---------- Forwarded message ----------
From: Gopal Dabade <drdabade@gmail.com>
Date: Mon, Apr 13, 2009 at 10:08 AM
Subject: WHO to blame for dangerous child vaccine? by Dr Puliyel- UPDATE
To: aidanindia <aidanindia@yahoogroups.com>, Janaarogya Andolana <jaak@yahoogroups.com>, PHM <pha-exchange@phm.kabissa.org>
Our faith on the WHO as an impartial organisation is misplaced. - Jagannath.WHO to blame for dangerous child vaccine?
- Dr. Jacob M Puliyel
The World Health Organisation (WHO) is facing a crisis of transparency and accountability over the perverse decision it has made to ignore its own advice and promote a children's vaccine for pneumococcal disease, which does not significantly decrease the incidence of pneumonia but doubles the number of children with asthma, which can last a lifetime.
The WHO cannot claim ignorance about the dangers of the vaccine because they published the startling facts in their own bulletin. The statistics show that for every 2000 infants vaccinated, only seven cases of the uncommon pneumonia will be prevented. Furthermore, for every five cases of pneumonia avoided, two children will develop asthma as a direct consequence of the vaccine.
Pneumonia is a one-off illness that is usually cured with simple (inexpensive) antibiotics. Asthma on the other hand can be a lifelong disability, requiring treatment with inhaled drugs and steroids, and sometimes hospitalisations. The benefit of the vaccine in terms of pneumonia prevented, pales into insignificance in the face of this risk of asthma.
To add insult to injury, the pneumococcal-vaccine is one of the most expensive vaccines on the Indian market. The three doses required to immunise one child costs a whopping Rs. 12,000. In contrast the treatment of an episode of pneumonia using Septran (as recommended by the WHO protocol) costs Rs. 10 per child. The vaccine is therefore exorbitantly expensive and it does more harm than good.
All these facts were documented in studies and known to the experts. However, in a sinister move by the WHO, the results were cleverly shielded from the public for 5 years before being finally exposed in the October 2008 WHO Bulletin. It is crucial that the public are informed as to how such a vaccine came to be advocated by trusted advisors - the WHO, the expert body of the Government of India (the department of biotechnology (DBT)) and by individual doctors. This is crucial for accountability and for trust to be slowly rebuilt.
There is currently an unhealthy nexus between the WHO, the GOI agencies and the drug industry. These unhelpful relationships need to be exposed and corrective actions put in place to avoid such risks in the future. The influence of drug manufacturers on professional medical advice has been discussed widely in journals like the British Medical Journal, the New England Journal of Medicine and the Canadian Medical Journal. Such discussions in professional circles are sterile unless the lay press also takes it up and demands a change in standards of behaviour.
Perhaps what has led to this dangerous vaccine being given to our children is the way the WHO has recently lost its independence by getting into bed with pharmaceutical companies. The 19 January 2008 issue of the British Medical Journal details how the WHO Expert Group Meetings are now sponsored by pharmaceutical companies and manufacturers now have access and can influence the decisions made by Expert Committees. With such obvious conflicts of interests, how can the WHO possibly be trusted as an honest broker between the needs of public health and the pharmaceutical industry?
In the case of vaccines the WHO has joined forces with vaccine manufacturers in the Global Alliance for Vaccines and Immunization (GAVI) to promote vaccines in third world countries. Shamefully, this promotion is done without regard to the costs, the lack of benefits in countries with a low incidence of the problem and the imperatives of more pressing public health needs.
GAVI has entered an Advance Market Commitment (AMC) with manufacturers. Through the AMC, donors commit money to guarantee the price of vaccines once they are developed. In 2007, GAVI began working with partners on a US$1.5 billion AMC pilot to fund the introduction of pneumococcal vaccines in poor countries. This fund will ensure that manufacturers receive their high guaranteed rate. Poor countries are enticed to introduce the vaccine with huge subsidies. For example, the asthma causing pneumococcal vaccine, which costing Rs. 12,000 per child was being provided for Rs. 50. The subsidy and co-financing schemes prevent nations from doing a proper cost benefit evaluation.
Like all introductory offers, it is for a limited time only. Countries are forced to pay full market rates after the offer is withdrawn. The AMC having promised manufacturers a guaranteed market for their vaccine at the rate of Rs. 4000/dose (Rs 12,000 per child), led to both the GAVI and the WHO glossing over the lack of efficacy and the obvious harms of the vaccine when marketing the vaccine to poor countries.
In April of this year, experts of the Government of India recommended the introduction of the vaccine in the country's routine immunization, 'if the vaccine covered 70% of the strains of the bacteria in the country'! It must be clarified here that the lack of efficacy reported in the WHO Bulletin relate to countries where up to 80% of the local strains were covered in the vaccine! The risks in terms of asthma were available in the literature but do not seem to have caught the attention of these experts.
The price of a vaccine is inversely proportional to its usefulness. The less useful the vaccine, the higher the inducements needed to encourage reluctant doctors to use it. On one end of the spectrum we have the highly effective DPT (diphtheria tetanus pertusis) vaccine which costs just a few paisa and on the other end we have the pneumococcal vaccine which costs thousands of rupees. Out of the Rs 4000 the public pay for one dose of pneumococcal vaccine Rs 1000 goes directly to the doctor or dispensary that sells the vaccine. This is a fail-safe marketing strategy by the pharmaceuticals. Indeed, with these types of incentives it is a win-win situation for everyone, aside from the child patients who have an increased chance of getting asthma and having their health impacted for the rest of their life.
India cannot afford such costly public health mistakes like the pneumococcal vaccine. Currently, we only have around 50% coverage of the basic vaccines and it is crucial that all the resources available be used to improve this coverage in the interest of public health for all. Spending money on newer vaccines of doubtful utility will ensure that even less is available for the rural poor. Perversely, those parents who don't have access to immunize their children against pneumococcus may however be relieved that their child avoided asthma. We can only hope that the pneumococcal faux pas will prompt the policy makers into developing a more coherent policy for public health and equity in services.
The WHO website reads that "It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends." For this reason, the WHO and the GOI need to ask searching questions as to how they came to promote a vaccine that does more harm than good. Further to this, by trying to hide the vaccine's health risks and ignoring requests from civil society organisations as to the reasons why this decision was made, the WHO has shown an astonishing lack of both transparency and accountability, which poses serious questions about the legitimacy, authority and judgment of the organisation.
Recently the All India Drug Action Network wrote to the Director General Margaret Chan asking her why she was promoting this vaccine that does more harm than good. She has replied through her personal assistant that she looks forward to creating a world where no person should die of a vaccine-preventable disease. So 12 million rupees will be spent to reduce 3.6 cases of pneumonia with this vaccine while millions die of malnutrition. The letter suggests that the WHO plans to siphon off millions of dollars contributed by member countries for the Millennium Development Goals to pay pharmaceutical companies through Advance Market Commitments.
To repair its reputation and to protect people's health rights, both the WHO and the GOI need to purge the people who have allowed this catastrophe to take place and safeguards must be put in place to never again allow people's health rights to be comprised. Furthermore, the WHO and GOI should issue a full and prompt apology to the children and families who have been adversely affected by their mismanagement.
From:-
Jacob M. Puliyel MD MRCP MPhil
eFax 00 44 7092-124285
Phone 00 91 11 23946388
00 91 9868035091(The author is a consultant Paediatrician at the St. Stephens Hospital New Delhi is a member of the Overview Team for the Public Report on Health.)
Hippocrates once said "Give me a fever and I can cure the child". By understanding that a simple fever is a symptom rather than a condition orillness in itself, you soon come to realise that it is an ally and notan enemy. Fevers are the first sign that your child's immune symptom isfunctioning as it should. By increasing core body temperature, feversenable the immune system to swing into action, indicating the body'sdefences are fighting an infection and consequent temperaturefluctuations indicate how the body is coping.. - Natural Parenting.
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