Hib vaccine: Are press releases telling whole truth?

BANGALORE - Is the Hib (Haemophilus influenzae type B) vaccine that India is considering for routine immunisation really effective and should it be introduced in developing countries? The answer to both is ‘yes’ if one believes the joint press release issued by a number of international agencies sponsoring the research.

But in a just published report in the Indian Journal of Medical Research, three senior Indian paediatricians have accused these agencies - USAID, Johns Hopkins Bloomberg School of Public Health, The Hib Initiative and The GAVI Alliance - of misrepresentation of facts by selectively and inaccurately reporting the actual findings of the Bangladesh Hib probe study in order to promote the vaccine’s wider use.

According to the agencies’ joint press release, the results of the Bangladesh study conducted in 2007 “showed that routine immunization of infants with a Hib conjugate vaccine prevented over one-third of life-threatening pneumonia cases and approximately 90 percent of Hib meningitis cases”.

It further said “this vaccine study builds on the evidence of the real burden of Hib pneumonia” in Indonesia.

Both these statements argue in favour of Hib vaccination in developing countries through “selective interpretation/presentation of the actual research findings”, says Jacob Puliyel at St.Stephens Hospital in New Delhi and one of the doctors finding fault with the press release.

The Bangladesh study compared Hib vaccination status among children with confirmed pneumonia or meningitis against those without these diseases (controls). The major finding that there was “no difference” in the Hib vaccination status of children with pneumonia compared to community controls was omitted in the press release, the Indian doctors claim.

The study also found that among those who received all three doses of the vaccine, there was “no statistically significant protective effect” against either confirmed meningitis or probable meningitis but it found statistical significance in a sub-group that received only two doses of the vaccine.

“This latter point was highlighted in the press release in a manner suggesting benefit of the vaccine, without mentioning that no significant difference was found with three doses of vaccine,” Puliyel points out.

The press release made another misrepresentation by saying the study “builds on” evidence of the burden of Hib pneumonia from Indonesia whereas the Indonesia study actually reported more pneumonia in the Hib vaccinated group than controls, says Puliyel.

In fact, the Indonesia study paper concludes by saying “Hib vaccine will not have a major role in efforts to reduce the overall burden of respiratory illness…..as improvements in nutritional status, maternal education and socioeconomic status” (can have).”

Puliyel says the Indian government abandoned a planned Hib trial in the country largely influenced by claims by sponsoring agencies that the Bangladesh study was a great success and any further trial to test Hib efficacy on Indians would be unethical. The Indian doctors suggest that international organisations should ensure balanced reporting of research through the media and not misrepresent facts.

However, the USAID spokesperson skirted the specific question if its press release suppressed facts about the Bangladesh study and issued a bland statement.

It said: “USAID strongly supports improving health and decreasing mortality through the use of vaccines and immunisation, including Hib vaccine. The introduction of the antigen into immunisation programmes around the world has had significant health impact and USAID strongly encourages sound data driven decision making by countries around the introduction of this and other vaccines.

“As the supply continues to increase and the price continues to fall for developing countries, Hib vaccine has become more available, affordable and cost effective for country use the world over, particularly for GAVI eligible countries.”

But The GAVI Alliance and The Hib Initiative, the other signatories of the controversial press release, did not reply to emails.

(Killugudi Jayaraman can be contacted at killugudi@hotmail.com)