Immunity Too Dear

Should the government pay for a Rs 3,000 immunisation vaccine?

Cost per dose is rising...

The most expensive vaccine presently in the immunisation programme is for Hepatitis-B at Rs 50 per dose

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The project is being conducted by the Indian Council of Medical Research (ICMR) in collaboration with PATH, an international health group. The results of the trials will be examined later by a national technical advisory team before any decision is taken on large-scale administration of the vaccine, including through the UIP. “It should also help manufacturers assess market opportunities better and, we believe, lead them to lower pricing decisions than they would otherwise make,” says Martha Jacob, a director at path India.

Cervical cancer infects the neck of the uterus and it takes many years before symptoms show up. Nearly all cases are caused by the human papilloma virus (HPV) that spreads through unsafe sex—not just through intercourse but also through direct contact between infected skin patches. This means that, like HIV, HPV mainly targets high-risk groups that are sexually active. Critics, therefore, argue against any mass administration of the vaccine through the immunisation programme. “What also needs to be mentioned here is that HPV, unlike HIV, doesn’t even spread through infected body fluids,” says C.M. Gulhati, editor of the Monthly Index of Medical Specialities. “It may make sense to make it mandatory for all in the US, where teenage sex is common, but to do so in India is absurd.”

Gardasil, manufactured by Merck, protects against four subtypes of HPV that account for about 70 per cent of cervical cancer cases. But there are over 100 subtypes. Even Merck asserts that vaccination is no substitute for regular screening.

Nonetheless, the disease kills about 74,000 women each year in India. “There’s no denying the prevalence,” says N.B. Sarojini, coordinator of the women’s health group Sama. “But why doesn’t the government talk of reinforcing preventive measures rather than make an expensive vaccine mandatory?”

The health activists’ memorandum to the health ministry, which Sarojini has also signed, calls for providing basic  screening facilities at public health centres and filling up vacant posts meant for gynaecologists and paramedics. But Jacob counters that vaccination “will relieve pressure on the screening system, and will help protect women who may not avail of the screening services”.

Each dose of the vaccine costs Rs 3,000 and every 10-year-old, the age when vaccination is normally recommended, needs three doses that protect her for five years. This necessitates a booster dose every five years that accounts for eight doses till menopause, around the age of 50. This accounts for Rs 33,000 per girl. But the price is likely to come down, argues Jacob.

Drug controller-general Surinder Singh says the government is not in a hurry and would wait for a full report of the trials before taking any decision. But that hasn’t quelled the concerns of health activists about the increasing role of a profit-minded private sector in deciding the composition of the country’s immunisation programme.