India needs to now focus on the research, development, and manufacture of vaccines as well

Health Care, Heart Care Foundation of India, Medicine Comments Off

Myths and misconceptions about vaccination should also be eliminated

Vaccines are free at government set ups

New Delhi, 5th January 2019: Vaccines are estimated to avert 2 to 3 million deaths annually from diseases such as pneumonia, diarrhea, measles, and diphtheria. They are universally recognized as among the most cost-effective public health interventions. Vaccines also provide benefits to countries far beyond better health outcomes, such as increasing economic growth and development.

India has played an increasingly important role in the global immunization landscape. We have been able to reach several significant immunization-related landmarks – namely elimination of polio (in 2014) and maternal and neonatal tetanus (in 2015). However, efforts beyond this are now needed to focus on the research, development, and manufacture of vaccines.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Immunization is necessary for one and all. Often, people assume that it is not necessary because their children appear healthy or do not fall sick often. In other cases, health workers may not be able to reach out to some families due to non-availability of members at a certain point. There is a need to create awareness on the importance of immunization particularly for children and expectant mothers. Doing so will help us play a role in the larger good of the nation and achieve the government’s target also in a timely manner. Apart from this, there is also a need to scale up manpower, supplies, budget, and other resources to speed up the process.”

Mission Indradhanush, depicting seven colours of the rainbow, targets to immunize all children against seven vaccine preventable diseases namely Diphtheria, Pertussis, Tetanus, Childhood Tuberculosis, Polio, Hepatitis B and Measles. In addition to this, vaccines for JE (Japanese Encephalitis) and Hib (Haemophilus influenzae type B) are also being provided in selected states. Apart from this, there are also vaccinations for adults.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “If the coverage is not sustainable year on year, it will ultimately lead to fatigue. If the mission is intensified, the efforts ahead also need to be at par. There is still reluctance, opposition, and slow acceptance of vaccination apart from other operational challenges. The challenges faced in delivering lifesaving vaccines need to be addressed from the existing knowledge and lessons must be learnt from past experiences.”

The Vaccination Schedule under the UIP is as follows.

  • BCG (Bacillus Calmette Guerin) 1 dose at Birth (upto 1 year if not given earlier).
  • DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6weeks,10weeks and 14 weeks and two booster doses at 16-24 months and 5 Years of age.
  • OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one booster dose at 16-24 months of age.
  • Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.
  • Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age.
  • TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age
  • TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year
  • In addition, Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006-10 and has now been incorporated under the Routine Immunisation Programme.

Quit, or patch up!

Health Care Comments Off

Should e-cigarettes, nicotine patches, other nicotine-replacement therapies, and heat-not-burn (HNB) tobacco products be encouraged? Are they less harmful than smoking and traditional ways of taking tobacco? The current tobacco debate, as always, is between the hard line and pragmatism. Both sides have cogent arguments in this suspicion-ridden contest, clouded by the shadow wars staged by big tobacco and pharma lobbies.

Among those in India who argue for a pragmatic approach is leading cardiologist Dr KK Aggarwal, a Padma Shri and former president of the Indian Medical Association (IMA). “If a patient tells me he smokes, I tell him he must quit. As a doctor, my ethics dictate that I do that – and I always advise young people to never consume tobacco in any form. Or get into other drug dependencies, for that matter. I also took part in the campaign for bigger pictorial warnings on cigarette packets,” he says. “But when a patient with a long history of tobacco use is unable to stop, or does not want to, what can a doctor do? A pragmatic solution is to suggest that the patient switch to less harmful ways of getting his nicotine high. Also, these aids may help him quit ultimately.”

Nicotine patches or e-cigarettes may help smokers or tobacco chewers assuage the craving. Since there’s no smoke or tar, nor any chewing, the risk of lung and oral cancer is lower. Though nicotine is highly addictive, causes hypertension, constricts and hardens arteries, and increases the heart rate and the risk of blood clotting, it’s not per se known to cause cancer.

Aware that controversy hovers over the topic, Dr Aggarwal sets down strong caveats: sale should be restricted to those above 21; some items must be available only on prescription; efforts should be redoubled to discourage tobacco use in young people; and students should be cautioned on the health risks of tobacco use and other dependencies, right at school level. Since a ban on tobacco can neither be effected nor prove effective, he says there should be enough leeway for “harm reduction”. He cites reports from Public Health England; the US National Academy of Sciences, Engineering and Medicine; the American Cancer Society; Cancer Research UK; and the Royal College of Physicians.

“Harm reduction” is a new buzzword, but those on the other side call it a euphemism coined to ease in new fashions that benefit tobacco giants. They suspect a nascent tobacco-pharma lobby is at work: after all, the nicotine in the patches and vaping fluids comes from tobacco. Researchers at the University of California, San Francisco, say “the pharmaceuticalisation of the tobacco industry” has begun.

In the US, as across the world, the debate is polarised. On December 18, surgeon-general Jerome Adams issued a rare public health advisory calling for immediately addressing the vaping epidemic among teenagers. He warned that nicotine exposure in adolescence can harm the developing brain. Vaping fluids in kid-friendly flavours and e-cigarettes with sleek gadget appeal would hook teens and make them adult smokers. Or marijuana users, since teens start using the devices for vaping marijuana too. On the other hand, in a November 15 article in the Washington Post, Tom Miller, a former attorney-general, wrote that if smokers are denied safer alternatives because of the overreaction against e-cigarettes, the country risked losing the huge fall in smoking rates (from 24 percent to 14 percent) achieved over 20 years.

There is also the controversial case of Derek Yach, a former World Health Organisation (WHO) hand who took part in the scripting of the Framework Convention on Tobacco Control. He now heads the Foundation for a Smoke-Free World, which advocates the use of e-cigarettes, patches, etc. The foundation is promoted by Philip Morris International, a tobacco giant.

Dr Aggarwal, like Yach, is all for switch-and-quit. Even if quitting does not happen, the harm at least is reduced, he reasons. As for behavioural therapies for quitting tobacco, he says they are not practicable on a large scale in India: counselling takes months and there arent enough counsellors. The debate smokes. Or perhaps does the dragon, a teen-favorite trick in which vapers exhale fumes through the nostrils and the corners of the mouth at the same time.

(Reproduced from: Governance Now, January 15, 2019 edition, pg 10)

Also watch a video on Impact of Smoking vs Vaping Demonstration

@https://www.youtube.com/watch?v=5EOLvHzE1×8&feature=youtu.be