Dr Leon Ochiai (DPhil, MSS), a research scientist, led the analysis of large scale multi-centric, multi-disciplinary typhoid Vi effectiveness trials. Currently he is coordinating the VIVA (Vi-based vaccine for Asia) initiative, which aims to develop the Vi-DT typhoid conjugate vaccine and introduce the Vi polysaccharide typhoid vaccine as a pilot public health program in Nepal.
How effectiveness is the typhoid fever vaccine?
The efficacy of the vaccine is 60 to 70 percent. That means 60-70 percent of people who receive the vaccine will be protected from the disease. Only human gets typhoid. So the impact of the vaccine in the community is much larger.
What has been your impression about Nepal´s overall health services?
I can talk specifically about vaccination. Well, I found Nepal to be an excellent place. Commitment of the government towards health programs is very high in terms of vaccine introduction and vaccination programs. This is my own experience. Within the District Public Health Office there is the District Immunization Coordination Committee which is responsible for implementation of the program. I found this very unique in Nepal, and it involves not only the health sector for implementing the programs but other partners also.
How does Nepal compare with other countries in terms of health services? What does Nepal have to do to meet the level of other developed countries?
Nepal in fact is much further ahead compared to some other countries in your neighborhood. Compared to Bangladesh, Sri Lanka, Pakistan and India, Nepal has been a pioneer in introducing vaccines. For example in introducing the hepatitis B and Japanese encephalitis (JE) vaccines, Nepal was actually number one. In a sense it is a leader within the region. In the case of typhoid vaccine, piloting has been successfully done. If Nepal introduces the vaccine there is another chance to become a pioneer again.
Lots of developed countries do not necessarily have successful immunization programs. They have good systems but many of the countries do not see the diseases you see in Nepal. So what the Nepal government is doing is to react to the diseases. Nepal is doing its best already. Nepal also has its National Committee on Immunization Practices (NCIP), which is led by an independent specialist and takes rational decisions in introducing vaccines in Nepal, which is a very good initiative. So the government is meeting the demand for disease control, which is very important.
What role should private pharmaceuticals companies play in serving poor patients in countries like Nepal?
I believe there has to be some kind of public-private partnership. The public sector needs to work closely with the private sector. The public sector needs medicines which the private sector produces. At the same time the private sector should voluntarily involve itself in social services. I think there should be a good partnership between the private and public sectors.
The government does not keep typhoid vaccines in it regular program and it is expensive also. How can it be effective when the general public cannot afford it?
Well, the vaccine has already been introduced in the market. Yes, it is expensive. I think this is where the role of public-private partnership comes in. If the government provides facilities and encouragement to the private sector, they will bring out the products at affordable prices. The government should also think about the burden of disease.