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Research Article

Accelerating Policy Decisions to Adopt Haemophilus influenzae Type b Vaccine: A Global, Multivariable Analysis

  • Jessica C. Shearer mail,

    shearejc@mcmaster.ca

    Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Hib Initiative, Baltimore, Maryland, United States of America

    Current address: Center for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, HSC 2D1, Hamilton, ON L8N 3Z5 Canada. Phone: 1-647-388-4280. E-mail: shearejc@mcmaster.ca.

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  • Meghan L. Stack,

    Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Hib Initiative, Baltimore, Maryland, United States of America

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  • Marcie R. Richmond,

    Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Hib Initiative, Baltimore, Maryland, United States of America

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  • Allyson P. Bear,

    Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Hib Initiative, Baltimore, Maryland, United States of America

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  • Rana A. Hajjeh,

    Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Hib Initiative, Baltimore, Maryland, United States of America

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  • David M. Bishai

    Affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

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  • Published: March 16, 2010
  • DOI: 10.1371/journal.pmed.1000249

Reader Comments (3)

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Demolishing democratic institutions to promote biotechnology

Posted by puliyel1 on 06 Apr 2010 at 20:26 GMT

previous comment we had noted that the authors had found that democratic institutions retard introduction of vaccines. We had also written about how data from a local multi-center study was obtained through the ‘Right to Information Act’ (RTI) in India. This data showed the problem of Hib was much lower than what was being projected, to justify introduction of the vaccine in the national programme of immunization. This ‘RTI data’ was used for a ‘public interest litigation’ against introduction of Hib. The argument was that invasive Hib disease was rare in India and so the vaccine costs could not be justified considering the benefits from alternate use of those resources. We stated in our comment that it was hoped that vaccine manufacturers would not take the cue from the article by Shearer and colleagues, and attack democratic institutions as a means of promoting their vaccines.

Such a comment seemed excessively alarmist and paranoid. However it seems the fear is not completely unfounded. Already a draft bill to form a new biotechnology regulatory authority (BRAI), that they say stifles opposition to genetically modified (GM) products, is planned to be introduced in the Parliament in India. It contains a clause to the effect that people who criticize a GM product ‘without sufficient scientific proof’ could face penalties including a fine and jail. Another clause causing concern, article 27, suggests that the BRAI could override India's Right to Information Act, which mandates citizens' right to obtain information from the government. Readers are referred to a recent issue of SciDev Net for details (1).

Thomas Jefferson has said “The price of freedom is eternal vigilance.” Dare I say, even paranoid vigilance!

Jacob Puliyel MD MRCP M Phil
Head of Pediatrics
St Stephens Hospital
Delhi
puliyel@gmail.com

Reference
1) Padma T. V. Furore over silencing clause in Indian biotech bill
http://www.scidev.net/en/... accessed 7/4/10

No competing interests declared.

RE: Demolishing democratic institutions to promote biotechnology

AlexanderMathew replied to puliyel1 on 07 Apr 2010 at 06:50 GMT

I am one who believes that some of the criticisms against genetically modified (GM) products are excessive and sometimes unscientific. But to put in jail or fine anybody making such criticisms "without sufficient scientific proof" is violative of the principle of freedom of speech and unimaginable in a democratic country like India. If the same principle is applied to other fields like medicine and healing, most practitioners of such will be behind bars, and that may not be too bad either. But still we do not do that.

Dr.Alexander Mathew

No competing interests declared.

RE: Demolishing democratic institutions to promote biotechnology

jshearer replied to puliyel1 on 08 Apr 2010 at 00:14 GMT

In response to comments posted on March 18 and April 6, we wish to clarify the interpretation of the democracy variable in the referenced article (Shearer et al. 2010). In fact, we found that a country's level of democracy was positively associated with shortened time to decision. Said another way, the more democratic a country, the sooner it made a policy decision to adopt Hib vaccine. This can be seen in Table 3, where the hazard ratio of the democracy variable is less than 1 (0.97; p<0.05), indicating its accelerating effect. We hope this clarifies any confusion surrounding this variable.

Sincerely,

Jessica Shearer, Meghan Stack, Marcie Richmond, Allyson Bear, Rana Hajjeh, and David Bishai

No competing interests declared.

RE: RE: Demolishing democratic institutions to promote biotechnology

puliyel1 replied to jshearer on 18 Apr 2010 at 19:39 GMT

I thank the authors for responding to our posting and for clarifying the issue. It is reassuring that they have shown that a higher democracy score was helpful for immunization.

However they do not explain why their finding is different from that of Gauri and Khaleghian (1) whom they quote as reference 15 in their paper. Gauri and colleague found that in countries with a per capita income higher than $1000, democracy hampered introduction of vaccines.

The answer may lie in the different instruments and scales used in the two studies. Gauri used three parameters to measure democracy. Shearer and colleagues use 10 parameters, although what these parameters were, is not explicitly stated in the paper. It will be useful if the authors can please publish in this column, the instrument they have devised for measuring democracy.

As explained in our previous posting, in India tools of democracy like the 'Right to information' are being perceived as obstacles on the way of 'progress' and to the introduction of modern bio-technologies like GM crops (2). Having the instrument the authors have used, and their finding that democracy helps, rather than hinders technology, can be used in advocacy against the new law.

Jacob Puliyel
puliyel@gmail.com

1. Gauri V, Khaleghian P (2002) Immunization in developing countries: its political and organizational determinants. World Development 30: 2109-2110-2130.
2. Padma T. V. Furore over silencing clause in Indian biotech bill
http://www.scidev.net/en/... accessed 7/4/10

No competing interests declared.