India’s Vaccination Problem: CDDEP Director Weighs in for Nature and Health Affairs

22 Jun 2011
Andrea Titus

With GAVI's enormous fundraising success last week, there is great hope within the global vaccine community.  In the middle of the conversation about strategy is India – a test case for worldwide vaccination efforts.  Approximately 27 million children are born in India each year – the largest birth cohort in the world – but less than 44% receive a full schedule of vaccinations.

There are a number of reasons why India lags behind its per capita GDP counterparts in vaccination rates (compare to Bangladesh, where 82% of children are fully vaccinated by age 2), and they are outlined in this article in Health Affairs, co-authored by Ramanan Laxminarayan (CDDEP) and Nirmal Kumar Ganguly (Translational Health Science and Technology Institute, Jawaharlal Institute of Post Graduate Medical Education and Research). India will spend just $113 million on vaccine interventions in 2011, down from $137 million in 2009-10.  There is a shortage of trained personnel as well as limited surveillance and monitoring of both disease prevalence and vaccination efforts.  A lack of good data complicates the planning and prioritizing of vaccination programs. 

Demand for vaccines also suffers in India.  Low levels of education negatively impact health-seeking behavior.  In addition, “[a]dverse events following immunization, even when these are shown to be unrelated to a vaccine, have been widely reported in the Indian news media and have contributed to a culture hostile to vaccination in certain Indian communities,” according to Drs. Laxminarayan and Ganguly.

It is the hostility theme that's been picked up by Nature in an article exploring skepticism about the safety and quality of vaccines in India following the deaths of four girls participating in a trial study for vaccines against human papillomavirus (HPV).  While the vaccine was ultimately not found to have caused the deaths, the outcry launched an investigation which brought to light not concerns over vaccine quality, but ethical issues with the study itself.  Problems included inappropriate processes for obtaining participant consent, misclassification of the study as observational instead of clinical, and insufficient reporting of adverse events. “India still needs clear national guidelines on the ethical conduct of clinical trials,” said CDDEP director Ramanan Laxminarayan to Nature.

Ethical concerns, skepticism, and low vaccination rates persist despite India’s emergence as a global manufacturing leader in vaccines.  Currently about 43% of the global Universal Immunization Program vaccines come from India, and the Serum Institute is the world’s leading producer of measles vaccines.  This combination of factors will make India an important and unique proving ground in the "decade of vaccines."

Read India’s Vaccine Deficit: Why More Than Half of Indian Children Are Not Fully Immunized, and What Can –and Should – Be Done About It (Health Affairs, subscription required)

Read Vaccine Trial’s Ethics Criticized (Nature)


Image credit: Flickr: Jonathan Camuzo

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