The national advisory body recommended in 2014 that a vaccine for measles-rubella, commonly known as German measles, be introduced in the universal immunisation programme. More than 18 months since, MR does not figure anywhere in the government’s vaccine priority list.
Ironically, the manufacturer, Serum Institute, is ready with a stockpile of 400 million doses and has offered to sell these to the government at one-fifth the price. It is initial estimates that the publicity campaign for the vaccine could end up costing Rs 1,500 crore that, according to sources, is causing the government to drag its feet.
The National Technical Advisory Group on Immunisation had recommended during the end of the UPA regime the inclusion of three new vaccines — for MR, injectible polio and rotavirus. The Ministry of Health had also given a presentation in the PMO on the recommendations in July 2014. Inactivated polio virus (IPV) vaccine was introduced in UIP in November 2015 and phased introduction of the rotavirus vaccine starts in February 2016 in four states — Odisha, Himachal Pradesh, Haryana and Andhra Pradesh. The MR vaccine, however, may not see the light of day before the end of this year or even next year, ministry sources fear.
Every year, approximately 25,000 children with congenital rubella infection are born in India, say estimates available with the ministry. According to a study by the University College of Medical Sciences, Delhi, “1-15% of all infants suspected to have intra-uterine infection were found to have laboratory evidence of CRS (congenital rubella syndrome). About 3-10% of suspected CRS cases are ultimately proven to have confirmed CRS with the aid of laboratory tests. CRS accounts for 10-15% of pediatric cataract. 10-50% of children with congenital anomalies have laboratory evidence of CRS. 10-30% of adolescent females and 12-30% of women in the reproductive age-group are susceptible to rubella infection in India.”
Symptoms of CRS can include problems with the eyes such as cataracts and deafness, apart from affecting the heart and the brain. German measles was central to the plot of Agatha Christie’s The Mirror Crack’d from Side to Side, a Miss Marple mystery in which one woman murders another responsible for the first woman contracting German measles while pregnant, leading to the death of her child.
Rubella vaccine is available in the private sector as MMR and is a part of the mandatory vaccination schedule of pregnant women. Vaccination for children, however, is optional and is done only if parents can pay for it. “Right now we are concentrating on IPV and rotavirus. MR may not make it before the end of this year or maybe next year,” said a senior official in the Ministry of Health. “It needs a consolidated campaign to cover 45 crore-plus children aged between nine months and 15 years and the publicity alone is likely to cost Rs 1,500 crore. We need to embark on it when we are ready for it and not in a piecemeal manner,”
As and when the government decides to buy the vaccine, Serum Institute of India, which is currently the world’s largest vaccine manufacturer by volume, has decided to sell it at a reduced cost of Rs 25 per dose.
Replying to an e-mail questionnaire from The Indian Express, CEO A C Poonawalla said: “Although the price is Rs 125 per dose in the market, for our government Serum Institute has decided to give it at Rs 25 per dose, which is five times less than the prevailing market rate, as a philanthropic gesture to Government of India. Serum Institute already has a capacity of 400 million doses. This will only be 20 per cent of our capacity and we already have the product lying in our basic inventory for the entire requirement of India.”