Using past public vaccine controversies in India (rotavirus, pertussis, measles/rubella etc.) as a basis for enquiry, this case study aims to make a contribution to understanding healthcare structures and partnerships and their impact on vaccine confidence. Vaccine controversies involve disputed facts, concerns or fears, and intense public discussions/disagreements about vaccination affecting vaccine uptake, usually directed at specific vaccines for a period of time. Controversies typically do not only concern the vaccine itself as a healthcare intervention but other societal issues such as trust of the government, view of stakeholder interests (pharmaceutical/pharma companies and international donors), and how different ethnic or social groups are treated.
A recurrent fear and concern, particularly with the introduction of new vaccines or vaccine campaigns has been of Indian children being used as 'guinea pigs' for medical testing and experimentation, for the profit of governments, pharma companies, and the international community. Historical roots for this line of thinking can be found in an anti-BCG movement that involved high profile Indian health activists in the 1950s reacting to the introduction of the BCG vaccine for tuberculosis. Medical historians including McMillen and Brimnes located the opposition not with anti-Western or antiscience sentiments but a reaction to, “...a cheap, potentially unsound vaccine in lieu of substantial infrastructural changes”. Issue was taken with India being an early adopter of the first live-attenuated vaccine, previously associated with tragedy. Also collaboration between countries and the imposition of outside forces is another important aspect to take account. For example, in 1987 a controversy arose in the Indian national press about an Indo-US vaccine program, where the rumours spread about the Indian population being used experimentally.
As is more common now for LMICs, several indigenously-made vaccines are currently under development with Bharat Biotech, a pharmaceutical company based in the Hyderabad area ('Genome Valley'). This includes a chikungunya vaccine and work on the Zika virus, even though India only had laboratory-confirmed cases of Zika in 2017. However India pharma companies face challenges from the international medical community about the safety and efficacy of new products. This compares with the supposed ‘fast-tracking’ of vaccine development and delivery to cut red tape bureaucracy as promised by the Indian government, especially in times of outbreak and for reasons of vaccine diplomacy (e.g. with fellow BRIC country Brazil).
The deployment of new vaccines requires the cooperation and involvement of various actors across the systemic apparatus (from the Indian Council of Medical Research, the Ministry of Health and Family Welfare, to the Drugs Controller General of India). Furthermore, how the media portrays deployment of new vaccines and how public perceptions of such vaccines affect vaccine confidence and corresponding
policy reactions. This project therefore aims to assess the abilities and capacities of healthcare systems to respond to controversy in a LMIC context.