Starting September 2002, about two million children would be vaccinated free of cost against Hepatitis b in 15 cities and 32 districts in the country. The move follows the inclusion of the vaccination in the Universal Immunisation Programme (uip) by the Ministry of Health and Family Welfare (mhfw), which took five years to finally arrive at a decision on the controversial issue.

Controversial because some experts, including the majority of doctors, strongly feel that the programme is not well thought out. They go so far as to predict no reduction in the prevalence of Hepatitis b in the country because 40 million people are already chronically affected (see box: Killer on the prowl ). Others argue that the inclusion of the vaccine in uip is a shade presumptuous, considering the fact that India is still grappling with a host of other diseases like polio, diphtheria, tetanus and measles.

Another debatable aspect is the identification of people who are likely to contract the disease. As the task is very difficult, experts like Ajay Gambhir, secretary, Indian Academy of Paediatrics (iap), Delhi chapter, recommend "overall vaccination starting with infants and high-risk groups such as doctors and people receiving blood transfusions'. However, since this entails huge expenditure, others prefer to opt for a more rational approach that focuses solely on susceptible groups.

But that's not all. There are more equally contentious issues that plague the programme.
Glaring loopholes "To begin with, the faulty protocol being followed,' avers Gambhir. Ideally, every child should be vaccinated within the first 24 hours of birth to protect it from transmission of hepatitis from the mother and future infections. This procedure, when incorporated in Taiwan, reduced disease prevalence from 15 per cent to 0.9 per cent in a span of 15 years.

Unfortunately, in India most births are not monitored by trained personnel. So an infant will end up getting the first dose of the vaccine only when it is six weeks old and due for the dpt (diphtheria, pertussis and tetanus) shot. "Consequently, one out of three babies ends up getting infected,' laments S K Sarin, president, Indian Association for Study of Liver (inasl), New Delhi. In response, all that S Malhotra, assistant commissioner, mhfw, can promise is that "a more effective protocol might be incorporated at a later stage'.

On the implementation front, too, the slackness is evident. How else does one explain the fact that even though the World Health Organisation (who) recommended the move way back in 1987, it is only now that the government has taken steps to initiate the vaccination programme?

The current programme is being initiated courtesy the us $4.1 million being given by the Global Alliance for Vaccines and Immunisation (gavi)