A few shots too many

Written by Garima Pant | Updated: Oct 4 2010, 05:12am hrs
New parents are caught in a dilemma. Apart from the mandatory vaccines (as per the national immunisation schedule), they are faced with a tough choice about the additional barrage of pricks and drops that doctors recommend. And, the fear of side effects makes the confusion worse, not to mention the hole these additional vaccines burn in the pocket.

The latest addition in the 'optional list' was the influenza vaccine, that once taken before a child turns one in two successive shots, has to be an annual affair till one attains the age of 80. And if that wasn't all, to top the list came in the H1N1 scare, providing a windfall for the vaccination industry.

It's a Catch-22 situation. On one hand are health concerns and on the other are the ever-increasing number of vaccines flooding the market and the mind, forcing an average person to gamble. With new paediatric vaccines being suggested by doctors, parents are surfing the Internet, cross-checking, ringing up friends abroad, and making a beeline for paediatricians to find out whether new vaccines like pneumococcal (for pneumonia), mencivac or meningococcal vaccine and injectable polio vaccines are a must for babies. With immunisation cards in hospitals reprinted every few months following new additions, even paediatricians say the confusion among parents is understandable.

Compounding the confusion are the various brands available, besides options of foreign-made vaccines.

A single dose of pneumococcal vaccine costs Rs 4,000. The entire dose comes for Rs 12,000, says homemaker and first-time parent Reema Rewal. Though it is prevalent in other countries, the vaccine is new here and it is important that we find out whether the vaccine is effective for babies in Indian conditions. Doctors say though expensive, some of the new vaccines guarantee less pain and no fever for children. The DPT vaccine, now called DTaP vaccine, is one such, say doctors. What also holds potential to succeed, feel health experts, is the adult vaccine segment, which is being recognised globally, but is yet to make a mark in India.

According to a 2009 Frost & Sullivan published report on the Indian vaccine market, the total vaccine market estimated around $79.4 million in 2009. The paediatric vaccine market in India is valued $23.5 million in 2008 and it is estimated to reach $28 million in 2009. The adult vaccine market in India is valued $50.3 million in 2008 and it is estimated to reach $51.4 million in 2009.

Though it's the metro cities that are the primary consumers for the optional vaccines right now (with their higher paying capacity), experts see the trend going to smaller towns in the near future as well. Even in the villages and other tier-II and tier III cities, the paying capacity of people is going up and so is the demand for the optional vaccines, says Dipta Chaudhury, Program Manager, Pharma and Biotech Practice, South Asia and Middle East, Frost & Sullivan. And with the swine flu scare, the vaccine market for the influenza vaccine is also increasing, especially in the developed countries.

With swine flu fear triggering pandemonium among the general public, the H1N1 influenza (swine flu) vaccine global market is forecast to grow beyond $7 billion by 2011, according to a report by Markets and Markets, a research and consulting firm. The market will peak to $7.03 billion in 2011, growing at a compounded annual growth rate (CAGR) of 222.4% from 2009 to 2011. Even though there occurs a huge price difference between the Indian and foreign-manufactured versions of the vaccines (Indian versions are available for Rs 150-350), doctors have seen people still preferring the international versions.

The reason: It's just a question of mindset and an individual's perception. We do try to educate people about the cost-effectiveness of vaccines, but the final decision is theirs, says Dr Arvind Taneja, specialist in infection diseases and paediatric, Max Healthcare. The market, especially in the metros, witnessed approximately a 300% jump in the vaccine market after the H1N1 scare, adds Dr Taneja.

However, the demand for the Indian version of the vaccine has reportedly gone down. The lack of demand for H1N1 vaccines has put the spotlight on the World Health Organisation (WHO), accused of creating a panic about the disease to give the pharma industry a boost. WHO had declared H1N1 a pandemic on June 11, 2009. An investigative report in the British Medical Journal on June 3 said pharma companies, for their own profit, paid key scientists who were advising the UN health agency on pandemic preparedness plans. WHO, though, has refuted the claims. It is the scare that is making people also go for swine flu vaccines, although not in large numbers. But we do see more people opting for the vaccine by next year, says Chaudhury.

Dr Sushum Sharma, senior consultantinternal medicine and HOD, preventive healthcare programme, Max Healthcare, feels that too much of a scare is being created regarding the H1N1. No one, even the WHO, is talking to us doctors who are seeing almost 50 patients a day. We are at the ground, directly in touch with the infected people, but who is asking us about the statistics asks Sharma.

He also points out on how there have been researches (September issue of the Journal of American Medical Association), that cite how there are more deaths by a normal flu than the overhyped swine flu. An analysis of data from influenza cases in the US state of Wisconsin indicates individuals with 2009 H1N1 infections were younger than those with H3N2, and that the risk of most serious complications was not higher in adults or children with 2009 H1N1 compared with recent seasonal strains, cited the journal. Sceptics also doubt if in India's case, whether other illnesses have a greater toll than swine flu.

As per a research titled, Global Vaccine Market Forecast to 2012, India represents one of the fastest growing vaccine markets in the world. The vaccine market in India is forecast to grow at a CAGR of around 23% from 2009-10 to 2011-12. The research has found that focus of vaccine majors has shifted towards developing countries like China, India and Brazil. Most of the investments at the global level are being done in these countries to tap the benefits offered by them and expand business operations. Vaccine has emerged as one of the most profitable business segments in the global healthcare industry. The segment registered revenues of around $ 27 billion in 2009.

Meanwhile, whether its the paediatric vaccine segment or the adult vaccine segment, the confusion continues.

The must-haves

At present the immunisation schedule for Indian children includes six mandatory vaccines, such as BCG to prevent TB and OPV or IPV (both polio vaccines) given at birth and every four-six weeks (a total of six doses: four within the fourth month with a booster given at 18 months to two years, and a second booster between ages four-five years). Pulse Polio immunisation is also given in addition to the routine polio drops to prevent poliomyelitis.

The Hepatitis B vaccine is given in three dosesat birth and then at the end of the first and sixth monthsto prevent liver infection. DTwP (formerly DPT) or DTaP prevent diphtheria, tetanus and pertussis and is given at six weeks in three doses at intervals of four-six weeks, followed by two boosters between two and five years. The measles vaccine is given at nine months; the MMR vaccine, given at 15 months, is for protection from measles, mumps and rubella.