Measles outbreaks in the US are the result of choice. To get vaccinated or not. But there’s another vaccine-preventable disease that’s making a global comeback—whooping cough or pertussis.

Since 2011, whooping cough has become the most common cause of hospitalisation and death in infants in the UK. Australia, too, saw a particularly severe epidemic between 2008-10. In 2010-11, California experienced its largest whooping cough outbreak in 50 years. Similarly, the incidence of whooping cough has increased in both Norway and Canada as well.

All from a disease that is potentially preventable through a routine vaccination.

The signs of resurgence are fast becoming evident in India, too. Although there is no officially reported nationwide data on incidence of pertussis till date, Indian doctors have begun to raise red flags. Like Arjun Padmanabhan, a specialist in respiratory diseases at the Kerala Institute of Medical Sciences in Thiruvananthapuram, Kerala. Every now and again, one of Padmanabhan’s patients let out a worrying noise while coughing—the ‘whoop’ sound associated with pertussis.

“Over the last few years, I have started diagnosing cases of whooping cough once or twice a year,” he says. And each time, he wonders why an ‘ancient disease,’ preventable with a vaccine used in the government-funded universal immunisation programme (UIP) since the seventies, is still showing up. After all, India’s UIP has been largely successful in controlling most vaccine-preventable diseases, such as polio, due to its reach in the public health system.

What is whooping cough?

Whooping cough or pertussis is a bacterial infection leading to a nasty cough. It can last for up to three months in adults. In children, it spreads very easily and can even be deadly. While government programmes using effective and long-lasting vaccines also offer herd immunity to the entire population, less effective, short-lived vaccines can compromise this.

When he looked deeper, he found that this resurgence, too, is born of choice. Not about whether to vaccinate, but rather what vaccine to use. The older, more painful vaccine used in the UIP or the newer, second generation vaccine sold by pharma majors GlaxoSmithKline (GSK) and Sanofi Pasteur. Almost counter-intuitively, it is the latter, introduced in developed countries in the 1990s and later in private markets of developing countries, that is being linked with the global resurgence of pertussis.

In developed countries, this makes sense. Governments in these countries have overwhelmingly favoured the second generation vaccine. In India, however, the story is different. The Indian government has continued to favour the older vaccine for its UIP.

AUTHOR

Ruhi Kandhari

Ruhi writes on the impact of healthcare policies, trends in the healthcare sector and developments on the implementation of Electronic Health Records in India. She has an M. Sc. in Development Studies from the London School of Economics.

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