THIRUVANANTHAPURAM: Dr Patrick Zuber, Group Leader on Global Vaccine Safety at the Department of Immunisations, Vaccines and Biologicals of the World Health Organisation, in an e-mail interview with the Express, has clearly stated that the pentavalent vaccine to be soon included in the national immunisation programme is safe and effective. In the second part of the interview, Dr Zuber talks about the logic and reasons behind the introduction of the pentavalent vaccine in India and of the pilot programme in Kerala and Tamil Nadu.Question: According to the statistics from the Union Ministry of Health, the death rates for acute respiratory infection, pneumonia, meningitis and diphtheria are several times over in Delhi when compared to Kerala or Tamil Nadu. Why is the pentavalent vaccine being introduced in an area where the disease burden is less?Answer: The decision to introduce the vaccine first in Tamil Nadu and Kerala was made by the National Technical Advisory Group on Immunisation (NTAGI) in India and not by WHO. Our understanding is that the choice was due to better infrastructure to monitor the impact and safety of vaccination in these states.Q: The equity argument which says that it is the responsibility of the government to make it available to the poor has been countered by scientists from reputed research institutes saying that this was like giving lipsticks free to women living in the slum - ‘’Let’s give it to them otherwise they will not be able to afford it.’’ How would WHO react?A:The risk factors for Hib disease and death include overcrowding, poor nutrition and lack of access to good quality health care. All of these are more prevalent in the poorer segment of society. Data from India, as is the case with all other countries, also show that the risk of death from pneumonia and meningitis is highest in the poorest segments of the population. Hence, ensuring that these segments of the population benefit from vaccination would provide the greatest impact in terms of disease prevention.Q: As per figures from the government on deaths following vaccination, of the total 128 AEFI deaths last year, 48 were coincidental, four vaccine reactions, two injection reaction, two programme error and 72 unknown. Would it be surprising if such figures erode the trust regarding vaccination among the general public?A: In all countries the majority of adverse events following immunisation (AEFI) reflect the coincidental occurrence of health problems rather than a true effect of vaccines. The ability of a country to report on the number of AEFI reported, the findings from the investigation and the conclusions from experts who reviewed the cases should, indeed, be perceived as additional reassurance that local authorities are serious about monitoring any unexpected reaction in relationship with vaccine use. Furthermore, the number of children immunised in India has been steadily increasing in recent years, as has been the sensitivity of the AEFI monitoring system. So, it is not unexpected that there was a slight increase in the number of AEFI reported, whether coincidental or casual.Q: While the WHO recommends a vaccine ‘where resources permit its use and the burden of disease is established’, has the disease burden been estimated by any tool to check if it is that high in India to include Hib vaccination in the national programme?A: The burden of Hib disease was indeed estimated by WHO for all member states for the year 2000. The model and data were reviewed by two independent expert committees and published in the Lancet (2009, volume 374, issue 9693, pages 903-911). The burden estimates are also available on the WHO website at:
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