Accepting the recommendations made by the National Technical Advisory Group of India (NTAGI), Prime Minister Narendra Modi last Thursday announced the introduction of four new vaccines as part of India’s Universal Immunisation Programme (UIP). These include vaccines against rotavirus, rubella and polio (injectable), along with an adult vaccine against Japanese encephalitis.
According to an article in the Times of India (TOI), if the recently announced introduction of the newer, more expensive vaccines into the Universal Immunisation Programme (UIP) has to be implemented, the budget allocation for vaccine procurement will have to go up six times by over Rs 5,200 crore in the forthcoming budget.
The TOI states that this budget allocation is to maintain the current level of immunisation coverage of less than 75% of all the children who should be covered. Earlier, the cost of immunising a child under the UIP was roughly Rs 100 including the cost of syringes (Rs 2.5 per syringe). With the newer vaccines, the cost per child could go up to Rs 1,000 or ten times the current cost. However, Global Alliance for Vaccines and Immunisation(GAVI) is supplying the pentavalent vaccine, the most expensive among the new vaccines, worth Rs 390 per child, free of cost till the end of 2015. Hence, the immediate cost per child will be about Rs 600. Over the long run, health ministry officials believe the cost of many of the newer vaccines could drop significantly after they are introduced in the UIP.
The TOI article also argues that there are developing countries such as Thailand and Rwanda that are making remarkable progress in reducing child mortality by spending on strengthening primary health care through hiring and training thousands of health workers and not by pouring money into increasing the number of vaccines.For example, Rwanda has achieved 95% immunisation coverage. Its infant mortality rate, 201 in 2000, has fallen to 62 per 1,000 births and under-five mortality fell from 170 to 103 per 1,000 live births. This was achieved, the ToI says, by the emphasis on primary care where two health volunteers were hired per village (100 to 150 households) and by ensuring that 80% of nurses and 64% of doctors were working at the primary and secondary level.
However, the ToI is completely wrong about the role of vaccines. Whether willfully or through genuine ignorance, Rema Negarajan ignores the fact that both Rwanda and Thailand have introduced rotavirus vaccine (one of the four vaccines announced by the PN last week). As the WHO says, “rotavirus is the most common cause of severe diarrhoeal disease in young children, with more than 500,000 children under the age of five dying worldwide each year. Highly contagious, the virus causes vomiting and severe diarrhoea that can lead to dehydration and potential death.” Indeed, Rwanda has made a big point of introducing vaccines that India has not yet planned to bring in such as pneumococcal and HPV. Given that Rwanda has a much lower per capita GDP than India, this surely is the real lesson.
Ms Negarajan has an unfortunate habit of reproducing the assertions of some ideologically-driven NGOs without checking the facts behind them as another story in today’s ToI showed. She claims that India is allowing its public sector vaccine manufacturers to fall behind those of countries such as Brazil. The truth is that, for better or for worse, India has drowned HLL — a state-owned mini ratna — in money to supply vaccines to the public sector. The fact that it cannot do so is a testament to the inadequacy of public sector producers not a lack of trying by government.
We absolutely agree that strengthening the primary health care network and system is an urgent need and will go a long way towards reducing child and maternal mortality. But coming back to the main question that this article seeks to answer “can India afford costly vaccines?”,the question really should be can India afford not to include them?
According to this article, currently in India the IMR is 42 and under-five mortality is 52.The government claims that the expanded vaccination programme will help meet the MDG targets of reducing child mortality by two-thirds by the year 2015 . While this may be difficult, India needs to leave no stone unturned to achieve this target as soon as possible.