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Why Immunisation Is Not An Expense But An Investment

Without it the nation would suffer heavy losses.

05/05/2017 9:08 AM IST | Updated 05/05/2017 9:08 AM IST
Jayanta Dey / Reuters

A few decades ago there were only a handful of diseases that could be prevented by immunisation. We had the BCG vaccine (against tuberculosis), diphtheria-pertussis-tetanus vaccine (DPT), oral polio vaccine and measles vaccine. These vaccines were developed in the early or mid-20th century, and production technology was relatively simple. Also, the production cost was low. So, in the mid-1970s, when the Expanded Programme on Immunisation was launched by the World Health Organisation (WHO), these vaccines were included in it for cost-free dispensing. Governments could afford to buy them with revenue income. Vaccines made later on, however, used more sophisticated technologies and production costs escalated.

The one in 100 to 1000 who gets the disease will cost the family (and eventually the nation) many times more than what it would have taken to immunise all 100-1000 children.

When the hepatitis B vaccine (HBV) was imported, it cost some ₹800 in the private market. When it was made in India the selling price fell to less than half. When India's EPI (now called Universal Immunisation Programme, UIP) included it in the schedule, companies were able to sell it at less than ₹10 a dose. Purchase by UIP assures volume off-take and the manufacturer takes no risk of guessing what volume to keep on the shelf. This sequence has played out with other vaccines subsequently introduced in UIP. India-made Haemophilus influenzae b (Hib), pentavalent (DPT-HBV-Hib) and rotavirus vaccines, all in UIP now—again at only fractions of the prices we would have paid if they were imported at international market rates.

The newest additions in UIP are inactivated polio vaccine (IPV), rotavirus vaccine (RVV) and Measles-Rubella vaccine (MR), with Pneumococcal Conjugate vaccine (PCV) to be added soon. MR and RVV are made in India; IPV and PCV are currently imported and are relatively more expensive than many others in UIP. It is but natural for people to ask if such expensive vaccines are really necessary in UIP. That brings up the question as to why we vaccinate children against more and more diseases, spending more and more money.

In many traditional cultures, India included, diseases are considered "natural", and immunisation is viewed as "unnatural". Some ask if it is even right to prevent diseases. The "natural", however, comes with a price—the discomfort of disease, the worry of parents, school attendance lost, examination missed, family vacations messed up. Some like pneumonia requires hospitalisation; some like pneumococcal meningitis results in hearing loss, brain damage, even death. The probability of disease is low for any one child, but, if you count a thousand children, it is Russian roulette. How much do any of these inconveniences or events actually cost in terms of economics? Will the health economist among us please stand up? We don't have any in the Health Ministry or in most Medical Colleges. Many think the cost of immunisation, even using public funds, is merely an expenditure item, but in reality it is investment for profit.

Health economists have calculated that investing in immunisation brings in huge profits—some 20% every year in perpetuity – even with expensive vaccines.

Well, what exactly is the probability of a bad disease that could have been prevented by immunisation? Rural folk tell me a simple calculation: fifty-fifty. Either it is going to happen or it is not. If you cannot predict that my child will get the disease, should my child be vaccinated? How do we convince them the chance is 0.1 or 0.01? As long as the microbe is in circulation, the probability is never zero. The one in 100 to 1000 who gets the disease will cost the family (and eventually the nation) many times more than what it would have taken to immunise all 100-1000 children. Health economists have calculated that investing in immunisation brings in huge profits—some 20% every year in perpetuity – even with expensive vaccines. That is exactly why many licensed vaccines are recommended for all children in the USA—not because they have more disease. They routinely immunise against hepatitis A, chickenpox, mumps and human papilloma virus infection, in addition to all the diseases we immunise under UIP.

The government insists on helmets and seat belts to protect the brain from external injury. Hib, PCV, MR, and Japanese encephalitis vaccine protect the brain from internal sabotage. It is the birthright of every child to be protected from locally prevalent diseases that affect the nutritional balance and cause disability of any kind— it is parental duty to provide that protection to every child. Parents depend upon the State to provide immunisation.

Done well and transparently, immunisation is a win-win-win—for children and families, for the vaccine industry, and for the nation.

Do vaccine manufacturers make financial profit? Of course, they do. Do food producers and distributors make profits? Does anyone work without a salary? No. Does that mean we work only for salary? No. When governments give free vaccines, they are not really free—taxpayers pay for them. When public sector companies manufacture vaccines, all expenses are covered by government budgets and what is called free is actually expensive. Good private sector companies can produce vaccines at competitive prices and yet maintain high quality and also invest in research to improve production or create new vaccines. Public sector companies have no compulsion to do any research.

Even though vaccines are "essential commodities" and not luxury items, the manufacturers deserve fair profit. However, there must be purchase on tender basis, encouraging competition and lowest prices. The Indian vaccine industry provides a huge proportion of vaccines used all over the world. That makes the country richer. Government regulatory mechanisms ensure that the quality of the product is assured. Done well and transparently, immunisation is a win-win-win—for children and families, for the vaccine industry, and for the nation.

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