Intended for healthcare professionals


Should immunisation against hepatitis B take priority over provision of clean drinking water?

BMJ 1999; 319 doi: (Published 17 July 1999) Cite this as: BMJ 1999;319:188
  1. Jacob M Puliyel, Head (puliyel{at}
  1. Department of Paediatrics, St Stephen's Hospital, Delhi 110054, India

    EDITOR—The World Health Organisation has suggested universal immunisation with hepatitis B vaccine.1 The Indian Academy of Paediatrics has recommended vaccination to paediatricians in the country and to the government; paediatricians have in turn been recommending it. The cheapest Indian vaccine costs 360 rupees (£ 5.21) for three doses.

    The India Development Report 1997 suggests that a third of the population earn less than 57 rupees (83p) per capita per month.2 The main causes of death in India are diarrhoea, respiratory infections, and malnutrition.

    Does the World Health Organisation really want universal immunisation with hepatitis B vaccine to take priority over the provision of clean drinking water? At what stage of development of a country's infrastructure does the prevention of hepatitis B by vaccination take priority? Is there any study about this? We would like to be rid of this vermin, but the Pied Piper must be paid.


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