Controversies in vaccination scene in India

Abstract

The 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.