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News Archives 4301-4320
Number Title Post Date
4301 The Worsening Journalist Disgrace At Wired 28/12/2010 17:35:13
4302 Did Pfizer Bribe Its Way Out of Criminal Vaccine Charges In Nigeria? 28/12/2010 17:41:03
4303 Beware UK Government Swine Flu Media Terror Campaign 28/12/2010 17:42:52
4304 Personal Responsibility - The War On Terror (Video Banned) 28/12/2010 17:47:13
4305 One Click Stats - December 2010 31/12/2010 10:15:04
4306 Happy New Year 2011 - Mantra For Peace 31/12/2010 10:21:57
4307 XMRV: A Human Retrovirus With Unknown Pathogenic Potential, Not A Lab Contaminant 05/01/2011 16:32:06
4308 Multiple Pfizer / Chantix Smoking Gun Lawsuits Hit USA Birmingham Court 05/01/2011 16:36:30
4309 A Nobel Peace Prize Winner Torturing Bradley Manning 05/01/2011 16:40:23
4310 8 Smears And Misconceptions About WikiLeaks Spread By The Media 05/01/2011 16:44:05
4311 Aftenposten Breaks WikiLeaks' Monopoly Media Cartel 05/01/2011 16:51:44
4312 Lies Damned Lies And Swine Flu Statistics Exposed! 05/01/2011 16:56:49
4313 Why Bradley Manning Is Fighting For His Sanity 06/01/2011 14:08:53
4314 Scientists Urge FDA To Stop Amalgam Use 06/01/2011 14:12:04
4315 Astellas Pharma Sues Prescrire, A Medical Journal 06/01/2011 14:14:03
4316 Swine Flu Redux 06/01/2011 14:16:12
4317 UK Public Health In Dire Straits 06/01/2011 14:17:56
4318 Ex-MP David Chaytor Gets 18 Months Jail For Expenses Swindle 09/01/2011 12:01:46
4319 Deadly Medicine 09/01/2011 12:03:15
4320 An Index Of 'Arm-Twistability' Of Governments Will Be Useful 09/01/2011 12:06:43

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An Index Of 'Arm-Twistability' Of Governments Will Be Useful
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An Index of 'Arm-twistability' of Governments Will be Useful

Jacob Puliyel on 08 Jan 2011

The authors assume that all vaccines are equally useful and cost effective in all countries. This is far from established.

The 1998 position paper of the WHO stated that countries should consider Hib burden before introducing the vaccine (1). After the Bangladesh and Indonesia probe studies showed little benefit from Hib vaccine in these countries (2), inexplicably, the WHO modified its recommendation to say Hib vaccine must be introduced in all routine immunization programs, regardless of national burden (3).

Vaccines against pneumonia (Hib and pneumococcal vaccine) only address two of the many causes of pneumonia (and causes of deaths from pneumonia). Even vaccines that are very efficacious against strain-specific-disease may have very little utility in the community, because the strain-specific-disease is a rare, compared to all the other causes of pneumonia (- low utility in terms of absolute risk reduction). For example, the Pneumococcal vaccine reduces only 3.6 cases of pneumonia per 1000 children vaccinated according to Madhi et al. The abysmal cost-benefit equation of this vaccine was discussed by us in the Lancet not long ago - ( $250,00 will need to be spent to prevent 4 cases of pneumonia. Treatment of 4 cases of pneumonia with Septan- as recommended by the WHO - would instead cost $1) (4). And this was before strain shifts made these vaccines even less useful (5-13).

The uptake of expensive vaccines of doubtful utility in poor countries thus requires a huge push. International organizations like the WHO and GAVI have all played their part. A previous study has shown that countries without democracy take up vaccines more easily (14). I wonder if one can develop an index of arm-twistability of these poor countries. Factors like corrupt dictatorships, greater dependence on foreign aid, absence of an empowered civil-society movement and lack of expertise within the country to allow it to make an independent evaluation of the costs and benefits, will all contribute to this index of arm-twistability. Excellent correlation to vaccine uptake with this index is likely to be found. It will allow international agencies to concentrate on these countries where the response to their overtures is likely to be more gratifying.

Jacob Puliyel
puliyel@gmail.com



Reference

1. Anonymous (1998) Global programme for vaccines and immunization (GPV). the WHO position paper on Haemophilus influenzae type b conjugate vaccines. Wkly Epidemiol Rec 73: 64–68. Find this article online

2. Puliyel J. GAVI and WHO: Demanding accountability. BMJ 2010;341:c4081 Pg 266.

3. World Health Organization (2006) WHO Position Paper on Haemophilus influenzae type b conjugate vaccines. Wkly Epidemiol Rec 81: 445–452.

4. Dabade G, Puliyel J. Global health and the Bill and Melinda Gates Foundation. Lancet 2009;373:2195-6

5. Sheldon L. Kaplan, William J. Barson, Philana L. Lin, Stephanie H. Stovall, John S. Bradley, Tina Q. Tan, Jill A. Hoffman, Laurence B. Givner, Edward O. Mason, Jr.
Serotype 19A Is the Most Common Serotype Causing Invasive Pneumococcal Infections in Children. PEDIATRICS Vol. 125 No. 3 March 2010, pp. 429-436 (doi:10.1542/peds.2008-1702)

6. Brown VM, Madden S, Kelly L, Jamieson FB, Tsang RS, Ulanova M.
Invasive Haemophilus influenzae disease caused by non-type b strains in Northwestern Ontario, Canada, 2002-2008.
Clin Infect Dis. 2009 Oct 15;49(8):1240-3.

7. Tsang RS, Sill ML, Skinner SJ, Law DK, Zhou J, Wylie J.
Characterization of invasive Haemophilus influenzae disease in Manitoba, Canada, 2000-2006: invasive disease due to non-type b strains.
Clin Infect Dis. 2007 Jun 15;44(12):1611-4.

8. Urwin G, Krohn JA, Deaver-Robinson K, Wenger JD, Farley MM.
Invasive disease due to Haemophilus influenzae serotype f: clinical and epidemiologic characteristics in the H. influenzae serotype b vaccine era. The Haemophilus influenzae Study Group.
Clin Infect Dis. 1996 Jun;22(6):1069-76.

9. Perdue DG, Bulkow LR, Gellin BG, Davidson M, Petersen KM, Singleton RJ, Parkinson AJ.
Invasive Haemophilus influenzae disease in Alaskan residents aged 10 years and older before and after infant vaccination programs.
JAMA. 2000 Jun 21;283(23):3089-94.

10. McConnell A, Tan B, Scheifele D, Halperin S, Vaudry W, Law B, Embree J; of The Canadian Immunization
Monitoring Program, ACTive (IMPACT).
Invasive infections caused by haemophilus influenzae serotypes in twelve Canadian IMPACT centers, 1996-2001.
Pediatr Infect Dis J. 2007 Nov;26(11):1025-31.

11. Adderson EE, Byington CL, Spencer L, Kimball A, Hindiyeh M, Carroll K, Mottice S, Korgenski EK, Christenson JC, Pavia AT.
Invasive serotype a Haemophilus influenzae infections with a virulence genotype resembling Haemophilus influenzae type b: emerging pathogen in the vaccine era?
Pediatrics. 2001 Jul;108(1):E18.

12. [No authors listed]
Invasive Haemophilus influenzae disease in Manitoba in the post-vaccination era suggests a changing epidemiology.
Can Commun Dis Rep. 2006 Jun 1;32(11):125-30.

13. Kalies H, Siedler A, Gröndahl B, Grote V, Milde-Busch A, von Kries R.
Invasive Haemophilus influenzae infections in Germany: impact of non-type b serotypes in the post-vaccine era.
BMC Infect Dis. 2009 Apr 20;9:45.

14. Jessica C. Shearer, Meghan L. Stack, Marcie R. Richmond Allyson P. Bear, Rana A. Hajjeh, David M. Bishai.
Accelerating Policy Decisions to Adopt Haemophilus influenzae Type b Vaccine: A Global, Multivariable Analysis. http://www.plosmedicine.o...
 

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