E-Kantipur

AUG 30 -

Every year, millions of vaccines for polio, tuberculosis, mumps and measles are administered by the government. On August 20, something went terribly wrong at a health post in Kadamandu VDC in Doti, where four infants, all under 18-months, died a day after they were administered the measles vaccine. This is an alarming incident, not least, because it isn’t the first of its kind. In 1998, the death of three children in Mrigauliya in Morang was linked to a similar case of vaccinations gone wrong. Last year, over one million ‘pentavalent’ vaccines (the combination of Diphtheria, Pertussis, Hepatitis B and Haemophilus influenzae Hib disease vaccines) were rightly sent back by the government to manufacturers citing “errors” in them. But the “errors” in Doti were discovered much too late and four infants had already lost their lives. While the government claims “human error” as the cause of death, there is reason to believe that the problem is more than a slip-up. More importantly, who’s responsible and what’s the government going to do so that such incidents don’t occur again?

Vaccines are bought in bulk by the government through the Kathmandu-based Logistic Management Division, under the Department of Health Services. From there, they are transported to five regional medical stores, and on to district health offices and posts. The journey is a long one, and transporting vaccines require a temperature-controlled supply chain to keep their quality intact. It obviously is a long drawn-out process. Government health workers admit to poor infrastructure for cold chain supply, whether they be by road, flight or even mule. Given the difficult logistics, good vaccines at the time of purchase could well become toxic en route to their destination. That’s certainly something that needs looking into  but that’s not what happened in Doti, says the government.

There was no fault in the vaccine itself at the final point— only in its administration. Many cases of poor service delivery at health posts have been reported where patients are not fully briefed about the vaccines, possible side effects, and most importantly, post-vaccination procedures. The parents who bring their children in for immunisations often do not know the emergency procedures to be followed. For example, in Doti, the infants had shown some irregularities, like convulsions, right after reaching home. But the parents either did not know this was a serious problem, or had nowhere to go in case of emergency.  By the time the newly-formed Adverse Effects Following Immunization Committee got to Doti, the infants’ last rites had already been performed and the toxic vaccine vials disposed of. That’s why the first thing AEFI should do is create a mechanism for post-immunisation care, through briefings beforehand and services afterwards. The government needs to realise the gravity of the situation for such incidents may well deter parents from getting their children immunised. The Doti incident should be a lesson—in first finding out precisely where the fault lies (name the individuals if that helps), then addressing the issue and, above all, going public with the entire story to convince people that what happened in Doti is only a one-off incident and that the government immunisation mechanism is very much in place, and safe.

Posted on: 2012-08-30 08:14

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