[WSF-Discuss] II World Social Forum on health condemns the WHO’s lack of transparency

[CACIM]

*Special Article*

Vanishing vaccines

Serious Threat To Public Health

By Bharat Dogra

@
http://www.thestatesman.net/page.news.php?clid=3&theme=&usrsess=1&id=234941

The Universal Immunisation Programme is a very important segment of India's
public health effort. In view of the enormous scale of the operations, the
government has to ensure an adequate supply of vaccines at a reasonable
cost. Keeping costs reasonably low is important in a country like India
which has to cope with a serious resource constraint in the face of a huge
task.
Unfortunately the global vaccine industry is today more interested in
selling high-profit vaccines, rather than ensuring a bulk supply of the
most-needed vaccines at a low cost. As a recent editorial in the Indian
Journal of Medical Research noted, "In the face of the burgeoning and
aggressive marketing of vaccines of doubtful utility, we have a widening
demands-supply gap in the Expanded Programme on Immunisation (EPI) vaccines.
Over the last few decades, due to the decline of the public sector and the
growing disinterest of the private sector, the number of firms supplying
EPI vaccines has declined drastically both in India and abroad. This has
prompted the UNICEF to express serious concern over the shortage of EPI
vaccines.

High prices

"Private manufacturers prefer to sell them as 'value-added cocktail
vaccines' at exorbitant prices in the open market, rather than supply to
EPI. The general tendency to combine EPI vaccines with non-EPI ones not only
creates an artificial scarcity for affordable EPI vaccines, but also opens
up a backdoor method for the entry of expensive and perhaps unnecessary
non-EPI vaccines into the universal immunisation programme, riding piggyback
on the EPI vaccines."
The government should have strengthened the vaccine production in its
existing facilities. Instead, in a decision that sent shockwaves in public
health circles in January the Union health ministry cancelled the licences
of three vaccine-manufacturing public enterprises ~ the 103-year-old Central
Research Institute (CRI), Kasauli; the 100-year-old Pasteur Institute of
India (PII), Coonoor; and the 60-year-old BCG Vaccine Laboratory (BCGVL) in
Chennai.
The reason given was that these institutes lacked the latest facilities in
accordance with international norms. Actually, however, the Centre had
repeatedly ignored the appeals from these institutes for upgradation of
facilities and greater autonomy to ensure better talent. First ignore the
pleas for better facilities and then snatch away the licences citing lack of
proper facilities. This indeed is a strange argument, one that conceals the
hidden agenda of facilitating the entry of imports and big business.
This hidden agenda is also revealed in the case of oral polio vaccine
(OPV). During 1967-77, OPV was indigenously produced at the Pasteur
Institute of India. This production was suddenly stopped when one batch was
alleged to be virulent, even though subsequent tests by reputed scientists
revealed that this finding was incorrect and the vaccine was of good
quality. Even if the earlier allegation had been true, the batch in dispute
could have been rejected. The production of OPV should not have been stopped
for all time. In this case, even when the allegation of virulence was found
to be totally false, the manufacture of OPV was not resumed.
This was also the time when the demand for OPV was increasing in India.
Since 1978 the country has been importing OPV. Midway, an effort was made to
resume the production of OPV at Bharat Biologicals and Immunologicals
Corporation Ltd but this too was terminated all too suddenly, all too
quickly. Efforts to produce inactivated polio vaccine (IPV), an injectable
vaccine at the Indian Vaccine Corporation Ltd Gurgaon, never materialised as
they were not pursued vigorously enough.
As the country became entirely dependent on OPV imports for its polio
eradication programme, this campaign was pursued in such a manner as to
prolong the need for excessive imports. This is clear from background papers
written for the officially constituted National Commission on Macroeconomics
and Health (NCMH) and included in its official publication titled
'Financing and Delivery of Health Care Services in India.' In one of these
papers, titled 'Delivery of Health Services in the Public Sector', the
secretary of NCMH, K Sujatha Rao, wrote, "The single-point pursuit of
polio-eradication has resulted in adversely affecting the routine
immunisation, which was initiated in 1986 as a technology mission for
achieving full protection against all vaccine-preventable diseases by 2000.
As per a household survey conducted in 1998 and again in 2003 (Indian
Institute of Population Sciences 2004), the data for 220 districts showed
that in the majority of the districts, there was either a declining
performance or no improvement at all under the Universal Immunisation
Programme (UIP).
"Discussions with field staff seemed to suggest that this decline was
largely on account of the emphasis given to polio, which not only commanded
better resources and visibility in the media but also consumed nearly
one-third of the time, 30 times the cost and exhausted the staff."
Another paper in the same publication titled 'Financing of Health in India'
informs us that an estimated Rs 3,592 crore was spent on Pulse Polio
Initiative during 1996-2005. This amount does not include the
"extra-budgetary expenditures incurred by WHO on the appointment of over
1,000 consultants in the country to monitor the programme and the amount
being incurred by UNICEF or IEC." Nearly 13 per cent of the health
department's budget in 2003-04 was spent on this single activity. This paper
adds, "It is estimated that one drop of polio vaccine is almost 30 times
more than the drop given in routine UIP."

Dubious role

In fact a leading role in perpetuating this huge distortion for years has
been played by highly-paid international consultants who were repeatedly
brought in to endorse blatantly wrong policies. Their dubious role extended
to several other developing countries, as is evident from the following
resolution which was passed by the 'II World Social Forum on Health' and
adopted by the WSF (World Social Forum) 2007, on 24 January, 2007, in
Nairobi.
"The II World Social Forum on health condemns the World Health
Organisation's lack of transparency in acknowledging the failure of the
Global Polio Eradication Initiative strategy and instead, identifying a few
low-income countries as scapegoats; subjecting the children of these
countries to an unprecedentedly high number of Oral Polio Vaccine
(OPV) through the pulse polio programmes with no concern for its negative
impact; and the use of monovalent OPV, an untested vaccine without informed
consent.
"While the WSF on health acknowledges the place of OPV in the overall
immunisation programme as part of integrated public health services, the
strategy of intensive pulse polio rounds has had a detrimental fragmenting
effect on the already weak public health systems in low-income countries."

The writer is a social activist
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