Rejecting Quinvaxem a 'disaster' to vaccination program: Vietnamese doctor

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Vietnam made a reasonable choice of vaccines for its free vaccination program for children under one considering its economic status and resources, a pediatric expert said.

A local newspaper quoted an Indian doctor as saying Quinvaxem, the pentavalent vaccine used in the program, causes more harm than good. Ten children have died in Vietnam after getting Quinvaxem shots since last November.

But Dr Nguyen Huu Khanh, head of pediatrics at Nhi Dong 1 Hospital in Ho Chi Minh City, said he thinks the some of the points in the article were "inaccurate."

What was inaccurate?

The doctor said fewer people die of meningitis and pneumonia in India than those getting Quinvaxem shots, and therefore argued against the vaccine saying it does more harm than good.

It should be noted that Quinvaxem contains several antigen components for vaccination against five diseases [diphtheria, pertussis, tetanus, hepatitis b, and diseases caused by haemophilus influenzae type b (Hib)]. The Hib antigen is not the main agent that causes Quinvaxem to have side effects; it is the whole-cell pertussis vaccine component.

Vaccination against Hib is definitely helpful because what Hib may cause is much more serious than just death.

What do you mean?

Without Hib vaccination, children may contract the disease and the burden caused by its effects is heavy and costly. Haemophilus influenzae type b is the biggest cause of meningitis in children under five. It takes a long time to be cured, and therefore very expensive, and late treatment means patients die. Even when they escape death, the children stand a high risk of hearing loss, hydrocephalus, and cerebral palsy. Then the family and society will have to take care of them for the rest of their life.

In countries with a low number of Hib cases, the reason is that people have got Hib shots for a long time. There is no other explanation.

However, vaccines that contain whole cell pertussis antigen similar to Quinvaxem are banned or not used in rich countries like the US, Canada, European countries, Australia, and Japan. How do you explain that?

I must point out that those countries also used whole cell pertussis vaccines for many years. Now they have found alternative vaccines and ... by spending big money on the new vaccines, there are fewer side effects and the cost of treating side effects is [therefore] reduced, so they use the new vaccines. So it is not about banning [whole cell vaccines].

In countries that had problems with whole cell pertussis vaccinations, their governments were also under huge public pressure, and their people avoided vaccination. However, scientists in those countries have advised people not to do so because it is very dangerous. In my opinion, it is scientists' and the media's responsibility to explain [the issues ] in a clear, detailed, and unbiased manner.

Some argue that Quinvaxem is produced based on dated technology and even South Korea, where the vaccine is made, does not use it. What is your opinion?

If the technology were dated, how come Quivaxem is still bought by tens of countries worldwide? The technology to make Quinvaxem in South Korea is in fact that of Novartis, a well known vaccine maker. If we look at this in the supply-demand perspective, if the Korean producer knew no one would buy their vaccine, why did they buy the technology? South Korean people do not use Quinvaxem because they are rich. But because South Koreans do not use Quinvaxem does not mean they should not produce it.

Some also argue that Vietnam insists on using Quinvaxem because it has to do with the World Health Organization. Do you think that makes sense?

No organizations force the Vietnamese government to use one vaccine or another. The use of Quinvaxem was [decided] based on consultations with many prestigious organizations, not just WHO, and consideration of economic benefits, the public good, and the sustainability of community protection coverage to prevent diseases. To achieve that, it takes many years for a certain community to get vaccinated. It is pointless to just do vaccinations for two or three years and then stop or only vaccinate a few rich people.

In a country with limited resources like Vietnam, when the income of the majority of the population is low, the selection of Quinvaxem for its [free] expanded vaccination program is correct.

It must be made clear that the Quinvaxem we are using now is sponsored by the Global Alliance for Vaccines and Immunizations (GAVI Alliance). The sponsorship will end in a few years. Then we will have to pay it ourselves and commit to pursuing this vaccination plan. Had Vietnam asked for a better vaccine, GAVI would possibly have agreed too, but will the government be able to afford it after [the sponsorship ends]? We still need to tackle many other diseases, but our resources are limited; so we have to use them wisely.

You have a point there, but parents are puzzled by Quinvaxem-related complications "¦

The issue here is [medical authorities] are not determined to clarify whether there is a connection between getting Quinvaxem shots and the [fatal] incidents. People tend to blame the vaccine when there is a post-vaccination fatality and do not think that the child may have another disease. An autopsy can set the record straight. But when people refuse autopsies, how many cases can be resolved? The medical sector is surely to blame when it is too slow in reacting to problems and does not explain clearly to people.

But, honestly, the staff of the expanded vaccination program have made huge sacrifices. Unlike those in paid vaccination services, these workers do not get any benefits for themselves. But they have to devote themselves to work and constantly entreat people to vaccinate their children for their own future as well as that of society.

What do you think about the media's role in the issue of vaccination in general and that of Quinvaxem?

I think journalists should be more accurate with their language. When a child develops symptoms such as local fever, pain or inflammation, or anaphylactic shock, please call it by its right name -- "side effects" or "unwanted effects" instead of "accident." Even vaccines used in paid vaccination services can have side effects. The only difference is that in paid services such incidents were not made public because otherwise who would dare to get [vaccine] shots there, how could they make profits?

The media also has to be objective and not biased rather than merely shout "too many vaccine-related accidents." What will happen when people read this information? They certainly will be  confused. Those in cities who can afford paid vaccination services will switch to them, while those who cannot or live in remote areas will simply reject vaccinations. The coverage of vaccines will shrink, and it will be easier for diseases to spread. Once we have disease outbreaks, who will suffer? It is the poor, those who dare not vaccinate after being confused by the media.

It is straightforward - rejecting Quinvaxem shots would be a disaster for the expanded vaccination program, and all the efforts that the medical sector made in the past decades to contain diphtheria, pertussis, tetanus, and hepatitis b would come to naught.

Don't you have any fear speaking your mind like that?

I don't because I am saying this for [the benefit of] the majority of the people and do not derive any personal benefit from this.

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