As doctors and public health professionals, we are often transfixed by a compelling question: Why are public health debates limited to just doctors and those with abbreviations like MBBS, MD, MS or MPH?
Does the ambit of health not extend to other areas of specialisation? Georges Clemenceau, the former prime minister of France, once famously remarked, “War is too important to be left to the generals.” Likewise public health discussions are not just in the domain of doctors, medical practitioners and public health specialists. They intersect various other disciplines. The tackling of an illness is a complicated affair – though to the patient often only requires a jab or pills to feel better. However, this outcome is the product of a continual battle against disease, where there have been successes – most notably, new health tools – and failures. Today most of the world’s people recognise the importance of vaccination. Vaccines area major advance in humankind’s battle against disease. The eradication of smallpox and imminent defeat of polio could not have been possible without vaccines. Vaccines, to be sure, have made an impact on those most at risk of disease in India and around the world. In fact, vaccines are one of the most effective and affordable tools available to fight disease. That’s why the importance of vaccines has come to be recognised by a variety of stakeholders concerned with social development.

One of the greatest triumphs of science, vaccinations has saved the lives of millions of people. Today, when the focus is on public policy and public health here too vaccines are essential to the conversation. The reason is disarmingly simple. It is because treatment is more hazardous and unpredictable than prevention. Take an unfortunate everyday example from India. If a patient has pneumonia – the leading cause of death among children less than five years of age –successful case management is contingent on a whole host of parameters, many of which are not in the paediatrician’s control.

Will the mother take the child to the doctor at the right time?

Will the paediatrician diagnose the problem correctly?

If so, will the patient begin right course of treatment?

These are questions that would not need to be considered if the case of pneumonia were prevented in the first place. Overwhelming evidence Despite the overwhelming evidence, there are still some who do not fully appreciate the value of vaccines. Hence there is little sympathy for those whose claims are rooted in a misguided interpretation of science. What is the history of this movement – as fringe and small as it may be – in India? The introduction of the first six odd vaccines in India under the Expanded Programme on Immunisation was not a problem. Murmurs startedin the 1980s during discussions on introducing measles vaccine. Advocates for the measles vaccine, some of them among India’s finest public health specialists, contented there was more than enough evidence of impact in societies that had used the vaccine. Challenged and disparaged, they were asked to produce evidence of the extent of the measles problem in India. Today, the debate has been settled. We know the measles vaccine has been efficacious, that millions of children have been saved, and that someday in the foreseeable future, young Indians will cease to encounter measles al together. Sadly the same argument– about whether the vaccine was necessary or not – is still with us in other areas.Vaccines and their utilizationor absence have several ramifications that we do not often consider. For instance, there is often an impact on disease beyond the specific agent that has been vaccinated against.

In the six weeks following a measles infection, a child is 4 to 6 times more likely to develop blood dysentery. This can kill children. However, the measles vaccine prevents the organism from weakening the immune system and allowing the blood dysentery. Thirty years ago, in the early 1980s, when an ORS programme began in a poor community in Faridabad (Haryana), just south of Delhi, the visiting team encountered a considerable outbreak of blood diarrhoea in children because of shigella, a kind of bacteria. The cause was later attributed to poor measles vaccination coverage in the community. What followed was a measles immunisation campaign – and soon enough the results were there for all to see. There are so many other examples. All infections can lead to malnutrition – the child doesn’t eat, the parents may have to make a choice between treatment and nutritious food as they lack the monetary means for both. Whatever the reason, the fact is nutrition suffers, and this is so common in socio-economic settings in which India’s poor live. If you prevent the entire episode of illness, are you not making a big change?

There is a need to get away from the mentality that vaccines simply prevent death. That is certainly true, but an equally important impact is in reduction of morbidity (burden of disease) and in diminishing of severity of disease (resulting in fewer cases of hospitalisation). A healthy childhood would make it more probable that the youngest in this country have fewer handicaps to cope with when they reach adulthood, and so can contribute to the prosperity of their society. Immunisation facilitates this journey.However, there is no inevitability to this evolution. It can be helped – or hampered – by a set of choices taken or not taken, by investments made or not made, by public health systems scaled up or not scaled up, by vaccines embraced or not embraced. India is at the cusp of many such once-in-a-lifetime decisions. As the world reflects on the impact of vaccines, there is hope we choose wisely. (The writer is Director, INCLEN, an advocacy group)