Questioning Vaccines: Polio Ravivaar

This is in continuation of a new series of posts I hope to do on this blog.

*DISCLAIMER: I have no medical training, not even a sniff of one, unless one counts two months of aborted Aakash Institute classes (hee). So feel free to direct me to other sources I can use to expand my knowledge on the topic in question. Just don't tell me that since I'm not in the medical field, I won't understand any of this.That only motivates me to dig more :) 

Today's Hindu (Thursday, 24 January, 2013) ran a short article about how a baby named Rukhsar in (where else? The state that has been in the news a lot lately, West Bengal) has not been vaccinated orally against (wild) Polio because her Grandmother refuses to allow it. The Grandmum saw her son become 'violently sick' after being given the Polio Vaccine, and referred to a baby 'across the canal' who died a day after being vaccinated, and refuses to chance the same fate for her two grandchildren. I'm pasting it below (link to article).

                      This Rukhsar has still not been vaccinated for polio

                                                                           -Ananya Dutta

Two years ago, this village in Howrah district made headlines when one-and-a-half-year-old Rukhsar Khatoon contracted polio. A year later Rukhsar shot to even greater fame when it was revealed that she was the last reported case of wild polio in the country for an entire year – a milestone that took India off the World Health Organisation’s list of polio-endemic countries. 

Rukhsar has gone on to become the face of the campaign to eradicate polio in Sahapara village if not the whole country, but another two-year-old Rukhsar, who lives less than 500 metres away, has never been given the oral polio vaccine; her grandmother will not allow it. 

“I have seen with my own eyes that my son became violently sick when he was given the polio vaccine. How can allow any other children in my family to suffer,” asked Rukhiya Bibi on Wednesday. 

Before polio struck the locality, there were about 30 families who refused the vaccination. As news of Rukhsar’s affliction spread in Sahapara village, many of those who had been resisting all these years, changed their minds, said Sabana Khatoon, a United Nations Children’s Fund (UNICEF) volunteer who works in the polio eradication programme in Sahapara village. 

The family of Rukhiya Bibi is among the two that still hold out in the area where Sabana Khatoon works while there are eight families in all in Sahapara village who will not allow their children to be vaccinated. 

Rukhiya Bibi is convinced that if her grandchildren are administered the vaccine, they are sure to come to harm. Describing vividly the images of her son Surpan, who had become sick when he was given the vaccine at least five years ago, she emphatically rules out the same fate for her grandchildren – two-year-old Rukhsar and ten-month-old Noorbina. 

“Surpan was gripped with fever. His limbs, his abdomen, his whole body had swollen up. I will not allow my granddaughter to suffer that,” she said, dismissing all arguments about allergic reactions or any other cause for his ailment. 

Asked about the risk that her granddaughters may contract polio, Rukhiya Bibi recounted: “There was that child, who lived in the house across the canal. He died a day after he was given the vaccine. Can I take that risk?”

The author of the article asks whether what she saw was but a violent reaction to the vaccine (and hence 'normal'), but the old lady refuses to accept this as reason enough to acquiese. Is her response totally irrational and superstititious? Medically speaking (and I wouldn't know), perhaps. But should we dismiss it? Perhaps not. I found it useful to read a short paper on whether or not it is time for India to discontinue its Polio programme (in it's current form, and not immunisation against wild Polio per se) on Dr. Puliyel's website. I'm pasting below the abstract:


Title of Paper:  
Polio programme: let us declare victory and move on
                                                      
Authors:
Neetu Vashisht, Jacob Puliyel 

Abstract:
 It was hoped that following polio eradication, immunisation could be stopped. However the synthesis of polio virus in 2002, made eradication impossible. It is argued that getting poor countries to expend their scarce resources on an impossible dream over the last 10 years was unethical.
 
Furthermore, while India has been polio-free for a year, there has been a huge increase in non-polio acute flaccid paralysis (NPAFP). In 2011, there were an extra 47,500 new cases of NPAFP. Clinically indistinguishable from polio paralysis but twice as deadly, the incidence of NPAFP was directly proportional to doses of oral polio received. Though this data was collected within the polio surveillance system, it was not investigated. The principle of primum-non-nocere was violated.
 
The authors suggest that the huge bill of US$ 8 billion spent on the programme, is a small sum to pay if the world learns to be wary of such vertical programmes in the future.

Link to paper:
http://jacob.puliyel.com/download.php?id=251

Questioning Vaccines: 2013 and a new series

Dubious vaccines? Say whut? I thought. So those anti-vaccine people aren't nutters?


In 2010 I first started reading up on vaccines and the politics of profit behind them. I am a part of the generation that received the basic immunisation programme. Kid nowadays are getting flu shots, chicken pox shots, hepatitis shots, and what have you. Not only does a lot of this sound unnecessary, but they are also not cheap. Anyhow, prelims aside, this is what this new 'series' is going to do: I'm going to trawl the net and pick up articles, medical and otherwise, that question vaccines and put them up here. I link to the original home of the piece, so you can, if interested, check it out in context.

To begin with, Dr. Jacob Puliyel's website is a great repository of essays and papers on medical 'truths' we non-medical folk tend to take for granted. Here's an article he wrote in response to a piece in The Guardian.
                                             ------------------------------------

India cannot afford to use vaccines that are not cost-effective

Developing countries must spend their budgets wisely to save as many lives as possible

-Jabob Puliyel

Your article about anti-vaccination scares "spilling over into the developing world, where they are threatening to derail global vaccination programmes" failed to present a balanced view of the situation (Why fear of vaccination is spelling disaster in the developing world, G2, 12 October).

The article states that "Indian lobbying groups, led by opposition politicians, still claim that Hib [Haemophilus influenzae] vaccines are not only unnecessary, but have caused a number of deaths" and that the Indian government's decision to re-examine their usefulness is putting lives at risk. I am a member of the Indian government's National Technical Advisory Group on Immunisation, and I know of no politician in the opposition that is leading any lobbying group against vaccines. For a vaccine to be introduced into the national immunisation programme, it must reduce the disease burden sufficiently to justify its costs. Unfortunately, Hib does not fit that bill in Asia. Repeatedly, Asian studies have shown there was no reduction in meningitis or pneumonia among those who received the vaccine.

In particular, a vaccine effectiveness trial using Hib – conducted in Dhaka, Bangladesh, in June 2007 and involving 68,000 infants under two – showed that there was no significant reduction in clinically diagnosed pneumonia compared with the control group. However, the Global Alliance for Vaccines and Immunisation (Gavi) claimed the Bangladesh trial demonstrated the vaccine's usefulness.

It is clear that the vaccine does not save many lives – it merely swallows up funds that could have been used for genuine life-saving interventions, such as the provision of clean potable water.
In the article, Lois Privor-Dumm of the Bloomberg School of Public Health is quoted as saying "it would be wrong to characterise all opposition to vaccines as cranky or anti-science … There is often a grain of truth at the bottom of it".

An analysis in the Lancet showed how the pneumococcal vaccine reduces only four cases of pneumonia per 1,000 children. According to Gavi's own figures, the cost of vaccinating 1,000 children is $12,750. Treating the four cases of pneumonia in India, using WHO protocol, would cost $1. The pneumococcus strains prevalent in India are nearly all sensitive to inexpensive antibiotics like penicillin. In the US, which has been using the pneumococcal vaccine, there has been a strain shift – strains covered in the vaccine are being replaced by more antibiotic resistant strains. Vaccine has simply made the problem of pneumococcal disease worse. Yet this vaccine is being pushed in Africa and Asia.

India is a country where 50% of the population do not receive the six basic vaccines against diphtheria, whooping cough, tetanus, polio, tuberculosis and measles. The incremental cost of complete immunisation with these basic vaccines is less than $0.75 (30 rupees) per child. This week I had the heart-wrenching experience of explaining to a mother that her eight-year-old daughter had died from diphtheria, which could have been prevented with the DPT vaccine. The push to include expensive new vaccines must be viewed in this context. Any vaccine introduced in developing countries needs to be weighed in relation to its cost and benefit.

Many of the organisations that are pushing these vaccines have profit margins to protect. To put it bluntly, for them, it is not about lives lost in poor countries – it is all about the cash register.

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*DISCLAIMER: I have no medical training, not even a sniff of one, unless one counts two months of aborted Aakash Institute classes (hee). So feel free to direct me to other sources I can use to expand my knowledge on the topic in question. Just don't tell me that since I'm not in the medical field, I won't understand any of this.That only motivates me to dig more :)