BackShots in the arm
Shots in the arm
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Many of us tend to think of vaccinations as something that is over and done with in childhood. But, as various pharma companies aggressively promote vaccines such as hepatitis B and typhoid and go all out to find a preventive shot for everything, from influenza to malaria, it appears that the list of protective jabs is increasing by the day and stretching well into adulthood.
Soon, you might not even have to suffer an injection to get immunized, as a lot of research is being carried out on new needleless vaccines.
The malaria vaccine is still only in its Phase III trials and the dengue vaccine hasn’t yet reached India, but there are others available here that doctors say are a must for every adult. Says Dr Anant Gore, consultant, medicine, Wockhardt Hospital, Mumbai: “Vaccines available for adults in India include tetanus, influenza, measles, typhoid, hepatitis A and hepatitis B."
There is also a host of optional vaccines recommended if you are visiting an epidemic-prone area—yellow fever and Japanese encephalitis, to name a few. In addition, if you haven’t had chickenpox during childhood, the varicella vaccine can save you many uncomfortable days and complications if you contract the disease as an adult.
Although most Indians have a lax attitude to adult vaccinations, the trend, according to pharma companies, is now changing. Even though the Indian government has largely been silent on the issue of adult vaccinations unlike many developed countries, where there are organized adult vaccination schedules, initiatives are emerging from the workplace, with corporate and other employers pushing vaccination programmes.
In Bangalore, for instance, at the onset of summer, when the risk of food- and water-borne illnesses such as jaundice and typhoid is high, several software companies (Oracle, for instance) hold vaccination camps in their office campuses, offering doses of hepatitis A and typhoid vaccines. Anshu Sharma, who used to work for The Energy Research Institute in New Delhi, describes how her entire family got inoculated against hepatitis B thanks to a free camp held at her office.
Apart from the health benefits, several studies have pointed out the economic and social benefits of vaccination programmes. Dr Sanjoy K. Datta, director, clinical R&D and medical affairs, GlaxoSmithKline Biologicals (South Asia), cites a Harvard University research conducted by David Bloom and David Canning with Mark Weston—an independent policy consultant—that looked at two vaccination programmes and attempted to calculate the benefits beyond disease prevention. The first benefit was that healthy children are more likely to attend school and learn better. The second was that healthy workers are more productive.
To curb absenteeism due to even minor illnesses, companies all over the world are now introducing vaccination programmes at the workplace that go beyond life-threatening diseases. For instance, a report in a South African paper last week describes how an increasing number of companies in the country set aside a day to provide influenza vaccinations for their employees before the onset of winter to prevent mass absenteeism due to the disease.
“Globally, we are seeing a move towards wellness. People are demanding a better quality of life, fewer sick days and more productive lives. The shift from just absence of disease to healthy living is a global demand. For example, how often would you have checked your cholesterol level as a screening measure a decade ago or prioritized quitting smoking 20 years ago? Hence, the growing role of vaccination in the welfare of the individual, family and communities at large," says Dr Datta.
When, where and how should one get vaccinated?
This question is especially relevant because several of the new vaccines in the market are not single-dose but require three doses and an additional booster, which one inevitably forgets to take. The capsular polysaccharide typhoid vaccine gives immunity for only three years, while the influenza vaccine has to be taken yearly since every year, new formulations are introduced to combat the current strains of influenza virus in circulation.
This is why doctors say that it is best to avoid camps and go to the general physician who will either mail or call you with reminders.
There is an array of options available, especially in the case of hepatitis A and hepatitis B, with a difference in prices and dosage schedules among brands. There are also some convenient options such as a combined hepatitis A and hepatitis B (Twinrix from GSK Bio).
In the near future, expect the vaccination timetable to get even more crowded. A look at the R&D efforts of big pharma companies reveals a host of new shots waiting in the pipeline. Says Dr Datta: “We are investigating the possibility of having a conjugate typhoid vaccine as the current polysaccharide vaccine provides only two-three years’ protection and cannot be given to infants." GSK Bio also has a candidate hepatitis E vaccine that has undergone detailed studies, details of which were published recently in The New England Journal of Medicine. “The vaccine has shown 90% efficacy, but will need further studies before it is ready for licensure and general use," says Dr Datta.
Even as a great deal of noise is being made about a vaccine against HIV/AIDS, closer to launch appears to be a tetravalent dengue vaccine that is in trial in Thailand currently, a malaria vaccine (long a dream of medical men), for which several companies are in the race, and an adult vaccine for tuberculosis.
Vaccines for children
Go by the Universal Immunization Schedule (UIS) of the Indian government and the recommended list for children is a fairly short one. But go by the schedule prescribed by the Indian Academy of Paediatrics (IAP), and there are a whole lot more. Why the anomaly?
Explains Dr Prashant Vaidya, consultant paediatrician at Wockhardt Hospital, Mumbai: “The Government of India, in its wisdom, allocates funds for health schemes and a small portion of that is for child health, including immunization. These amounts generally fall well short of fulfilling any reasonable requirement. Hence, only a few vaccines, deemed ‘essential’, are included in the UIS."
However, Dr Vaidya warns against taking lightly the word “optional" listed against several vaccines. “In fact, the IAP has given up the term ‘optional’ as it is rather misleading. These vaccines are now referred to as “vaccines that can be given after discussion with the parents". These include the varicella (chickenpox) vaccine, the hepatitis A vaccine and pneumococcal vaccine.
As for the Hib (haemophilus influenzae type b) vaccine and typhoid vaccine, these figure in IAP’s must-give list. Hib was the leading cause of bacterial meningitis and a major cause of other serious invasive diseases among children under five till the vaccine arrived in the late 1980s. “If the Hib vaccine were to become cheaper, it could well figure in the UIS list in future," says Dr Vaidya.
Indeed, some of these vaccines do seem prohibitively expensive—the varicella vaccine, for instance, is priced at around Rs1,375, the meningococcal at Rs1,000 and the pneumococcal, at Rs4,000. To compound problems, a single dose is not enough.
But weigh this against the World Health Organization statistics, which say that about 1.1 million young children die every year from infections of pneumococcus—a type of bacteria that causes meningitis, pneumonia, sepsis, septicaemia and bacteraemia (bacteria in the blood)—and of rotavirus, which causes severe diarrhoea, and you will stop worrying about costs. According to Dr Vaidya, “Rotavirus vaccine is expected shortly as are the 11- and 13- valent pneumococcal conjugate vaccine."
Another new vaccine, recommended for girls in the US and expected soon in India, is the cervical cancer vaccine. This is advised for girls aged 11 to 12, although it may be given to girls as young as 9. The vaccine is against the human paillioma virus (HPV), a major cause of cervical cancer in women.
Dr Rahul Nagpal, senior consultant, paediatrics, Max Healthcare, Saket, New Delhi, points out how recent advances have taken place in existing vaccines, increasing their efficacy. If cost is not a constraint, then Dr Nagpal recommends the injectable inactive polio vaccine (IPV), priced at Rs385, over oral polio vaccine (OPV) as the protection level after three doses of IPV is much higher than in case of the OPV. Also, in the case of IPV, there is zero risk of vaccine-associated paralytic polio, which is known to happen (admittedly very rarely, but yet there is a small risk) in the case of OPV.
Also, medical opinion on vaccines such as varicella, which till recently was rather conservative, is now firming up in its favour. Till a few years ago, most paediatricians would advise parents not to vaccinate children under 12, but let them develop immunity in the natural course by contracting the infection.
Now, doctors are changing their stance. As Dr Vaidya points out: “When the vaccine was first launched, I did advise parents not to immunize their younger children against chickenpox. I have subsequently been hesitant to give this advice as I regularly see children with various complications from chickenpox, including a few life-threatening ones." Also, as Dr Nagpal points out, the demand is high from parents who worry about children missing exams and so on. “It’s a safe vaccine and there is nothing wrong in giving it. I have given it to my own kids," he stresses.
According to the IAP timetable, one is done with all these vaccinations by the age of 10. But now global trends are veering towards vaccines for teenagers. In the US, new formulations of meningococcal vaccine targeted at teens has hit the market, as has a booster dose against pertussis (whooping cough).
Finally, heartwarming though these advances are, a reality check from Dr Vaidya: “Ironically, the strata of society that ‘needs’ the newer vaccines the most, is the one that cannot afford it at all."
Global vaccination trends
Fewer shots
A host of combination vaccines are hitting the market, which means children and adults need to take fewer shots. Comvax combines the Hib and hepatitis B vaccines, TriHIBit combines DTaP and HiB and Twinrix combines the vaccines for hepatitis A and hepatitis B. Proquad combines MMR (measles, mumps, rubella) and chickenpox vaccines in one shot.
Needle-less vaccines
Several pharma companies are investing in vaccines that won’t cause any pain. For instance, FluMist, a nasal spray vaccine against influenza, was launched a few years ago. Now, research is on to find edible vaccines.
Vaccines for teenagers
No longer can you reassure 10-year- olds that it’s the last visit to the paediatrician for a shot. With increasing cases of meningitis, whooping cough and other infectious diseases among teenagers, pharma companies are coming up with protective jabs for the 12-16 age group.
(For additional information on vaccines and schedules, log on to www.cdc.gov and www.iapindia.org.)
(Write to us at businessoflife@livemint.com)
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