Following a global manufacturing shortage of the vaccine

Immunisation: Bhutan ran out of the Inactivated Polio Vaccine (IPV) in the beginning of this year following a global manufacturing shortage of the vaccine.

This has left parents of infants worried, as the vaccine, is administered by injection at 14 weeks after birth.

Officials of the health ministry’s vaccine preventable disease programme (VPDP) said that the country will get its stock on

August 4 and is expected to last for about five to six months.

The next stock is expected to arrive in December 2017.

VPDP’s deputy chief programme officer Tshewang Tamang said that IPV was introduced in July last year in line with the polio endgame strategy to get additional immunity along with the polio vaccine.

He said there was a global manufacturing shortage, as the vaccine has to be prequalified by the World Health Organisation (WHO).

“We have informed health centres to give the vaccine as per the schedule as soon as they receive it,” he said, adding that health officials would contact the parents.

Tshewang Tamang said that WHO gives priority to the high-risk countries such as India and Myanmar in the region while Bhutan is categorised as a low-risk country. “Although the vaccine is supposed to be given at 14 weeks after birth, we’ve no choice given the shortage,” he said.

However, pediatricians said as the polio vaccination is provided at birth, at six, 10 and 14 weeks to infants as part of the regular immunisation programme, it has to be administered on time as scheduled.

“There are no studies or evidence to show that a child is protected by two doses of currently used Bivalent Oral Polio Vaccine (BOPV),” a pediatrician said. A child less than five years requires four doses of Oral Polio Vaccine (OPV) or three doses of OPV combined with one dose of IPV.

The pediatrician also said that the primary series of Oral Polio Vaccine doses and one IPV is as per WHO requirements irrespective of whether a country falls in the high or low risk categories. “If there is shortage, one more dose of BOPV should be administered if IPV is not available,” the pediatrician added.

Health officials said the vaccination should be given on time and that two doses would not be enough. They said timely immunisation of infants was required as their immunity was low which leads to more infection.

A parent of a newborn said that his baby didn’t receive the vaccination on time given that the hospital has run out of the vaccine. “I was asked to check with the hospital in September or October,” he said. “I’m worried as it is an essential vaccine.”

Bhutan switched to BOPV from Trivalent Oral Polio Vaccine (TOPV) from April 25 this year as part of the polio endgame strategic plan 2013-2018. TOPV consists of type I, II and III virus while the bivalent consists of type I and III virus.

Although type II virus was eliminated since 1999, Bhutan continued to provide the trivalent vaccine. The oral polio vaccine is provided at birth, at six, 10 and 14 weeks to infants as part of the regular immunisation programme.

According to health officials, polio is a serious disease that cripples the life of the affected person. One in 200 infections leads to irreversible paralysis usually in the legs. Among those paralysed, five to 10 percent die when their breathing muscles become paralysed. There is no cure for polio but it can only be prevented by the polio vaccination. The number of polio cases has reduced globally by more than 99 percent over the last two decades.

Bhutan launched the expanded programme on immunisation in 1979 and achieved universal childhood immunisation in 1991. Records show that the last case of clinically compatible polio was reported in 1986. Since then no polio cases were reported.

Bhutan received polio-free certification from the WHO in 2014. Although the country had managed to eradicate polio some 30 years ago, Bhutan had to wait until India achieved polio-free status as the disease could have been acquired from India and the neigbouring countries.

Health officials said that Bhutan conducted national immunisation days in 1995 and sub-national immunisation days from 1996-2002 in high-risk districts. Polio immunisation coverage in Bhutan stands at 99 percent. In 1996, Bhutan initiated acute flaccid paralysis surveillance, the core strategy to detect the transmission of wild poliovirus and circulating vaccine-derived poliovirus.

The existing polio surveillance and high immunisation coverage is to be maintained until polio is globally eradicated.

Kinga Dema