Urgency of Protecting National Interest in Vaccine Sector

Bharat Dogra

In the recent debate on COVID-19 there has been a lot of emphasis on finding vaccine for COVID-19. However, at the same time there is need for this discussion to take place more in the context of the needs of poor and developing countries and their people. Under the existing dominating world system of vaccine development and production, how will the interests of making available rational and safe products at low cost to the people of these countries be protected?

In recent years it has been seen in the health programmes of  one developing country after another that the dominating influence of multinational companies and their networks in the vaccine sector has increased and this process has been facilitated by some private billionaires who present themselves as philanthropists but in fact promote their own narrow interests and agendas. This has happened to such an extent that the national government no longer decide the vaccines agenda; for all practical purposes  it is these powerful outside agents and the international vaccine networks dominated by them who have their way.

All this should be seen within the wider framework of how various vested interests have tried to dominate vaccine production and research to carve out markets and maximize profits. This is explained well in an editorial of the Indian Journal of Medical Research  (written by Jocob M. Puliyel and Yennapu Madhavi.

"The methods used by economically well-off nations to gain control over economically poor countries by accessing their markets and creating demand for medical technologies/vaccines, irrespective of local needs, have been documented extensively. As a new product is being readied, research is published to highlight the number of deaths in the country caused due to the absence of that vaccine. The estimates are often outright exaggerations or reflect poor research design. The limitations of such models have been pointed out previously.

"In the face of bourgeoning and aggressive marketing of vaccines of doubtful utility, we have a widening demands-supply gap in Expanded Programme on Immunization (EPI) vaccines. Over the last few decades, due to the decline of the public sector and the growing disinterest of the private sector, the number of firms supplying EPI vaccines has declined drastically both in India and abroad, prompting the UNICEF to express its serious concerns about the short supply of EPI vaccines. Private manufacturers prefer to sell them as ‘value-added cocktail vaccines’ at exorbitant prices in the open market, rather than supply to EPI. The universal tendency to combine EPI vaccines with non-EPI vaccines not only creates an artificial scarcity for affordable EPI vaccines, but also creates a backdoor method for the entry of expensive and perhaps unnecessary non-EPI vaccines into the universal immunization programme, riding piggyback on the EPI vaccines.... Only a ban against combinations of EPI and non-EPI vaccines, and a stipulation that only those private manufacturers who supply EPI vaccines to the government will be allowed to sell them in any form in the open market will save the EPI as well as the consumers. Dire situations call for drastic action.... Within the emerging scenario where expensive vaccines swallow up the less expensive options, India could emerge as the ethical EPI vaccine supplier to the world."

For India to be able to play such a noble role, we should first defeat the nefarious designs of those who seek to sabotage the indigenous production and R and D in the area of vaccines , as several such steps have been taken in recent decades and these have damaged the national interest in this important sector badly.

In the rush for combination vaccines preferred by marketing campaigns of some multinational companies it is sometimes forgotten that some of the benefits of single vaccines may be partially lost. Quoting several studies, Dr. Y. Madhavi, former Principal Scientist at the National Institute of Science, Technology and Development Studies, wrote in her paper," Vaccines and Vaccine Policy for Universal Health Care', (Social Change, June 2013), , "Scientific literature show that in general the safety and efficacy aspects of combination vaccines are not proven beyond doubt, and it is reported that they are less protective when compared to their individual components. In pentavalent vaccine (DPT-HB-Hib), lower immunological responses to Hep-B and Hib were observed when compared to their separate administration."

Dr. Madhavi also raises the question whether the universal immunisation programme (UIP) is being used to provide huge markets for those vaccines of dubious benefits to India which can not find a significant market on their own merit - "Why is it that every combinations vaccine is a product of a combination of a UIP vaccine and a non-UIP vaccine? Is it because lack of demand-pull for individual new vaccines (for example, Hepatitis B, Hib) is sought to be covered up by the UIP vaccines that enjoy higher legtimacy? Virtually all combinations are a means by which new vaccines are gaining a back-door entry through the captive UIP market by riding piggyback on UIP vaccines such as DPT, measles, IPV, OPV etc. If a new vaccine can stand on its own merits (especially epidemiological merit), why does it need a piggyback ride?"

Another crucial question is whether these efforts, aided and abetted by international organisations, are part of a larger design for big inroads of vaccine multinational companies and their subsidiaries into India's captive market for UIP. What is already well known is that many public sector vaccines making plants in India were arbitrarily shut down at least temporarily or vaccine manufacture there was stopped for considerable time. The controversy reacted its peak in 2007-08 when vaccine production including DPT was stopped in three public sector units. This closure was condemned by the Parliamentary Standing Committee. In addition, legal action was initiated against it. In the process hope for continuation of vaccine production in public sector units was renewed.

The pressures to introduce Pentavalent vaccine as a replacement for DPT may also be related to snatch away the DPT market from public sector units. This, moreover, may be one of several other efforts to give a larger role to private sector, multinational companies and imports to sell their expensive, patent-protected combinations in India, using the captive market of UIP and in other ways.

In the process the costs of immunisation may well be increased several fold. Often international financial support for more expensive immunization is given for a short time to make this acceptable and after that a poor or developing country is forced to find its own resources to support an unnecessarily expensive and much more risky immunisation programme providing huge benefits to private sector and foreign companies, ignoring the potential available in the country for a much cheaper, less risky, self-reliant, reliable programme based on public sector and rational products.

In other words, serious health hazards are being accepted in the ruthless promotion of big business interests. Developed countries do not themselves use some combination vaccines but their companies and lobbyists have been  pushing these ruthlessly in India and some other developing countries. They seem to have several powerful collaborators sitting in high positions in developing countries. With their help health risks for children are being played down using crude methods, while benefits are being exaggerated in equally questionable ways. Hence it is important for citizens and experts to join hands to protect critical health and child interests in developing and poor countries.

The writer is a freelance journalist who has been involved with several social movements.  

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May 7, 2020

Bharat Dogra

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