A former member of the Indian Academy of Paediatrics (IAP), Dr Vipin Vashishtha was ousted from the academy for highlighting the nexus between physicians and vaccine manufacturers last year. The Bijnor-based paediatrician documented the rampant corruption and system of favours in an open letter addressed to all members of the academy. In an interview with Arushi Bedi, he lays bare the nexus and talks about how he is still under fire for raising questions. Edited excerpts:
What made you blow the whistle on corruption in the medical fraternity?
I was convenor of the Committee of Immunisation in the IAP for six years. When I took over in 2011, there was no way to address the conflict of interest among the academy members. Some IAP members are on the advisory boards of big vaccine companies and many participate in CME (Continuing Medical Education) programmes organised by such companies and get honorarium.
According to WHO guidelines, members must declare such relations and also whether the physicians or any of their family members have received any cash or compensation in kind from vaccine-manufacturing companies.
So what happened?
The implementation of these guidelines was going quite well until 2015 but, in 2016, two members of the academy were inducted into the committee as chairman and nodal president. Taking advantage of their position in the academy, they started opposing the regulations on conflict of interest. The academy drafted its new immunisation schedule for the year on May 6, 2016. Certain recommendations on the schedule were unanimously passed by the committee and the regulatory board, and then uploaded on the official website as per protocol. Such recommendations also need to be published in the Indian Paediatrics Journal, which goes to all members of the academy, so they can be implemented. Yet, with no authority to do so and without giving any reasons, the president of the academy stalled the process of publication for several months and, eventually, the recommendations were not published.
Most practitioners across the country depend on these recommendations for their day-to-day vaccine-administration practices. These recommendations are also monitored by the government and NGOs to evaluate policy for the entire country.
Who removed the recommendations from the website?
The recommendations can only be removed on the direction of the president. The two members I mentioned had asked the then president Dr Pramod Jog to write to the board of the academy to remove the recommendations. This has been the main conflict.
What did you do after this happened?
I immediately opposed it and sent many e-mails to Dr Jog and other committee members. When nothing happened, I wrote an open letter to all 24,000 members in December 2016. This letter was leaked by one of the recipients and was all over the media the next day.
What did you say in your letter?
I had asked for a proper investigation to find out what all had been going on in the academy in the past five to ten years in certain cases. Vaccine companies have huge resources at their disposal and are trying to influence recommendations by offering favours to practitioners. They promote their own agenda through doctors and their own KOLs (key opinion leaders). The letter also mentioned that such companies were funding most academic programmes and CMEs. This raises the possibility of a nexus between the companies and the doctors making profits on a quid-pro-quo basis.
How does this nexus work?
It operates at various levels. One is the private sector, which is badly regularised or controlled. There are no government guidelines to control this sector even though it constitutes 10-15 per cent of all vaccine-related functions in the country. The majority of vaccines, say around 80-90 per cent, are distributed or supplied by the public health system, which is also not all clean.
The companies try to influence the recommendations by sponsoring various members of the recommending body and, in fact, directly offering them incentives in cash and kind. Before the conflict of interest guidelines came into place, they used to decide who the participants at a panel discussion on a particular vaccine would be, what should be the subject of the discussion and even which vaccines should be recommended.
Has there been a change in practices since the new rules were put in place?
Things have improved since 2011. But vaccine companies still sponsor trips of certain members and pay for their travel. They pay for both work and leisure—and sometimes payments are made on a monthly basis. They have also been known to sponsor medical practitioners’ foreign conferences. Some physicians have tried to undermine the recommendations of the body by distancing themselves from the issue. Contrary to what the IAP committee on immunisation is recommending, these physicians have floated their own recommendations and guidelines, which seem more in consonance with those of the vaccine companies. This has created even further confusion. The ethical guidelines went out of the window and such recommendations were supported by the so-called KOLs in associations, which are also funded by the companies.
Is this happening all over the country?
Yes. The members in question come from all parts of the country. It is funny how they have already declared they have conflict of interest with such companies, but are still allowed to participate in CMEs as faculty. They might not be part of the main committee recommending a particular vaccine, but they are still opinion leaders and influence decisions.
What are the MCI guidelines on this?
There are strict guidelines for medical practitioners to not accept honorarium from pharmaceutical companies. A medical practitioner can receive gifts worth upto Rs 1,000. The government has also approved these guidelines recently. Such alliances with the vaccine companies are clear grounds for suspension of medical licence.
There was also news of you being manhandled by the academy members at the conference. What happened there?
At the paediatrics annual conference in Bangalore held in January, while the executive board meeting was going on, the president suspended me from the academy and debarred me from participating in the general body meeting because of my letter and its media coverage. I wanted to present my findings and defend my case, but got no opportunity. How can an office-bearer facing serious allegations of violation of conflict of interest be the same person to take this decision? The suspension order was sent to me on e-mail just a few hours before the meeting. When I started to put my point forward in the meeting, they manhandled me and threatened me with more physical assaults. This was on the night of January 20. The next morning, I went to the police station and lodged an FIR against these people, which I later withdrew in good faith.
How have other doctors reacted to this incident?
After the incident, I received support from all over the country. Several paediatricians have boycotted the activities of the academy. The current office-bearers have also been boycotted. States such as Kerala and UP have passed resolutions to look for members with any conflict of interest and not take part in the activities of the academy until these issues are resolved. In the last two months, the activities of the academy have been stalled.
Many doctors have also called my suspension illegal. The questions I raised in the open letter sent to the association had around 16-17 issues that are yet to be addressed.
What is your next course of action?
The battle has to be fought on two fronts—the personal and the organisational. On the personal front, I am going to approach the Medical Council of India (MCI) on the code of ethics. There is a guideline of the MCI that says it is the duty of a medical practitioner to use all available means to expose such unethical practices. I went through all recourses to bring what was going on to the notice of the president. Only when I was pushed to the wall did I write that letter.
At the organisational level, the system needs to be overhauled completely. Persons with dubious credentials should never be in a position to dictate terms of policy that will affect the health of our children. Our organisation needs to be freed from the clutches of the vaccine mafia and its agents. It is pharmaceutical money that is corrupting our organisation. The medical council has rightly put a cap on gifts and freebies that companies can give to doctors. It is high time they looked into organisational funding through conferences and CMEs by vaccine manufacturers.