Most malaria vaccines to date have been sub-unit
vaccines. Veteran malaria researcher, Michael Hoffman decided to use the
whole sporozoite and not just subunit components. But developing the
PfSPZ vaccine was extraordinarily complex. Mosquitoes were raised in
sterile conditions on an industrial scale and fed Plasmodium
infected blood and then irradiated. Billions of parasites were then
harvested from the mosquitoes’ salivary glands, purified and
cryopreserved. An initial trial in 2011 using intradermal vaccination
only protected 2 of the 80 who were exposed to Plasmodium.
However in the recent trial published in Science, six patients
who got 5 doses of the vaccine were 100% protected when exposed to
Plasmodium while 5 of the 6 who were unvaccinated developed malaria.
However there are many logistic difficulties with the vaccine. First, it
needs 5 intravenous doses and second it needs to be preserved in liquid
nitrogen. But given the impressive results of the phase I trial,
everyone knows that difficulties mastered will be opportunities won (Science,
Online August 8 2013).
The Ban on Pioglitazone
The brouhaha over the ban of the oral hypoglycemic
Pioglitazone and its subsequent reversal has raised many questions. It
is apparent that the Union Health Ministry imposed a ban on Pioglitazone
with unseemly haste and secrecy. The drug was approved for use in the
early 2000’s and 35 lakh patients are estimated to be on the drug. Based
on a letter sent by diabetologist V Mohan from Chennai who reported the
development of bladder cancer in 8 patients on the drug, the drug was
banned on June 18. What is perplexing is that the opinion of the Drug
Technical Advisory Board (DTAB) was not sought. Diabetologists from
round the country raised a hue and cry since this is a relatively
cheaper option for diabetic patients. It costs Rs 5/- per tablet as
against the other gliptin marketed at Rs 42/- per tablet. The subsequent
meeting by the DTAB on July 11 led to revoking of the ban. The only
valid Indian data is of 958 patients with a 2 year follow up, which has
not reported any bladder carcinoma. It is banned in France but is
available in the US with a box warning.The need of the hour is to
generate and evaluate authentic Indian data. The incident has also
highlighted the importance of pharmacovigilance and the need to develop
a simple country wide system of adverse event reporting (The Hindu 20
July, The Economic Times 18 July 2013).
Mid-day Meal Tragedy
India boasts of the world’s largest school meal
program which feeds 12 crore children in 12 lakh schools.But in July
2013, in a terrible tragedy, 23 children died in Bihar’s Saran District,
after their mid day meal which was found laced with poison. It was
probably the cooking oil contaminated with an organophosphorus ‘monocrotophos’.
There are two major issues about this horrific incident. This kind of
gargantuan welfare scheme needs a strong commitment, operational skills
and food safety considerations. The HRD ministry has announced a new
committee which will monitor effectiveness of the food supply chain and
kitchen hygiene standards. To its credit, Bihar has improved
tremendously in all aspects of the mid day meal scheme implementation
and coverage has gone up from 43% last year to 67% this year. The
incident has also brought into the limelight another sore area- the
continued use of organophosphorus insecticides in India. These have been
banned or restricted in 23 countries and is responsible for 200,000
deaths annually. In 2004 the government ruled out banning their
production on grounds that they were cheaper and more effective than
available alternatives. The issue is highly incendiary and needs deeper
thought and analysis (The Hindu 19 July, 20 July, 21 July, 2 August,
2013).
Supreme Court Quashes NEET
The Supreme Court of India quashed the National
Eligibility cum Entrance Test (NEET) for admissions into all medical and
dental colleges on 18 July 2013. The apex court ruled that the Medical
Council of India cannot conduct a unified examination.The court’s
decision came after 115 petitions challenging the MCI notification on
NEET for admission to MBBS and post-graduate medical courses conducted
in colleges across the country. A three-judge bench by a 2:1 verdict
held that MCI is not empowered to prescribe all India medical entrance
tests and was in violation of the Constitution. Justice A R Dave
dissented as he felt that NEET is legal, practical and is the need of
the society. The test would have allowed students from all over the
country study in any medical college without writing multiple exams.
However it also has inherent drawbacks as clarified by one of the
petitioners against NEET, the Christian Medical College,Vellore. The CMC
claims because of the NEET, there would be allotment of candidates to
non-native states which would ultimately leave states poorer of their
own native doctors. Permanence and long-term commitment to native states
would suffer. The CMC suggests that the MCI and the Health Ministry need
to do more research into the problem before implementing a workable
solution (The Hindu 20 July, 5 August 2013).