Disease is an event, but prevented disease is a non-event. National Immunisation Week (April 24 to 30) is the appropriate time to celebrate the successes of our national immunisation programme as well as introspect on what more needs to be done. T Jacob John, consultant at Christian Medical College, Vellore makes the case that immunisation is the birthright of every child and is a win-win-win for individuals, families and society
If disease and death are natural, prevention must go against nature. Just as cooked food, wearing clothes, using automobiles are all against nature, so is prevention of disease by immunisation. Two examples will suffice to illustrate just how powerful immunisation can be. Smallpox vaccination and polio vaccination have interrupted the natural transmission of their respective viruses, merely by making individuals immune – without improving the social conditions in which they thrived, namely overcrowding, low levels of sanitation and hygiene, ignorance about what caused these diseases and human behavior that promoted their community circulation. No more scarring of faces by smallpox, no more limb paralysis by polio.
What is the next disease targeted for elimination? Measles. India has pledged to eliminate measles virus from the country by 2020. We know how to do it and we have the vaccine, completely safe and remarkably effective if two doses can be given to every child. We can do that, since that is what we did to eliminate polio, and help immunise 100 percent of eligible children.
Disease is an event, but prevented disease is a non-event. Our children do not die any more of diphtheria, whooping cough, tetanus, tuberculosis meningitis, Hib meningitis, Japanese encephalitis, or get hepatitis B infection, thanks to the national ‘Universal Immunisation Programme’ under which vaccines against all these are given to all children, poor and rich, rural and urban, at taxpayers’ cost.
Only those who avail of this service are given the vaccines for free, while others go to private clinics and get immunised by paying the costs of vaccines to the doctor. Many do not use any opportunity for immunisation for various reasons which maybe either customer-related or delivery-related.
There is a specific age-schedule to give all vaccines in phases, soon after birth, at 6, 10 and 14 weeks, 9-12 months, 15-18 months and at 5 years. Many families just forget these time slots. Some parents find the timing of immunisation clinics inconvenient. For all of them, here is a second opportunity in the form of a National Immunisation Week, 24 to 30 April for catch up on missed doses. There will be some adjustments for the age-recommendations.
Some parents are dissuaded from immunising their children by dis-information that immunisation goes against nature. There is an anti-vaccine forum in India that dissuades parents from getting their children immunised, scaring them that no vaccine is quite safe. They hide the fact that every vaccine became a vaccine only after safety and efficacy were documented with evidence and that there is a National Regulatory Authority that allows any vaccine to be marketed in India – both in public sector and private. They keep an eye on the continued ‘post-marketing’ performance of vaccines – safety particularly.
Another anti-vaccine argument is that all vaccines are manufactured by companies interested in profit. That is a tricky argument. I work for salary; am I working only for salary? No. But would I work without salary? No. Then surely I must be working only for salary! Companies, marketing agencies, doctors – all get some profit but the most profit is taken by the families on account of death and diseases prevented in children. Immunisation is win-win-win for all parties.
What other diseases can be prevented? Believe it or not, two common cancers are vaccine-preventable, namely liver cancer(hepatitis B virus) by HBV vaccine and cancer of uterus cervix, by human papilloma virus (HPV) vaccine. The former is quite cheap but HPV vaccine is expensive. There are more vaccine-preventable diseases. Right now chickenpox is rampant in many South Indian communities –totally preventable by varicella vaccine. Common jaundice (hepatitis A) has HA vaccine. Everyone knows that rabies vaccine prevents rabies even after rabid dog bites. We have licensed vaccines against pneumococci(bacteria causing pneumonia and meningitis) and against Rotavirus, that causes severe diarrhea in infants. All these vaccines are sold in small volumes and prices remain high. The day the national immunisation program includes them in the routine schedule, their sales volume will pick up hugely and prices fall, also hugely.
Vaccines are an essential commodity for child health and survival. So, next time when you have the opportunity to advise someone or make a decision yourself, go ahead, go against nature and protect children. Full immunisation is the birthright of every child.