Vaccines - how much to trust the doctors?

Read a disturbing story in today's Times about how doctors are prescribing expensive vaccines without informing the mothers/fathers that there are cheaper alternative available which do the job just as well. The Government has prescribed a range of diseases for children to be vaccinated against, and there are a series of drugs available - But doctors often provide the much more expensive option since they pocket the difference which is shockingly high in many cases (refer below article). My doctor is a case in example- initially she used to tell me that she is using the more expensive injection since chance of fever for the baby is less, and i was fine with that.. Later she began using the more expensive injections without even informing that there is a choice, And while this is ok for me since the company reimburses the medical bills, it is certainly not ok for many other who cannot afford such expensive vaccines, or would probably need to forego something in order to pay for the imported vaccine without being aware that there is an alternative available.
Then there is the whole issue of additional vaccines which are not on the mandatory list but which the doctor will puch onto you saying it is good for the child-and i for one find it very difficult to say no when someone qualified as a doctor says that something is good for the child. Again the margins for the additional vaccines are very high as most of these are imported.

The main worrying thing about the vaccines though is their age/quality. Around the time S was 2 months old and many of her vaccinations were due, there were a series of reports in the newspaper about how small babies had been given old vaccines/spoilt vaccines and had died. Extremely scary. There are frequent power cuts in India and many of the vaccines need to be refrigerated, so the older they are the higher the chance of them being spoilt. So best to go to a dcotor who has lots of patients so that the drugs are rotated often and lesser chances of the drugs being old in my view

Lastly the whole question of whether to vaccinate or not? there is the problem of the child getting high fever after the vaccine (not in all cases though). Then many people believe that the child should build their own immunity for the milder diseases (pneumonia for instance) and also the vaccine does not provide protection against all strands of that particular virus (again pneumonia- the PCV only provides protection against one strain of pnemonia). My thought on this is that -should vaccinate against all major diseases, I would also try to vaccinate against the minor ones such as pneumonia where the child has a higher chance of contracting the disease ( I get chest congestion very often and very easily so would protect against this) but other minor diseases where likelihood is less and can be avoided with care I would chose not to vaccinate.


The referred article.....
Docs pocket hefty money for shots
Give Vaccines Not Recommended For Universal Immunization
Vaccines are meant to help prevent diseases. But they could also have another vital use as an alternative and significant source of income for doctors. Many vaccine manufacturers are offering vaccines at hugely reduced prices to doctors, many of whom charge the full price from patients, pocketing the difference. The greater the discount, the bigger the profit margin for the doctor. So when a doctor pushes a vaccine that is not part of the universal immunization programme, it would be difficult to decide whether he is thinking of your child’s health or his pocket. A study by Dr Rakesh Lodha of the Department of Paediatrics, AIIMS, and Dr Anurag Bhargav of Jan Swasthya Sahyog in Chhattisgarh, published in a recent issue of the Indian Journal of Medical Ethics, reveals the huge difference in the price of vaccines offered to doctors. “The percentage margin between the price to doctors and the MRP ranges from 30% to 69%, while in rupee terms, the discount over the MRP per vaccine dose ranges from Rs 85 to Rs 620,” the study says. Many vaccines require giving three or more doses and hence the profit margin could be as high as Rs 1,800 per child vaccinated. Interestingly, the vaccines being offered at hugely discounted prices to doctors are not those that are recommended for universal immunization. Such aggressive promotion is for new and expensive vaccines and combination vaccines whose use in the Indian context is “not well established in terms of epidemiological rationale or cost-benefit analysis”, says Dr Lodha. In yet another study, consultant paediatrician Dr Yash Paul from Jaipur found that the difference between the MRP and the price for doctors or chemists is very small for vaccines which are part of the National Immunisation Programme. The huge discount of Rs 500-Rs 600 is only for the newer vaccines. Dr Paul points out that doctors would be tempted to administer newer discounted vaccines which give them a huge profit margin. “If the difference between the MRP and cost to the doctors is equal or nominal, doctors may consider the comparative merits of the vaccines instead,” states Dr Paul. He cites the example of the DPT vaccine, recommended for universal immunization, which has an MRP of Rs 15.50, and given to doctors at the discounted price of Rs 12.50, a minimal difference, whereas the MRP of DaPT, a modified newer version of DPT is Rs 699 and the cost for doctors is Rs 595.