Recent diphtheria deaths in Malappuram are the price we pay for a distorted health development strategy. By Dr B. EKBAL
THE recent spread of the vaccine-preventable infectious disease diphtheria and the consequent death of two students of Arabic College near Perinthalmanna in Malappuram district of Kerala have been a blot on the much-acclaimed Kerala model of health care. This happened at a time when Kerala was moving forward in reducing its infant mortality rate to a single-digit number from the current 12 (per thousand), to be on a par with developed countries. Kerala was proud to have eradicated killer diseases such as diphtheria, pertussis (whooping cough), measles and tetanus several years ago because of the high female literacy rate and the successful implementation of the Universal Immunisation Programme.
However, the present sprouting of the vaccine-preventable disease has not come as a surprise. For the past few years, the State has been witnessing a misinformation campaign against vaccination by naturopaths, homoeopaths and religious fundamentalist groups. A few doctors who claim to be human rights activists have also joined this bandwagon. The deaths in Malappuram show that these campaigns are mostly affecting the backward classes and the weaker sections of society. The objections to vaccinations have intensified at a time when vaccines have become safer compared with earlier times. Their side effects have been brought down considerably and recombinant vaccines made with genetic technology are completely risk free. A few vaccines can now prevent even certain types of cancer.
The anti-vaccine campaigners are misleading the people by raising baseless allegations that have been disproved by scientific studies. A major argument is that certain chemicals in the vaccines can cause autism in children. The renowned medical journal Lancet had published an article that suggested that vaccines can cause autism, but the journal later retracted it when it was found that the paper did not have any scientific backing.
Similarly, another charge that started doing the rounds was that 34 children had died in Kerala after having been administered the pentavalent vaccine intended to prevent tetanus, whooping cough, diphtheria, hepatitis B and haemophilus influenza type B. A study proved that there was no connection between these deaths and vaccination, but a few human rights activists from the State are continuing their propaganda against the pentavalent vaccine.
A study by the Achutha Menon Centre for Health Sciences in 2005 showed that only 36 per cent of the children in Malappuram had received vaccines. In the same year, 37 per cent of the children had been vaccinated in a State like Rajasthan. According to the National Family Health Survey, the percentage of fully immunised children in the age group of 12 to 23 months was 54.4 per cent in 1992-93 and 79.7 per cent in 1998-99, but it came down to 75.3 per cent in 2005-06. The special vaccination programme to improve vaccination coverage in Malappuram and Kasargod districts, Mission Indradhanush, also failed because of the campaign by the anti-vaccine lobby.
A section of the media also joined the campaign by spreading unjustified arguments against vaccination. Unless remedial measures are taken immediately by the Health Department, socially committed doctors and public health workers, more such preventable deaths among the socially marginalised communities may recur in the near future. Fortunately, people’s science movements like the Kerala Sastra Sahithya Parishad have already initiated State-wide public awareness campaigns against the misinformation spread by the anti-vaccine lobby.
The apathy on the part of the government and the misplaced priorities of the Health Department have also paved the way for the current situation. The Health Department is busy establishing new medical colleges in the government sector without any infrastructure or qualified doctors and paramedical staff. In districts like Idukki and Malappuram, district hospitals are being converted into medical colleges, which will lead to the further weakening of secondary and primary care facilities.
According to medical norms, there should be a minimum of one sub-centre for 5,000 rural people and one for 3,000 tribal people. While in other districts there are sub-centres for every 7,000-8,000 persons, in Malappuram district one sub-centre is available for only 10,000 to 15,000 persons. For the State as whole, in place of the required 6,000+ sub-centres there are only 5,400 functioning sub-centres. For effective primary care and disease prevention and health promotion, there should be at least one primary health centre (PHC) for a population of 30,000. Kerala has only 850 PHCs, including community health centres, while the required number is 1,000.
A super-speciality culture centring around the establishment of corporate multi-speciality hospitals in the private sector is dominant in Kerala even as the government is responding to the misplaced popular demand by establishing more medical colleges while neglecting primary and secondary health care facilities. And the present vaccine-preventable deaths are the price we are paying for such a distorted health development strategy.
Dr B. Ekbal
(He is a consultant neurosurgeon and health activist.)