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New challenge to #pentavalent #vaccines is more ideology than science

Activists this week asked the Supreme Court to stop the government of India from using pentavalent vaccines throughout the country. This, say, the activists is because there have been 21 deaths following the use of the five-in-one vaccines in Kerala and Tamil Nadu

India’s pentavalent vaccine protects against diphtheria, pertussis (whooping cough), tetanus, hepatitis B and Hib, a bacterium which causes pneumonia and meningitis deaths among children around the world. Similar vaccines are used all over Europe and the Americas (they are similar but not identical because the threat to children is different in many countries so one of the elements of the five-in-one vaccine may be changed to give maximum protection. Here, for example, is a link to the vaccination schedule in the United Kingdom, you will see that the first item during the first three visits is “a 5-in-1 vaccine”).

No-one argues over the need for the first three components (DPT) of the penta vaccine: they have been given to children in India for years, often with vaccines made in public sector units which were closed down but have now been re-opened under court order at the behest of trades unions.

The activists sometimes argue that there is no threat from Hib in India: this would mean that, uniquely among the world’s people, India’s children were harmed only minimally by this bacterium. It’s inherently unlikely but difficult to test: Hib is fragile outside the body and can only be isolated under very strict conditions in sophisticated labs. What we do know is that over half of all of the world’s pneumonia deaths are in India. An Indian child is six times as likely to die as a child in China. Unless the laws of biology have been suspended in the lands of the Indus River, these children are dying of Hib and pneumococcal disease. (There is a vaccine against pneumo, used in every other advanced country but blocked in India by  the efforts of both local manufacturers — who are working on their own versions — and anti-vaccine activists. Possibly you see a pattern emerging here)

Is pentavalent vaccine dangerous then? The activists say that it has been banned in other countries. This is simply untrue: there were brief investigations during which penta vaccines were suspended and then reinstated because the investigations showed that they were not associated with any high risk of harm but I don’t know of any country that has decided to stop using them. Indeed, Bhutan (which the activists talk about) has now immunised 97 percent of its children with the penta vaccines.

Yet, children clearly have died shortly after being immunised. Sadly, this is true. Children do die when they are young: some die for reasons that we understand fully (an attack of malaria for example) and some for reasons that we don’t. If you immunise hundreds of thousands of children with any vaccine, random chance says that some will die in the next few days. This is a bit like saying that some people die after eating their breakfast: if enough people eat breakfast, a very few will die shortly afterwards. It was not breakfast that killed them. Similarly, exhaustive investigations by the WHO and the Government of India have shown that the deaths after pentavalent vaccines were not caused by the vaccine. Of course, it is devastating for any parent to lose a child and as a global society, we must move towards a future where children do not die of preventable diseases. At the moment, India has the unenviable distinction of leading the world in vaccine-preventable deaths.

Let’s have a thought experiment. Let’s pretend pentavalent vaccines really did kill infants. Where would we look for evidence? We would look for thousands of deaths amongst India’s middle and upper-middle classes because almost every child who sees a paediatrician privately in India gets a penta jab (along with pneumo and a  rotavirus vaccine that prevents illness from some kinds of diarrhoea — it’s available widely in the public sector in Africa but not in India because …. yes, a version from a national manufacturer is still having the glitches ironed out). Where is this missing cohort of dead affluent Indians? Have thousands of parents and thousands of paediatricians committed to a pact of silence in order to foist penta on the poor? Are there unremembered children, expunged from the records of hospital chains all over India whose pictures have been locked away in case anyone discovers the truth about penta?

This is obviously absurd. All the more absurd when you consider that one manufacturer in Pune supplies over 80 million doses of penta vaccine to over 100 countries around the world and they are unlikely to be orchestrating an even more ambitious cover up of side effects.

The activists are ideologically motivated in calling on the courts to ban a life-saving product. They would rather see old vaccines produced in government factories that fail to protect against India’s killer diseases than effective new ones. As the renowned UP paediatrician, Dr Vishwajeeet Kumar wrote in the HT in April, “we are rapidly ceding ground when it comes to providing life-saving healthcare to our children through the introduction of new vaccines. Ideologically-motivated attempts questioning vaccine safety and efficacy are partly responsible for this…. It is our collective responsibility to put science back in the driver’s seat.”


This post had minor edits at 1.30am IST on the 7th of September

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