Hepatitis B campaigns

Two and a half years ago, we put out a press release jointly signed by health professionals and voluntary organisations, excerpts of which are reproduced below:

“There is a major ongoing campaign initiated by some commercial agencies towards Hepatitis-B vaccination through vaccination camps, by providing injections of such vaccines as Engerix-B, Shanvac-B and Hepavac. These are being conducted along with very wide publicity by nonprofessional agencies, exploiting the ignorance of well-meaning social organisations. The claims made by these agencies do not present an accurate picture of the incidence of this disease, or the imperative for such a massive vaccination programme.

“Such campaigns are continuing without intervention from the relevant health agencies. Instances have been reported of excessive money making by exploiting the public’s ignorance. We take strong objection to such developments and aim to awaken the relevant health authorities, local and state governments, and public interest agencies and public-spirited individuals to join us in evolving a relevant and rational policy of immunisation.

“Hepatitis B is only one form of jaundice, and not the most widely communicable or of immediate public health importance. For instance, there are various other types of viruses that cause jaundice, spread through water and foodstuffs, which affect the public more. Other diseases of the liver also cause jaundice.

“Hence, the needless alarm created by the mass vaccination drive and associated information disseminated by the various agencies involved is wholly unjustified in its proportion and not relevant at all from the public health point of view. The ignorance of the people is being exploited, spreading fear and a wrong impression about the disease as well as the effectiveness of the vaccine.

“People have been led to believe that the vaccine guarantees protection against all forms of “jaundice” and “cancer” of the liver. Dissemination of such misguided opinion gravely limits possibilities of effective community intervention for even more serious diseases prevalent in our society, which are being ignored to the detriment of the public’s health.

“The introduction of these vaccines is highly questionable considering that there is no evidence based on community studies to justify their use on a mass scale in Indian conditions. Studies quoted in justification of the present campaign are extrapolations of very limited research based on hospital data, largely supported by drug companies with vested interests. Further, any documented evidence in our context has not proved the extraordinary claims that are being made about the effectiveness of the vaccine. On the contrary, small local studies negate the claims to efficacy of the vaccine.

“The department of health has been silent on the essential facts relating to the disease, vaccine quality, the product’s cost and the promotional methods used. This silence has been exploited to the detriment of the public. People feel swindled by the varying costs of the different vaccines at different camps. Most dangerously, there is no legal and medical responsibility being taken in case the vaccines react adversely or if the vaccination is ineffective.

“Considering the gravity of the situation, we demand that:

“Mass vaccination in schools, at public camps and to non-risk groups, must be stopped immediately.

“Drug control authorities and relevant government agencies should take action against the prevailing vaccination campaign and launch an information dissemination exercise presenting the facts of the disease as part of a rational disease control approach.

“The vaccination programme should be conducted only under proper medical supervision and not at all for profit, as is currently the case.

“The government must constitute a committee of experts to prepare guidelines for the prevention of the disease and introduce vaccination only where needed.

“The government should subsidise the cost of the vaccine so that high risk groups are protected from contracting or transmitting this virus.

“This statement is being made to prevent public confusion over the disease and to refute the exaggerated need for vaccination. This is also a strong entreaty to the government to end its ambivalent attitude to ongoing campaigns, and to prevent exploitation of the public by vested interests. Finally, this is meant to inform the public to guard itself against ongoing campaigns and approach the right people for accurate information on the disease and its control.”

Following this press release and the resulting press publicity, the government of Karnataka was pressurised by public attention and the media to set up a high-level committee to investigate into the affair in a “time bound” manner. When no report was forthcoming after a month, we wrote to the minister asking for the report to be produced in the Assembly. I also raised this issue before the new government’s task force on health. However, the report has not been made public.

It would help if your journal writes to the present health minister and as well to the task force, demanding that the report be made public. It would help establish the need for transparency on such critical issues. This will also help raise the ethical questions involved in the renewed attempts by SmithKline Beecham to campaign again (and with extraordinary claims and publicity) for not just their Hepatitis B vaccine, but also the chicken pox vaccine.