Controversies in vaccination scene in India
AbstractThe 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. In the developing country like India, Immunization is broadly carried out by Government agencies and Private paediatricians and general practitioners. The Government agencies follow the national immunization schedule as recommended by the National Technical Advisory Group on Immunization (NTAGI) on behalf of Government of India which is meant for mass strategy. Similarly majority of the private practitioners and paediatricians follow the guidelines recommended by Indian Academy of Paediatrics (IAP) which are meant for individual strategy for office practice. There are certain differences in the guidelines issued by these two bodies and caregivers do find themselves in confusion in certain situations. However in the recent two years certain changes have taken place and the National Technical Advisory Group on Immunization (NTAGI) has recommended for introduction of another dose of measles vaccine at 18 months of age. IAP since many years was recommending second dose of Measles vaccine as Measles Mumps and Rubella (MMR) vaccine. In 2011, Government of India recently universalized Hepatitis B vaccination to all States/UTs in the country. IAP also recommended Hepatitis B vaccine since many years. As per the universal immunization schedule previously it was recommended to give DT vaccine at the age of four and half years of age. However in the light of the epidemiological shift of age group of pertussis as observed by cases of pertussis in four to five years of age, the schedule now recommends DPT vaccine at five years of the age. IAP was recommending DPT at five years of age since many years. There is an urgent need that these two apex advisory group should interact and give consensus recommendations.
Bansal CP. IAP's perspectives on current vaccination scenario in India. Indian Pediatr. 2013 Oct;50(10):911-2.
Food and Drug Administration. Guidance for Industry for the Evaluation of Combination Vaccines for Preventable Diseases: Production, Testing and Clinical Studies. Washington DC: US Department of Health and Human Services, Food and Drug Administration, Center for Biologics. Eval Res, April 1997, Docket No. 97N-0029.
Buttery JP, Riddell A, McVernon J, Chantler T, Lane L, Bowen-Morris J, et al. Immunogenicity and safety of a combination pneumococcal-meningococcal vaccine in infants: a randomized controlled trial. JAMA 2005;293:1751-8.
Wouter H. Who can be confident about multiple vaccines in infancy? BMJ, 22nd April 2006, Rapid Response for Banatvala et al, hepatitis B immunization in Britain: time to change? 2006, 8th April, 332 (7545) 804-5. Available at http://www.bmj.com/cgi/eletters/332/7545/804#132291. Accessed 5 May 2014.
India officially removed from the list of polio-endemic countries. Available at http://new.paho.org/hq/index.php. Accessed 6 May 2014.
IAP Committee on Immunization 2009-2011. IAP Guide Book on Immunization, 2011. Available at http://www.iapindia.org/files/IAP%20Immunization%20Guide%20Book_2009_2010.pdf. Accessed 6 May 2014.
Friedman AL, Shepeard H. Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: findings from CDC focus group research and implications for practice. Health Educ Behav. 2007 Jun;34(3):471-85.
Murhekar MV, Dutta S, Kapoor AN, Bitragunta S, Dodum R, Ghosh P, et al. Frequent exposure to suboptimal temperatures in vaccine cold-chain system in India: results of temperature monitoring in 10 states. Bull World Health Organ. 2013 Dec 1;91(12):906-13.