"Improved hygiene and sanitation
leads to the development of a generation which lacks naturally
acquired immunity". Thus, laments an advertisement for Hepatitis
A Vaccine made by a major pharmaceutical company. The same
company in its brochure distributed to the public to "enlighten"
them about Hepatitis B Vaccine claims, "This will be the only
way we can protect our children from this deadly disease and
gift them with the chance to survive a dangerous infection like
Hepatitis B." The words in bold letters as given in the brochure
can be explained only by either of the following: the company is
ignorant of the other means of protection, or wants to
deliberately underplay the importance of other methods. Whatever
be the reason, the public is being misled in some important
aspects of public health.
Such vigour in the promotion of vaccines as the sole means of
eliminating some diseases, betrays an understandable though
indefensible corporate thinking centred only on selling more of
their products. Understandable, because their sole purpose is to
sell more of their products and make maximum profits.
Indefensible, because these slanted and self-serving promotional
campaigns misguide the public by diminishing the importance of
other effective and important means of reducing the risks of
such diseases. Vaccines are important and necessary components
in the first against several diseases. Yet, they are not the
only solution for many such problems.
Developed countries, before incorporating several of the latest
vaccines as part of their National Immunization Schedules, have
already done the preliminary public health measures which are
much cheaper, effective and of wider impact. Providing safe
drinking water is one of the most effective measures in this
regard. The arrival of several new vaccines. for Typhoid,
Hepatitis A and other water-borne diseases and the loud and
frightening advertisements will make the public seek such costly
means. But who is there to clamour for safe drinking water which
will be much more cost effective in reducing such diseases?
The appalling and embarrassing situation regarding stray dogs is
the epitome of such apathy towards public health matters. Our
collective paralysis in addressing the problem of eliminating
stray dogs from our streets is in strange contrast to the
enthusiasm of advocating the use of rabies vaccine even in
questionable situations. Even in the United States which has a
profligate medical system, the zero risk option of minimal
threshold for rabies vaccination is not recommended. The safety
of observing a domestic dog for ten days after a bite is still
recommended by several professional bodies including the Red
Book of the American Academy of Pediatrics. Contrary to such
balanced professional advice, the public here is being bombarded
with maximalist positions and given the message that it is not
safe based on anecdotal evidence. This suggestion of a putative
rabies carrier stage for dogs, if true, should be reason enough
to eliminate all pet dogs. Such imaginative conceptual
contortions are contrived to frighten a gullible public and
misguide a cautious profession.
Recently, several people in Rajasthan contracted Hepatitis B
through a contaminated needle used by a quack. What did our
politicians demand as a solution for the problem? Make Hepatitis
B Vaccine universal with Government subsidy! Never mind the fact
that the cost for immunizing everyone with the available
Hepatitis B Vaccines will be close to the total amount our
government spends for healthcare! Not a word about catching the
culprit who spread the disease and nothing about implementing
the already existing laws which prohibit such criminal
practices. In our prevailing public health scenario, it will not
be surprising if someone contracts Hepatitis B infection through
a contaminated needle used to give Hepatitis B Vaccine. The
presumption is not preposterous, considering our sense of
priorities where first principles are ignored and greed for
money overtakes sense of purpose. Like Marie Antoinette who
proposed cake when the clamour was for bread, we will offer the
vaccine when people really need water. Otherwise would not the
"improved hygiene and sanitation lead to the development of a
generation which lacks naturally acquired immunity"? Can anyone
allow that to happen?
The pharmaceutical industry's emphasis on vaccination as the
sole means of eliminating certain diseases, is understandable
given their priorities. Often their business and our profession
may find areas of common interests. At other times our
priorities may not be in conformity with those interests. At
those times should not our collective responsibility to the
health of the children make us proclaim what the priorities
ought to be? Should not there be good water along with vaccines
for hepatitis A, Typhoid and Cholera? Would not it be prudent to
attempt to eliminate stray dogs while advocating Rabies Vaccine
for all potential rabies contact? Should not there be an
endeavour to eliminate contaminated needles as long as we are
giving Hepatitis B Vaccine also through such potentially
dangerous needles? Should not the Academy voice its opinion in
such matters so that a balanced approach can be taken in the use
of our limited resources in a more cost effective way?
Alexander Mathew,
Chief of Pediatrics,
St. Joseph's Hospital,
Manjummel, 683 501,
Kochi, Kerala, India.
