A shot of hope

India should once again be the world's vaccine capital

A couple of recent events in the area of preventive public health care reveal the distinct contrast between the functioning of India's health bureaucracy and that of its medical research. On the one hand, procedural snags in repairing a damaged part in the country's sole plant that manufactures yellow fever vaccine, at Kasauli in Himachal Pradesh, have brought production of the vaccine to a halt for nearly two years. This critical vaccine - the administration of which is compulsory for those intending to travel to most African and South American countries - has thus become scarce, causing avoidable inconveniences to both the health authorities and the people. Shockingly, the repair work in this dysfunctional plant has been held up because the existing norms require at least three bidders in an open tender for undertaking the repair work; but, in this case, only one bidder responded to the tender since it is an old plant that not many firms can repair. Instead of working through the rules, Indian officialdom, predictably, preferred to import a higher-cost variant of the vaccine. Going a step further, people were asked to buy the vaccine from the market - despite the fact that chemists generally do not stock it, as only selected government centres are authorised to administer these shots.

In contrast, Indian medical scientists have successfully developed and tested an indigenous vaccine against rotavirus, which causes severe diarrhoea in young people, with cooperation and financial support from several domestic and foreign public and private bodies, including the Bill & Melinda Gates Foundation. This vaccine is expected to cost just a fraction of its imported counterpart, and should save the lives of innumerable children who die every year in India and other low-income countries due to diarrhoea and gastroenteritis. This virus is endemic, besides India, in Bangladesh, Pakistan, Kenya, Mali, Mozambique, Gambia and other developing countries of Asia and Africa. The new prophylactic drug has shown excellent results in trials, which were conducted in a manner that reportedly set new standards for testing drugs on human beings. The project authorities went to the extent of providing mobile phones to the guardians of the children enrolled, to enable them to seek immediate medical assistance if any adverse effects began to be seen.

These two developments need to be viewed in the context of the fact that India was once deemed the world's vaccine pharmacy - it accounted for over half of the total global production. The country was also home to the evolution of the world's first vaccines against cholera and the plague, by Anglo-Indian doctors, and the vaccines against rabies and smallpox. It is, thus, a pity that this legacy has been destroyed, and an earlier policy of encouraging domestic production of vaccines has been abandoned. In recent years, apart from the Kasauli unit, other facilities - including the Coonoor (Tamil Nadu)-based Pasteur Institute of India - have had to be closed. However, such lack of attention to the vaccine sector cannot be allowed to continue, especially when the stress is shifting globally from cure to prevention of diseases. Prevention must be an integral part of the expansion of public health programmes the Centre is planning. Not only should the government ensure speedy restoration of the manufacture of yellow fever vaccine at Kasauli, but it should also expedite approval for the mass production of the newly discovered rotavirus vaccine. And the lessons from these two incidents should be internalised, as the government prioritises the tasks of meeting the huge and growing demand for effective, cheap and available vaccines.