Over the past few months there have been news reports, with headlines that have grabbed our attention, on the spread of deadly infectious diseases. These include outbreaks of measles in Europe and Ebola in the Democratic Republic of Congo, and, closer home, Zika in Rajasthan and cases of diphtheria in Delhi. Consequently, the focus of discussion in the media has been on treatment and control, with news coverage dissipating after the peak of an epidemic. This is a time — between outbreaks — when we need to be asking ourselves how we can prevent the next epidemic.
A vaccination programme is perhaps our most important tool in preventing and controlling outbreaks of infectious diseases. Universally recognised as among the most cost-effective public health interventions, vaccines are estimated to avert 2-3 million deaths annually from diseases such as pneumonia, diarrhoea, measles and diphtheria. Vaccines also provide benefits to countries far beyond better health outcomes, such as increasing economic growth and development.
In recent years, India has played an increasingly important role in the global immunisation landscape. The country has reached several significant immunisation-related landmarks. These are, the elimination of polio (in 2014) and maternal and neonatal tetanus (in 2015). But beyond these efforts India has served another, perhaps less widely recognised, role namely in the research, development, and manufacture of vaccines.
India’s pharmaceutical industry is growing rapidly. The country already has the distinction of delivering more vaccine doses each year than any other country. Nearly half of all vaccines delivered globally are manufactured in India. India-made vaccines are driving reductions in childhood disease in Africa, Asia and beyond. There is also a substantial amount of indigenous research under way to develop new vaccines against other life-threatening diseases such as malaria, dengue, chikungunya, cholera and shigella.
Issue of public distrust
But despite this progress — and in keeping with global trends — there has been a parallel spread of misinformation and rumours in India about vaccines that have sometimes created public distrust of vaccination programmes. Unfounded claims about vaccination — spread for various reasons unrelated to health — have led to periodic drops in immunisation coverage, thereby putting entire communities at risk. With India providing protection against disease to millions of children in other countries, should not we ensure that every child in India has the same access?
For example, one vaccine that some have questioned the need for in India is the human papillomavirus (HPV) vaccine. The human papillomavirus causes cervical cancer, which kills more women in India than in any other country. The HPV vaccine is very effective in preventing infection by strains of the virus that cause the majority of cervical cancers. Yet, despite such compelling evidence, there has been controversy over the introduction of the vaccine in India because of unsubstantiated fears of possible adverse effects.
This example shows how unscientific voices can fuel public distrust, made worse by a lack of understanding of scientific procedures that are in place to ensure that vaccines are safe and effective. To start with, vaccine development takes years of rigorous research, followed by several rounds of testing to assess the product’s safety and efficacy.
Determination of whether a new vaccine should be introduced is taken by independent experts and government agencies. Once a vaccine is introduced, government agencies continue to monitor vaccine use to ensure safety.
India also has the potential to lead global research in vaccines and pharmaceuticals, and biotechnology. This can be achieved by creating an environment that fosters the training of new scientists, development of research centres, and cutting-edge clinical research. India’s scientific community must also continue to insist that decision-making about vaccination be based on scientific evidence. Only then will India’s capacity to make an indelible mark on the world — improving health and driving innovation — be realised.
Dr. Virander Singh Chauhan is Senior Scientist and Visiting Professor, International Centre for Genetic Engineering and Biotechnology