Countries need to produce their own vaccines, and they need to invest in public sector capacity to do it, says Indian scientist Y. Madhavi.
Developing countries must be able to research, develop and produce their own vaccines to provide a stable health system. This is particularly true when battling outbreaks of emerging diseases. For example there are already concerns that developing countries may struggle to access vaccines for influenza A(H1N1) — swine flu — because most major vaccine producers are based in developed countries (see Poor may lose out in swine flu vaccine production).
But disease control is not just about fire-fighting against outbreaks. In India, a few hundred cases of, and around two dozen deaths due to, swine flu are making headlines but the millions of deaths each year from diagnosable, preventable or treatable infectious diseases are mere statistics. Locally-produced vaccines are essential for reducing these deaths. Admittedly, they won't be enough without government action on safe drinking water and sanitation, crumbling hospitals and unaffordable private healthcare. But they play a crucial role.
The closure of India's public sector vaccine units over the past 15 years and the private sector's failure to keep its promises have led to a short-fall in affordable essential vaccines for India's universal immunization programme (UIP), which targets diseases such as diphtheria, petussis, tetanus, tuberculosis, polio and measles. Sadly, the UN Children's Fund (UNICEF) says this situation is common across the developing world.
There are plenty of private firms in India and abroad developing new vaccines for mass vaccination programmes. But these tend to be expensive, and target neither the right diseases nor the right people for India's public health challenges. For example, some companies produce vaccines against human influenza, but these soon become ineffective because the fast-mutating virus requires newer vaccines every other season. And such vaccines are doubly inappropriate in India, where there are indications that people have a natural immunity, so may not even need a vaccine at all.
To make a vaccine policy rational and sustainable one needs efficient disease surveillance, as well as data on indigenous strains of pathogens and on local immunity. One must also critically assess the suitability of imported vaccines and drugs. Sadly, these elements are lacking, or at best scarce, in India.
These aspects are all crucial for making informed decisions and developing evidence-based policies. And, perhaps more importantly, they are all local activities that can be complemented, but not replaced, by external inputs from the private sector.
Private and public roles
Public-private partnerships (PPP) are not the answer either. The Indian government is supporting PPPs to develop an A(H1N1) vaccine even though sceptics point to the neglected essential UIP vaccines. But our past experience with PPPs in India has not been good. Alleged dubious financial deals between the public sector Pasteur Institute and the start-up private firm Green Signal Biopharma in 2007 are now under investigation. The planned PPP Vaccine Park near Chennai has also faced severe criticism.
The push by big multinationals to buy up local companies as soon as they show promising signs of success in part result from corporate greed and economic policies in countries like the United States. Such policies are ruining public health systems in developing countries. The Shantha story shows that the private sector is not a reliable and sustainable substitute for public sector units in crucial areas like public health.
Public sector vaccine units are essential for building local capacity and creating a stable and affordable supply of essential vaccines, unaffected by market vagaries.
But there is hope, because the Indian government is now proposing to reopen public sector vaccine units. India has a century-old tradition of developing and producing vaccines through the public sector, and of mass immunisation. Indeed, the British established many vaccine units in India precisely for their strategic value in protecting their local personnel. With today's concerns over biological warfare and biosecurity, self-reliance through the public sector provides an ever more important way of ensuring national health. Consistent policy support and government patronage could make the country self-sufficient in essential vaccines.
The ongoing battle against A(H1N1) holds lessons for developing countries already struggling with their ailing economies. The swine flu battle will be won sooner or later, but the war against infectious diseases is far from over. There are no short cuts to government investments and public sector predominance in all aspects of public health and healthcare delivery.
Y. Madhavi is a scientist at the National Institute of Science, Technology and Development Studies in New Delhi, India. The views expressed in this opinion are her own.