Indian doctors express displeasure over vaccination policy.

February 14, 2007

Regulating Vaccines: Can Health- Economics Tools be used Profitably?

Dr Dhanasir, Dr Puliyel.

[Excerpt from article in Indian Pediatrics, January' 2007]

Direct-to-consumer vaccine advertisements are a recent phenomenon. In India a newborn can make up

to 27 visits to the doctor for immunizations before his fifth birthday(1) (Table I). The vaccines cost

approximately Rs 11,000. There is a built-in incentive for doctors to prescribe the vaccines.

After a market presence is established, in the next stage the equity argument is brought up. Pressure is

brought to bear on Government, to bring the vaccine under the Universal Immunization Program (UIP)

saying that the well-to-do are protected and it is not equitable that the poor go unprotected(2). The

Government of India recently had to take out advertisements in leading newspapers cautioning the public to ‘evaluate carefully the commercial claims’ of various vaccines beyond the 6 UIP vaccines(3).

Pressure is also put by international organizations like the World Health Organization (WHO) and Global Alliance for Vaccines and Immunization (GAVI). Resolution 45.17 of the World Health Assembly mandates that member countries integrate cost effective 'newer vaccines' into the national immunization programs. Regardless of costeffectiveness, organizations like GAVI persuade developing countries to use new vaccines by providing donor-grants (effectively driving costs to zero in the initial stages). The full cost implications are only realized once funding is withdrawn, after the vaccine has been included in the UIP.

As more vaccines come on to the market, the government needs a reliable strategy to evaluate

vaccines for the UIP.

Sujith Kumar Dhanasiri,

Research Officer,

Personal and Social Services Research Unit,

London School of Economics, London,

United Kingdom.

Jacob M. Puliyel,*

Department of Pediatrics,

St Stephens Hospital,

Tis Hazari, Delhi 110 054,

India