- Pakistani scientists have failed to make a single vaccine
The major factor found to impede current efforts to prevent and control hepatitis is lack of knowledge and awareness among all segments of society. For effective eradication of viral hepatitis from Pakistan, we need to focus on mass awareness programmes, prevention strategies, screening of all Pakistanis to find the undiagnosed, treatment of infected individuals and establishment of liver treatment and transplant centers.
Public awareness programmes are the first step. There is very little public knowledge about blood borne viruses, routes of transmission, methods of prevention, disease outcomes and treatment options. We need a complete social action in which governmental, community based and non-governmental organisations can be engaged at federal, provincial, district and union council level for better results. Awareness programmes can take different forms, including seminars, lectures, videos, brochures, and awareness camps. School, colleges, universities, celebrities on TV and ulema on Friday prayer sermons can play a role as agents of change in this regard. The curricula up to intermediate classes should include information on these deadly viral infections.
The second practical step after awareness is the primary prevention by vaccination. Vaccination is available only for hepatitis A and B. We can broadly categorised hepatitis viruses into two groups; Water borne (A & E) and blood borne (B, C & D). Hepatitis A and E can be avoided by personal hygiene, avoiding road side eateries and drinking boiled water. A and E infections are self-limiting and do not pose a life threatening challenge and mostly children below the age of 15 are vulnerable to them. As hepatitis A has vaccine and to be on safe side precautionary vaccination for hepatitis A should be administered to the children below the age of 15.
Hepatitis B, C, D and are blood borne infections and are dangerous. For hepatitis B there is a cheap preventive vaccine available since 1990s. Thus primary prevention of infection with hepatitis B viruses can be achieved through vaccination. Hepatitis D is baby of hepatitis B. So hepatitis B vaccine is a two in one package. Many countries have successfully eradicated hepatitis B by vaccination. Look at the example of Iran, for instance, hepatitis B related liver disease was prevalent but after administration of hepatitis B vaccine to adults and children it has reduced dramatically. In this regard, free and compulsory vaccination for hepatitis B for all Pakistanis of all age including the birth dose can prevent all future new hepatitis B infections.
A and E infections are self-limiting and do not pose a life threatening challenge and mostly children below the age of 15 are vulnerable to them
There is a big issue when it comes to vaccination in Pakistan. People in general and tribal areas in particular are conservative societies and have a deep rooted concept that vaccines are not safe and contains chemicals that reduce fertility i.e. polio vaccine. This is applicable to all vaccines. Unfortunately, Pakistan imports all vaccines. Therefore, a priority should be “made in Pakistan vaccines” to shun the conspiracy theories associated with vaccines.
Pakistani scientists have failed to make a single vaccine. But this is not their fault. They need budget and training. Take the example of our highly successful atomic scientists, space scientists and engineers. For this we need a visionary leader who can say we would eat grass and make vaccine. PM Imran Khan can do this. Again Pakistan armed forces should step forward because people have blind trust on them and their organisations due to their work just like militaries of advanced countries do. We need to set up an industry linked center of excellence for vaccine R&D in Pakistan immediately. We can take help from China in this regard. This will not only boost our local biotech industry but will also open a job market for youth. We can export these vaccines too.
As hepatitis C has no vaccine, transmission can be prevented through behavioural interventions only. For this, we need to monitor blood banks, public and private hospitals, dental clinics, nursing homes, clinics, labs, barber’s shops, street vendors performing body piercing and all those involved in blood related procedures. For this a Blood and Surgical Instrument Regulatory Authority (BISRA) are required with branches in capital, all the provinces, districts and union council’s level. Government can establish this regulatory body in Public Health Engineering departments in provinces or under PMDC or DRAP at federal level. This authority would monitor all infection related material including the sterilisation and hospital waste management. It should develop a new nationwide state of the art blood transfusion centers, training of the human resource and SOPs as per WHO standards and new legislation.
BISRA should introduce auto disposable syringes like the developed countries, syringe service programme for IDUs, screening of prisons, collect medical wastes by a mobile van going to villages. Some people use syringes at home and will throw in garbage, it should be forbidden by law and people should dispose it only a designate place if syringes are used are at home. Same is recommended for nurses home and dispensaries in remote areas. Imposition of heavy fine on violation of SOPs and cancellation of licenses of those involved in corrupt health care practices. There is a need to hold accountable those who do not follow the guidelines. In addition to Food Regulatory Authority, BIRSA should also medical fitness certificate for persons working in hotels.
One of the most serious issues is barber’s acquired hepatitis B and C in Pakistan. In order to get rid of this, we need to follow Saud Arabia’s example. A large number of people going for Umrah or Hajj were found to be infected with HBV and HCV. It was found that barbers, shaving the heads of pilgrimages were the main drivers behind this infection. Saudi Arabia implemented use of disposable razors, gloves and plastic aprons. This well thought out strategy has worked and stopped all barbers acquired infections in pilgrimages. This initiative is a beacon of light for Pakistan. We need to implement this for all barbers, body piercing and body art shops (tattooing) at once all over Pakistan.
The last but not least is the free and compulsory screening for hepatitis B and C all over Pakistan to find the undiagnosed and linking them to care, otherwise millions will continue to suffer and act as a reservoir to spread the disease to others, and lives will be lost. To achieve these goals, PM IK should immediately establish a task force for the control of Hepatitis B and C. There should be a centralised surveillance and monitoring programme with computerised database for blood borne infections. Government should establish new liver centers with independent hepatitis B and C screening cells throughout the country with mobile testing units in remote areas. The control of these two blood borne infections would automatically result in the control of all blood borne infections in Pakistan.