Need for Technology in Health Management – Social Issue Essay, Article for Class 12, Graduation and Competitive Examination.

Need for Technology in Health Management

Scheme of The Essay

Exposition: Smooth coordination is needed for the medicines to move from the laboratory to the market.

Rising Action: During the last fifty years only one vaccine has successfully moved from the laboratory to the market.

Climax:

(1) Lack of attention to ethical issues has impaired the transfer of important research findings.

(2) Regarding the AIDS vaccine the bioethical questions are far more daunting.

(3) We should be cautious in adopting new technologies.

Ending: Technological innovations should be urgently adopted.

Dr. Abdul Kalam, the scientific adviser to the Indian government has called for the development of an AIDS vaccine which is more suitable to Indian conditions. In fact, thoughtless, administering of medicines, particularly allopathic has done more harm than good. For any vaccine that moves out of the laboratory to the market, it is necessary to ensure smooth coordination between scientists in the laboratory epidemiologists in the field and various organisations that regulate the conduct of trials. The Social Science and Immunisation Team (SSI), working under the auspices of the Centre for Development Economics, has found that in India during the 50 years has developed only one vaccine that moved successfully from the laboratory to the market.

In the case of vaccine research in India, a lack of attention to ethical issues has impaired the transfer of important research findings from the laboratory to the market. For example, research on fertility regulating vaccines which began in the seventies became so bogged down in ethical controversies that support was either withdrawn or diminished by global and national agencies for fear of scandal.

In the case of a possible prophylactic AIDS vaccine, the bioethical questions are far more daunting. By its very nature, such a vaccine would have to be tested on populations engaged in risky behaviour. But if such populations can be monitored for the testing of the vaccine, should not the same resources be spent on imparting health education that will correct risky behaviour? Yet, if a subject population changes its risky behaviour during the trial, the efficacy of a prophylactic vaccine cannot be estimated. Such trials can be ethically justified only if the vaccine being tested is a therapeutic one. Recently, populations in the US suffering from HIV have organised themselves to demand that not only should trials be a resource for patients, but also that the design of the trial itself must take into account the patient’s right to be included. Without a democratic discussion leading to a societal consensus on the production and use of expert knowledge in the country, even brilliant research is likely to be caught up in controversies of all kinds. With the advent of recombinant techniques for vaccine development, it has now become possible to imagine immunisation not only as a technique against childhood diseases but as a life-long practice. Recent studies into the organisational structures of some of the companies involved in vaccine research show that scientific diplomacy is an important component of their research strategy. Thus, representatives of pharmaceutical companies are now actively collaborating with the WHO to assess vaccines which will be required in the context of the global disease scenario of the coming decades. The time between the development of a vaccine in the laboratory and the commencement of clinical and field trials is being considerably shortened. In contrast, in our country, there seems to be little coordination between the regulating agencies for new drugs and the scientists.

For instance, Indian scientists were the first to identify the new 0139 strain of cholera in 1994, and by 1955 they had developed a bivalent oral recombinant vaccine against cholera. Initial results obtained from animal studies suggested that this vaccine may be both safer and cheaper than the other candidate vaccines that were being globally tested. Yet, field trials are to commence on this vaccine.

Although we do need to be cautious in adopting new technologies, we should not disguise our lack of infrastructural facilities for moving a vaccine from the laboratory to the field as a case of caution. There are not enough laboratories under the drug controller’s office to conduct toxicity studies before permitting to move in clinical trials Similarly, there is no vaccine testing centre which can systematically recruit volunteers for Phase 1 trials. Unless organisational innovation can be made, it is likely that even eminent scientists will not be able to move beyond the publication of papers in this competitive field.

In addition to organisational changes at the level of innovation, more effort needs to be put into systems of delivery. Even in the case of routine childhood immunizations, there are severe deficiencies in the delivery system. First, even in states reporting high immunisation coverage, work done by the SSI team has shown that the number of partially immunised children is unacceptably high-immunisation records are about the number of doses per antigen that have been distributed in a population and not about the number of children who have been vaccinated. Second, in states such as UP, Rajasthan, Orissa, MP and Bihar where the number of children is increasing but immunisation coverage is low, herd immunity is adversely affected Micro-health studies in some parts of UP by the same team have shown local epidemics of vaccine preventable diseases such as measles and whopping cough.

The biggest problem with HIV spread in India is that it is not contained in well-defined pockets as in the US. It is well known that there is a proliferation of the informal sector in health care-antibiotics, injections, and IV drips are regularly administered by quacks. Syringes and needles are not sterilised. Even in PHCs and district hospitals, disposable syringes and sterile needles are not always available or are sold to private practitioners. Important technological innovations have been made to address such delivery problems (an example is needles which bend after a single use and hence cannot be used again). Research is also underway to find routes other than thorough injections for delivering vaccines.

Such technological innovations must be urgently adopted in our health system to prevent transmissions of HIV and other blood product-related infections. In combination with such research, a more efficient use of resources to contain the threat of AIDS may be to emulate the example of Uganda which is the only country in Africa where the incidence of HIV infection has declined due to a programme of public health education and free distribution of condoms and sterilised needles.