Wednesday, June 3, 2009

Experience with Pneumococcal Vaccine

I have been unhappy with the pneumococcal vaccine since the company launched it a few years ago. At the start, let me say I have no problem with the vaccine. It is a seven-valent pneumococcal conjugate vaccine (PCV7). It is a good and effective vaccine.

I do have problem with the way the company started marketing the vaccine. Instead of going through the doctors as was the case in most other vaccines, the company decided to go directly to consumers with a media blitz. It took up full pages of advertisement introducing the pneumococcal vaccine and showing a child with brain damage due to meningitis and a guilt stricken mother. This is education by terror and guilt. The advertisement serves to scare people to vaccinate their children. Yes, pneumococcus is a bacteria that can cause meningitis (which is treatable by antibiotics), ear infection, lung infection and throat infection. But by highlighting just the worst case scenarios, the company hopes to panic parents into vaccinating their children.

Doctors should be gatekeepers for medical information because by the nature of their training they know more then the lay-public and are able to offer better advice. That is why all new vaccines and pharmaceutical products are launched through the doctors. There is a lot of medical information on the Internet but how will a lay-person decide which information is dependable or not?

It also does not help that somehow they managed to get the Malaysian Paediatric Association logo into their advertisement. I have written a complaint to the then President of the Association here. Furthermore at that time of the vaccine launch, we have no data about the disease incidence in Malaysia. That means we have no idea how common it is in Malaysia.

The company also recommends a regime of 3+1 which means three injections of one monthly interval during infancy and one booster at 15 months. At a cost of about RM 250-300 a dose, anyone can see what a cash cow this will be to the company. Also this has obviously put this so very important vaccine out of the reach of the poor.

What I have discovered from my reading and what the company did not highlight to the doctors in Malaysia is that the Scandinavian countries and the United Kingdom is giving a 2 +1 regime. This are not poor countries that cannot afford to buy vaccines for their people and are skimping on one dose per child. These are rich countries. When I confronted some senior managers of the company, they reluctantly admitted that some countries are using a 2+1 regime. Why was it kept a secret?
It is not as if the 2+1 regime do not work. Here is a paper describing the experience in Norway

Seven-valent pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian childhood vaccination program in July 2006 in a 2+1 dose (three-dose) schedule. Vaccine coverage quickly reached high levels and the incidence rate of invasive pneumococcal disease in children under 2 years of age declined rapidly. The vaccine program's effectiveness was estimated to be 74%. Read more

Reading the literature I have decided to adopt the 2+1 dose schedule for my patients. This vaccine is not given free in government clinics but is only available in private medical practice in Malaysia. The reason is to help my patent's parents save at least RM 250-330 per child. Some other pediatricians decided to follow my example. It is interesting that when the company heard about this, I was approached by two of the sales representatives last December, who offered to give me a free vaccine dose for every child I started on the vaccination schedule as long as I keep to the 3+1 schedule.

What do you think I should do?

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