I strongly support the well-reasoned and authoritative views of Dr. Jacob John, the Chairman of the lAP Immunization Committee(1) in response to some untenable and misinformed arguments put forward by Dr. J.M. Puliyel about the use of newer vaccines(2). There can be no question of lAP recommending to "use only vaccines mandated by the State". There is nothing sacrosanct about the Government's Immunization policy, which is constrained by the cost of additional vaccines. The fact, however, is that the Government is not short of resources. They just ha\"e different priorities. Health and education are considered the least important.

It is the lAP's duty to continuously guide the Government and put forward proposals and plans that are in the best interest of the health of children of our country. It is up to the Government to allocate funds. The lAP must keep on stressing the need of universal infant immunization with hepatitis B vaccine. Sooner or later the Government will find the necessary resources.

We must also realize that at least 10% of our country's population are highly educated and informed, and have the resources to afford and demand the best possible care for their children. Recommendations for this group for immunizations, and indeed for several other aspects of infant and child care, may have to be different from those applicable to the less fortunate in the country. The lAP may rightly choose not to give general directives for administration of vaccines the need and indications for which have not been examined in India (and there are regional differences in a vast country, which would necessitate appropriate studies in various parts). However, the Academy must still critically evaluate the evidence available from other countries and suggest guidelines {or their administration in situations where the cost is not a limiting factor. Provided a given vaccine is effective and safe (e.g., Hib vaccine, vaccines against varicella and hepatitis A) its use cannot be objected to.

I fail to see how the lAP immunization schedule has "added to the confusion". As a matter of fact the lAP has done the opposite! What Dr. Puliyel calls "ad hoc individual improvisations of the immunization schedule" is the right of the individual pediatrician to make a considered recommendation and decide what is best in a given situation.
 

R.N. Srivastava,
Past President lAP,
487, Mandakini Enclave,
Alaknanda,
New Delhi 110 019, India.

 

REFERENCES

1. John TJ. Comments. Indian Pediatr 1998; 35: 792-795.

2. puliyel JM. Newer vaccines-To vaccinate or not to vaccinate is the question: Ethical and medicolegal issues. Indian Pediatr 1998; 35: 791-792.