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Tuesday, July 5, 2022
R. Dev Raj
NEW DELHI, Mar 10 1998 (IPS) - When an Indian pharmaceutical company developed a cheap vaccine against Hepatitis-B, a virus deadlier in this country than HIV, it did not reckon on running into a trade war with a transnational.
So far, India has been unable to consider World Health Organisation (WHO) recommendations to include a vaccine against Hepatitis-B virus (HBV) in the Expanded Programme of Immunisation (EPI) because of the high costs. More than 85 countries have accepted the recommendations.
Well-to-do Indians think nothing of the 38 dollars it takes for three doses of the plasma-derived, “first-generation vaccine”, imported by the U.S-based transnational Smith Kline and Beecham. But such costs are beyond the reach of most Indians.
“We are talking about vaccinating 25 million children each year and only an indigenously produced vaccine can meet our needs,” says Dr. Lalit Kant at the Indian Council of Medical Research (ICMR).
With HBV lurking in the bodies of an estimated 50 million Indians, at least a quarter of whom can be expected to end up with serious liver disease, the new vaccine has come not a moment too soon.
“Approximately 200, 000 people die in this country every year from HB infection,” says Dr. Rakesh Tandon chief of gastroenterology at the prestigious All-India Institute of Medical Sciences (AIIMS), here.
According to Dr. Tandon, HBV is a silent killer because it escapes detection and because the liver goes on functioning normally until the virus has wreaked irreparable havoc.
If HBV cannot be prevented for lack of money, the economic consequences of large sections of the population getting debilitated by the virus is even more unaffordable.
“One has to consider work hours lost for patients and their attendants, poor quality of life after an attack and premature death,” says Dr. Nomeeta Gupta, one of a group of doctors who advocate inclusion of a vaccine in the national immunisation programme.
Worse HBV carriers pass on the virus to other people through the same routes as HIV – transfusion of blood, sexual contact and infected needles and sharp instruments such as dental equipment.
Dr. Gupta is critical that although funds are freely available for anti-HIV programmes, there is little interest in HBV even though it is far more infectious and vaccines are available against it.
Once the virus strikes, the only treatment available in India is administration of the drug called ‘Interferon,’ which is effective in only a third of patients and which costs around 2,500 dollars a course, says Dr. Arun Kumar, gastro-enterologist at the up-market, Apollo Hospital here where it is available.
Immunisation is clearly the cheaper option although the potential benefits of HVB immunisations is yet to get home to policy makers.
In fact, for years, SKB openly targeted the 2 percent of Indians who can afford their imported product as a strategy to develop a demand for the vaccine in India.
But poorer people just had to wait for a genetically- engineered vaccine developed indigenously by a Hyderabad-based company with funds provided by the ‘SPREAD’ programme of the World Bank and the Indian Ministry of Science and Technology.
While the older plasma-derived vaccine is made from the cells of infected humans, the genetically-engineered vaccine is made from yeast cells using the second-generation, recombinant technology.
After a five-year effort, the company, Shanta Biotech formally launched, last week, ‘Shanvac-B’ at about 14 dollars for three doses bringing it within the reach of the EPI.
“Even more important is the fact that the paediatric doses cost a little over 10 dollars,” says Dr. Gupta, a paediatrician by training.
According to the chief of Shanta Biotech, Varaprasad Reddy, if the government does adopt the vaccine for the EPI, the costs of ‘Shanvac-B’ could come down even further, through economy of scale.
But so far, the government has not even considered waiving customs duties on essential chemicals, biological reagents and important consumables.
“What I find galling is that the imported vaccine comes into this country without any customs duty at all and therefore enjoys an unfair advantage,” Reddy said.
Reddy also accuses SKB of launching what he calls “a vilification campaign” against ‘Shanvac-B’ saying that it is not well-tested. “More than 100,000 people have been vaccinated with this product and there has not been a single adverse reaction,” he said.
At the launch of his vaccine, Reddy hit back by distributing lapel buttons reading “I am proud to be an Indian,” and urging the government to “safeguard an indigenous product and the efforts of Indian scientists.”
Having sold 15 million dollars worth of the vaccine and with serious interest being shown by other South Asian countries like Bangladesh and Sri Lanka, Reddy really has no cause to complain.
“Actually there is room for everyone. The rich will continue to buy the imported vaccine simply because they think that what is costlier has to be better,” Dr. Gupta said.
Meanwhile, the good news for ordinary people is that SKB has been steadily bringing down the price of its imported vaccine and currently it sells at 20 dollars a course.
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