A shot at prevention
When Akanksha Kaushik got chicken pox at the age of 30, it wasn't her health that she was worried most about. She was losing sleep over her parents getting this highly contagious viral infection.
It was then that her doctor suggested to her that she got her parents vaccinated. "We were unaware about vaccinations for adults. It was the first time that I got to know about optional vaccines," says the Delhi-based instructional designer.
Essentially, there are two categories of vaccines available which can be given to children and adults - essential and optional. Under the Universal Immunisation Programme, essential vaccines like polio, measles and tetanus are mandatory and no child should be left out of this immunisation programme. Optional vaccines can be chosen at will without any risk or disadvantage. "But a physician should always be consulted before getting vaccinated. It is not advisable at all to depend on the Internet or any source of information for vaccination," says Dr Rommel Tickoo, associate director, internal medicine, Max Super Speciality Hospital, Saket. According to experts the merits of 'optional' vaccines for individual use must be considered mainly on the basis of factors such as the degree of prevalence of the infection and disease, age and rate of mortality.
It is common knowledge that vaccinations protect life, reduce the burden of infectious diseases, protect communities, are vital in pandemic, and have several other health benefits. And yet, in India, vaccinations, especially among adults, remain non-existent. According to Dr Suresh Jadhav, executive director of the Serum Institute of India, in Pune, the primary reasons for the low consumption of optional vaccines are lack of awareness and most importantly cost, "Most such vaccines are relatively priced higher than others," says Dr Jadhav. Lack of awareness makes many people stay away from vaccinations as common as flu shots that are a norm in the United States. According to Dr Arvind Aggarwal, senior consultant, internal medicine, Sri Balaji Action Medical Institute, getting a flu shot means not just protecting yourself but also the people around you. "So it is advisable for adults to get flu shots and stay safe from many diseases," says Dr Aggarwal. But the vaccines need to be taken every year as the flu virus changes rapidly and the vaccine is modified accordingly. "The vaccination should be taken before the onset of flu, before the monsoon sets in. It can reduce the risk of contracting the flu and its complications," he adds. In July 2018, pharma major Sanofi Pasteur launched FluQuadri®, India's first quadrivalent influenza vaccine for those aged three years or more. "Quadrivalent vaccines were developed to improve prevention of influenza and its risks, covering for some of the unpredictability of influenza type B, and broadening protection against the disease," says Jean-Pierre Baylet, country head, Sanofi Pasteur India & South Asia. The company maintains that FluQuadri® has been received well. "It only reaffirms that doctors realise the benefits and importance of a quadrivalent vaccine in a country where H1N1 and both B strains circulate and affect people every day," adds Baylet. And it's not just flu where adults can look at getting vaccinated. "According to a report, approximately 21 million cases and 2,22,000 typhoid-related deaths occur worldwide every year. So vaccination for typhoid is advisable for everyone," says Dr Aggarwal.
Medical experts maintain that the high cost of shots and lack of awareness among the general public to be the primary reasons that lead to low consumption of vaccines in India. "People in the country are not yet fully aware about the fact that vaccine consumption always helps in leading a healthy life. There are studies by various experts which showcase that the rate of consumption of mandatory vaccines is so low that optional vaccine consumption cannot be thought of," says Dr Tickoo. But there is a small percentage of people who are now opting for optional vaccines. With flu cases on the rise, more and more people are inquiring about optional vaccines. "The most common type of optional vaccines are H1b, Hepatitis B, HPV, Typhoid, Chicken pox, etc," informs Dr Aggarwal. The number of people opting to take flu shots has also increased in the city over the last few years. "Compared to a decade or half back there has been an increase in awareness among masses. Now people are focusing more on preventive measures," he adds. In India vaccines can be utilised for lowering the disease burden. "Various concerned agencies like World Health Organisation or the ministry of health can come up with guidelines based on randomised controlled trial," says Dr Satish Kaul, senior consultant, Internal Medicine at Narayana Superspeciality Hospital, Gurugram. And it's not just flu shots that are gaining traction among people. "Vaccines like Hepatitis B are necessary as they protect us from Hepatitis B infections and its accompanying complications like liver damage," informs Dr Kaul. Rabies vaccine should be given to everybody who is at risk considering the fact that dog bite is common in our city. "The HiB vaccine is again important in people with comorbidities," he adds.
Awareness about preventive diseases is the key driver here. "In India, less than one per cent of population gets vaccinated against flu compared to more than 40 per cent of people in the US. So when it comes to proactively taking steps towards prevention, we have a long way to go," points out Baylet of Sanofi Pasteur. The population of senior citizens in India is approaching the 100 million mark. The elderly have lowered immunity coupled with co-morbid conditions, making them increasingly vulnerable for infections. "It is high time we educate our society and update our fellow colleagues about the usefulness of these three vaccines i.e., pneumococcal vaccine, influenza vaccine and tetanus vaccine, about their usefulness in preventive disease, reducing morbidity and mortality not only from the above disease but also from other co-morbid conditions," says Dr Jadhav of the Serum Institute of India. Experts maintain that there are evidence-based and well-published studies in peer reviewed journals on the benefits of flu shots in terms of reducing hospitalisation and increase in workplace productivity (due to the reduced number of leaves, because of frequent flu infections). "The cost of flu vaccine was a hurdle initially. However, with the launch of affordable flu vaccines by the Indian vaccine industry, this is no more a hurdle. There is a need for awareness about such vaccines and for the government to promote flu vaccinations," adds Dr Jadhav. Most pharma companies work with external stakeholders like the ministry, medical universities, private hospitals and even corporate houses to spread awareness. Awareness around the disease needs to be made so that people can make an informed choice regarding vaccination. "We also work very closely with insurance companies and corporate to highlight the impact that diseases like flu have on work absenteeism and productivity, and how immunisation could help reduce this burden. We need to strengthen our disease surveillance systems to have a true picture of the burden of disease. Without the knowledge of the real disease burden impact on the population, people do not consider it important enough to protect themselves against these diseases," says Baylet of Sanofi Pasteur.