new vaccines are expensive but the cost must be balanced against the benefit. Cost is not a constraint for a fair proportion of our population. If many others can afford to pay for a large number of unnecessary medications that are prescribed only too often, they can also pay for vaccines. We cannot be unaware of the cost of vitamin preparations and cough syrups and misused antibiotics. One would hope that eventually vaccines will be produced within the country (one against hepatitis B is already being manufactured) and the costs will come down. The pharmaceutical industry, like all other industries, is free to advertise but the prescription for administration of a particular vaccine is still given by a doctor. Clear guidelines are available for immunizations and the physician is free to use his judgement.

The IAP and other professional bodies should indeed emphasize the need for safe water, vector control and many other well known measures for the prevention of infectious and other diseases. Many of these involve wider issues that must be addressed by the Government.
 

R.N. Srivastava,
Past President lAP,
487, Mandakini Enclave
New Delhi /10 019,
India.
Email: [email protected]