Doctors are finding it hard to meet the recommended dose of three injectable polio vaccines (IPV) in a child’s first year because of a shortage of the vaccine.
Children can be given more oral doses, or OPV, but this will put them at the risk of vaccine derived polio virus (VDPV), a known complication caused by oral doses that contain the live virus.
Public health experts said that the unavailability of the injectable vaccine puts India at the risk of resurgence of polio, which it has eliminated while neighbouring countries like Pakistan and Afghanistan still report cases.
Senior paediatrician at P D Hinduja Hospital Dr Nitin Shah said that he has not administered a single injectable polio vaccine in the past month. “Theoretically and practically both the situations are possible. Parents may not choose to give OPV to their children and the unavailability of IPV in the private sector only makes matters worse,” said Dr Shah.
Dr Jaydeep Choudhary from Institute of Child Health, Kolkata has not received any supply of IPV for the last four months. “Injectable polio vaccine is the best but we cannot deny vaccination to children because it is not available,” said Dr Choudhary.
Vaccines are made of the very virus against which it promises to give protection. OPV has live virus and there is a rare possibility that a child who is administered with it might develop polio. IPV has inactivated virus which doctors said does not give rise to VDPV.
Public health experts said that the shortage of the vaccine is not restricted to India. “It is a global shortage,” said Dr Pradeep Haldar, deputy commissioner, universal immunisation program, Government of India. “About 126 countries including India are in the process of introducing the injectable polio vaccine in their national immunisation program which has led to a sudden demand.”
To avoid the problems association with the oral vaccine, all states in India have been asked to administer the injectable vaccine along with oral doses from April. The problem here, according to doctors, is that OPV will give immunity against two strains of polio virus - P1 and P3 - while IPV gives immunity against the third strain P2. “World over we were seeing several Vaccine Derived Polio Virus cases owing to P2 strain. Now, this strain was there in the OPV vaccine and causing vaccine-related polio in children. Hence it was decided to remove the P2 strain from oral polio vaccine,” said Dr Raju Shah, Ahmedabad based paediatrician.
However, Dr Shah said that the unavailability of IPV in the market makes children vulnerable to the P2 strain. “They need to be immunised against P2 and that can be only done with the injectable vaccine. If the unavailability continues in the private sector and parents don’t go to public sector to take the IPV it can cause resurgence of polio in our country,” said Dr Shah.
At least half of the children born in the country take polio vaccinations at private hospitals. Given this scenario it will be extremely challenging to divert the children to public health facilities, said doctors. “It is a fact that many parents would not go to public hospitals for vaccination. If the vaccine is not made available at private hospitals, these children will remain unimmunised against P2 strain of polio virus,” said Dr Raju.
There are around 28 million births in the country annually, according to Dr Haldar. “India requires close to 30 million doses annually and we don’t have a global production to meet this demand,” he said, adding that if even there is a global shortage, the Indian government has secured enough doses to last till 2018.
With private doctors recommending three doses in the child’s first year, the 30 million doses will not be enough to meet the demand and IPV doses will have to be restricted to one per child.
Suppliers of the vaccine said that India is facing a shortage because of the worldwide shortfall. “Another important barrier is an Indian importation rule that does not allow vaccines with less than 60% remaining shelf life to enter the country. For that reason, we are currently struggling to import some IPV-containing vaccines for the private market,” said Jean-Pierre Baylet, Country Head, Sanofi Pasteur India, which is the main provider of IPV to the Indian government.