The current vaccination scene is marred by controversies and conflicts.
In the absence of clear-cut policies, hard-core evidence, and lack of
transparency in dealing with international agencies and donors,
industry, academic bodies, and the media, the public health
establishments dealing with vaccination are under unprecedented pressure
from different quarters. Their policies are criticized by experts,
openly questioned by the media, and dragged to the court by an emerging
coterie of disbelievers often described as ‘anti-vaccine activists’. The
government also seems a bit confused and scared to take head on these
groups mainly fearing judicial intervention and their adverse decisions.
The current controversy on the safety of pentavalent vaccines (DTwP-HepB-Hib),
introduced recently in few more states is just one glaring example of
the mess created by different stakeholders of the move in the government
circles and their many adversaries outside the circle [1].
On the other hand, the private sector is also not
bereft of its own ills, accusations, and indictments. The ‘private
market’ though quite miniscule in comparison to huge public sector in
terms of vaccine needs and usage seems quite unregulated. There is no
‘playing rules’ for the industry regarding their operations in this
sector. There is no ethical guideline, no monitoring, and no ‘code of
conduct’ for their promotional activities. As a result, the vaccine
industry evolves their own set of rules and regulations, driven solely
by sales and profits. And in the process, they often prop-up a group of
‘experts’ from the pool of so called ‘key opinion leaders’ willing to
help them in pursuance of their final goal of boosting sales and
garnering profits. They use the baits of ‘paid speaking assignments’ and
‘foreign jaunts’ to these experts to further their cause. Often they try
to influence the guidelines of academic bodies by sponsoring their
meetings, CMEs, and scientific sessions to get a favorable
recommendation. All these issues are not under any veil and frequently
discussed and debated openly by academia and lay media, now and then
[2-5].
Recent Initiatives by IAP
The Academy has taken several unprecedented steps to
tackle all the above mentioned issues in recent times. Though the
government is still not actively pursuing our guidance in many such
issues and only approaches us at the time of crisis and adversity,
nevertheless we do not feel shy of making them aware of our stand on
some very critical issues dealing with public use of vaccines and
vaccination practices. We are regularly publishing separate
recommendations on public use of vaccines in form of position papers,
issuing appeals in favor of key government initiatives of public
benefits, and of course, taking on misinformation campaigns by the
anti-vaccine groups. Recently, we arranged a roundtable discussion on
the current controversy on the safety of pentavalent vaccines and
discussed thread bare all the issues involved with open mind. All the
stakeholders were invited and final decision was made public [6].
We are still continuing with our advice to government
establishments on various key immunization related public health
activities like polio eradication and national vaccination policies
through our representation to various meetings organized by Ministry of
Health like the IEAG, NTAGI, National AEFI Meeting, etc. We are also
supporting the government on surveillance of VPDs and AEFI through our
own initiatives and programs. Our flagship program, ‘IAP Mission Uday’
has helped tremendously in reorienting our members regarding the
critical need of data keeping and reporting to appropriate authorities.
IDSurv utility has tremendous potential in boosting real-time infectious
disease surveillance from the private sector.
Our aim should be to highlight the indigenous
problems and find indigenous solution to such problems. Our support and
encouragement to homebred vaccine industry should be viewed in this
perspective. We should not wait for the foreign agencies and experts to
point out to us what our children are ailing with? What are the diseases
to be targeted for elimination or control? Which vaccines should be
introduced in our national immunization program? There may be some
vested interests involved and lead to criticism later from different
quarters.
Regarding setting our own house in order, we have
taken some very tough exceptional measures that would go a long way to
salvage the image of IAP and its experts in the sphere of immunization.
For the first time, the selection process of constitution of the
immunization committee has been made a completely transparent and
democratic one. Very strict codes of conduct are drafted to take care of
conflict of interest issues. An independent expert committee has been
constituted to deal with conflicts of interest issues at different
levels. The Academy is committed to issue all its recommendations solely
on ‘evidence-based’ process and a separate working group has been
assigned this responsibility. However, this is a very tedious, time
consuming process and would take time to deliver results. The
functioning of the new immunization committee, the advisory committee of
vaccines and immunization practices (ACVIP) has been made totally
independent of vaccine industry support.
We believe in the equity as far as distribution of
vaccines in the country is concerned. Currently, the newer vaccines
licensed in the country are quite expensive and beyond the reach of poor
children who need them the most. Ideally, this aberration must be
corrected. If a particular vaccine cannot be delivered to the one who
needs it the most, that vaccine ideally should not be licensed in the
country at first place. The issue of making undue profit by the private
practitioners on prescription of newer vaccines has been criticized by
both, the experts and the media [2, 7]. We have urged the vaccine
manufacturers to reduce the difference on actual price and printed MRP
of all the vaccines marketed in India so that some expensive vaccines
are made somewhat more affordable to the public.
There are many other issues that need to be looked in
to and addressed right away by the government and the Academy. However,
we need to be pragmatic in our approach. The system improvement is a
long process, and at least we are committed to the reforms at IAP. I do
sincerely hope my successors would also tread on the same path that
would ultimately help in redeeming the stature of the Academy at all
fronts.
References
1. Puliyel J. AEFI and the pentavalent vaccine:
looking for a composite picture. Indian J Med Ethics. 2013;10:142-6.
2. Lodha R, Bhargava A. Financial incentives and the
prescription of newer vaccines by doctors in India. Indian J Med Ethics.
2010;7:28-30.
3. Vashishtha VM. The nexus and the ills afflicting
the vaccination practices. Indian J Med Res. 2008;127:502-3.
4. Mohapatra PR. Interaction between medical
practitioners and pharmaceutical industry. Indian J Med Res.
2008;127:93.
5. Nagarajan R. Conflict of interest on
recommendation of immunization schedule? Available from:
http://timesofindia.indiatimes.com/home/stoi/special-report/Conflict-of-interest-on-recommendation-of-immunization-schedule/articleshow/18002445.cms?
Accessed on September 24, 2013.
6. Pentavalent vaccine is safe, assures IAP.
Available from:
http://www.indianexpress.com/news/pentavalent-vaccine-is-safe-assures-iap/1168599/.
Accessed on September 24, 2013.
7. Nagarajan R. Non-mandatory vaccines for babies: A
hefty dose of profit. Available from: http://timesofindia.
indiatimes.com/home/stoi/special-report/Non-mandatory-vaccines-for-babies-A-hefty-dose-of-profit/articleshow/18002439.cms?
Accessed on September 24, 2013.