Four new vaccines are being added to the arsenal of vaccines in India’s Universal Immunization Program. These include: Rubella, Rotavirus, Injectable Polio and Japanese Encephalitis for adults. This declaration was made on the Press Information Bureau website on the 3rd of July.
Rubella: Although this was being administered as a part of the Measles-Mumps-Rubella vaccine, it shall now be separately introduced in the UIP. Rubella in pregnancy can lead to a number of complications including cardiac deformities and deafness. I wonder why it is being separated from the troika of MMR though. I have very patchy access to internet now that I am traveling, so I have not been able to do a thorough search on this issue yet. However, this might explain why the MMR vaccine has been low in supply the past couple of months in our clinics. But there is no talk of MMR being phased out. So I wonder if the Rubella is being added on over and above MMR. What additional benefits that shall serve I need to study up… maybe a topic for a future post! At this point, however, I find myself wondering that while the Pentavalent vaccine (DPT+HiB+HBV), albeit greatly debated and controversial to the core, afforded the benefit of reducing the number of jabs (thus reducing costs and increasing compliance), and added Rubella vaccine over and above MMR might show opposite operative results.
Rotavirus: This has long been prescribed by Pediatricians and the IAP. Considering the burden of viral diarrhea in Indian children, and the cost it puts on life and monetary terms, I guess this is a positivie step. How this gets taken up by the community needs to be seen. Interestingly, it seems that the Rotavirus vaccine being recommended for the UIP has been indigenously developed through a pubic-private partnership model. Post-introduction assessments of adverse events following immunization needs to be observed for occurrence of any of the suspected GI complications as well.
Injectable Polio: Now that India has been officially declared polio-free, moving towards the Injectable Polio Vaccine is a positive step in my opinion. The issue of Vaccine Associated Paralytic Poliomyelitis is not only a very frightening eventuality, but, it also engenders a lot of suspicion and fear in the people regarding vaccines in general, and polio vaccine in particular. The polio vaccine has faced a number of unique challenges in India, including some weird assertions that this was a government ploy to sterilize people. In Pakistan, the espionage conducted in the garb of polio vaccinators was also a major blow. All said and done, the time for IPV has come and it is a timely step to introduce this in a systematic fashion. At present, however, there seems to be no talk of scaling down the oral polio vaccine and India is introducing the IPV as a part of a global campaign in 125 countries to move towards a polio-free world. This is a positive step, as we have seen with the polio outbreaks recently, there is no point in moving for a nation-based eradication movement unless the whole world moves towards eradication.
Adult Japanese Encephalitis Vaccine: This is being introduced in 9 states, in 179 endemic districts only. Of late, the JE virus has emerged as a major public health headache because of the putative role it has played in mediating children’s deaths during the litchi harvesting season (that is a post for another day!) and localized outbreaks in endemic places where the vector borne disease control program has faltered a bit.
Whether these shall help India proceed towards successful implementation of the fourth goal in the Millennium Development Goals (reduction of infant mortality by two-thirds by 2015) remains to be seen, but this is the first step in the right direction in a long series of steps that need to be taken to ensure that the nation proceeds towards a healthy future. However, simple implementation of the vaccine program will do no good until and unless there is adequate provision of reserves, training of healthcare workers and especially in the case of the IPV, priming of the target audience for establishing the need and demand for the vaccines.
Scepticemia 