When will the 5-in-1 vaccine see the light of day?

Will the five- in-one vaccine make it to the national immunisation programme soon?

That’s the debate raging in the $ 1.5 billion vaccine market in India. While some vouch for its convenience, others say the vaccine is not very effective and including it in the government plan will raise cost significantly.

The pentavalent vaccine — which immunises against five diseases, namely DTP (diphtheria/tetanus/pertussis), hepatitis B and hib - costs Rs 400-700 per dose (three doses are needed), making it unaffordable to the masses.

The inclusion of the vaccine in the programme should make it accessible to every child, argue the forces favouring its inclusion.

Nitin Shah, past president of Indian Academy of Paediatrics, said pentavalent vaccine implies one shot for five diseases. It will be more convenient to children and healthcare workers.

Sanofi Aventis, Serum Institute, Panacea Biotech have the vaccine in their kitty.

The government has been dilly dallying on the inclusion.

According to an official from the ministry of health and family welfare, it will take a lot of time for the government to decide on the issue. “All the pros and cons have to be weighed as inclusion in the immunisation programme would mean providing it to the entire population.”

However, there are many drawbacks with the five-in-one vaccine.

An analysis by not-for-profit group Cochrane shows that combination vaccine is not as effective as vaccines given separately.

“This apart, it is not very cost effective to include it in the immunisation programme, which implies all babies should be immunised,” said C M Gulhati, editor of Monthly Index of Medical Specialities (MIMS), a reference journal for medical practitioners.

Industry experts say the pentavalent vaccine combines the DPT vaccine, which costs Rs 5 per child, with hib and hepatitis B, and would hike the cost of immunisation per child to Rs 525.

The six vaccines that are currently part of the immunisation programme — DTP, measles, polio, BCG (bacillus of calmette & guerin) — cost Rs 30 per child.

Jacob Puliyel, head of paediatrics, St Stephens Hospital, New Delhi, said, “Every rupee we can mobilise, we need to invest to ensure that all babies in India get vaccinated. The push to include newer vaccines into the immunisation schedule must be viewed in this context”.

Y Madhavi, scientist at the National Institute of Science, Technology & Development Studies, New Delhi, suggests a middle path.

Selective vaccination of high risk groups (blood donors, medical/paramedical staff, soldiers, sex workers), and selective vaccination of children born to Hepatitis B carrier mothers is more cost-effective, she says.