Not a question of quality alone, a question of need as well

Not a question of quality alone, a question of need as well Tanim Ahmed

Feeding capsules and tablets would not preclude the need for them in the future but deepen one’s dependence on them, furthering the possibility of profit for the manufacturers. And by running the vitamin A campaign, the government may actually becoming a tool of corporate profit while reneging from its more serious responsibility

THERE have been three reported deaths till Wednesday. Thousands of children reportedly fell sick after taking vitamin A capsules and de-worming tablets. A government appointed committee began its investigations on Tuesday. According to reports, samples of the two drugs have been sent to laboratories for testing. But the health minister knows better. He reassured the parliament, and thereby the entire country, that those capsules and tablets had nothing to do with the deaths. And by making the statement he has also compromised the outcome of the investigation of the government committee.
This committee, headed by the director of the government’s primary healthcare directorate is expected to submit a report within three days. But now that the health minister has committed himself, it would be unlikely that the investigation would find something contradictory to what the minister stated and in turn make him look like a fool. One might still point out that the laboratory tests abroad would surely be neutral. Not necessarily. According to a New Age report published on Wednesday, the samples have been sent for tests to laboratories of the manufacturers of those medicines through the agencies that supplied them.
The report states, quoting sources in the health directorate, ‘initiatives had been taken to send the samples of the vitamin A capsules to Copenhagen in Denmark for laboratory tests through the UNICEF, which supplied the medicine produced by a company in Copenhagen’. Regarding the chewable de-worming tablets it states, ‘The samples of Albendazole have already been sent to Incepta Pharmaceuticals Limited, which produced and supplied the drug, asking the company to report the directorate after laboratory tests.’ The conflict of interest is obvious. The tests reports would hardly find anything amiss, as far as the quality of those medicines is concerned.
One must accept, until it is established that the drugs were of poor quality, that the deaths might have resulted due to other reasons. The World Health Organisation and the United Nations Children’s Emergency Fund, have both issued statements that suggest their conviction in the good quality of these medicines. There have been instances before when companies have shipped batches of products, including medicine and baby food, to poor countries in South Asia and Sub-Saharan Africa despite good knowledge of the poor quality of those products. One cannot but recall the instance of Norplant distribution in Bangladesh under USAID project for birth control even after they were discontinued in the United States and the manufacturer was facing thousands of class action suits.
More recently, there was the melamine scare in children’s milk powder. Although melamine is not a naturally occurring substance in milk, none of the brands that were initially found to have been adulterated with melamine were punished. The companies got away on a technicality, on the one hand dismissing tests that found significant traces of melamine while on the other accepting reports that could not find melamine over the ‘detectable limit’. All parties involved in the vitamin A capsule and the de-worming tablets can be expected to vouch for the quality of the medicines with all certainty. After all, these are commercial products. Even the government, as it already has, is likely to defend the quality of those drugs since the prime minister herself inaugurated the programme on Friday.
But amid all the hype over whether the drugs were indeed responsible for the three deaths and thousands taken ill, it is not being questioned whether administering vitamin A and de-worming tablets to almost all the children below 5 years of age is at all necessary. Vitamin A deficiency causes the death of some 670,000 children, according to reports quoting the statement of international agencies. Night blindness is said to be one of the first symptoms of vitamin A deficiency and the health secretary reportedly told the media on Thursday that child blindness was not a serious problem in Bangladesh. According to estimates that he cited to the press on June 4, only about 0.04 per cent of the children currently suffer from night blindness.
According to the report in New Age, the vitamin A campaign covering 20 million children would cost the government about Tk 14 crore, including the cost of medicine. The argument would be the same in case of the de-worming tablets. It is not the entire population of Bangladesh’s children that have worms and those with a higher risk of having worms could easily be screened for de-worming. In this case the state is undertaking a large-scale intervention targeting the entire population of children although the real requirement is only a fraction of that.
Identification of children suffering from night-blindness or those with a higher risk of having worms would substantially reduce the costs, not to mention the logistical problem of proper storage and administration. But such screening and identification would drastically reduce the amount of medicine required in turn reducing the prospect of business for the manufacturers. It appears that one of the driving forces behind conducting this programme across the country is commercial profit for these companies.
One gets the impression that this programme is being lauded by international quarters. At least it is not being criticised in any way. But similar programmes where the state targets the entire population through some intervention is always frowned upon by international quarters who then urge that the state must ‘target’ the more deserving groups — fuel subsidies being one of those instances in recent memory.
The ‘necessity’ of such supplements of nutrients that are generally available in balanced diet is often extolled through concerted efforts of the vested quarters. A seminar jointly organised on July 23, 2008, by the health ministry, Micronutrient Initiative, Johns Hopkins University, USAID, Brac and Helen Keller International, said as many as 20,000 lives of infants could be saved every year in Bangladesh if all newborns are provided with a dose of oral vitamin A each shortly after their birth. According to a report published in the Daily Star a day later, experts there claimed that a certain ‘safe’ dosage of vitamin A for newborns, costing only Tk 2, could save thousands of lives. Never was it mentioned there, that infant up to six months should not require anything, not even water, besides breast-milk.
It is the contention of experts that such interventions as the vitamin A campaign could become necessary in certain regions and only in such extreme cases as famine or natural disasters. This campaign is only an ad hoc measure. Feeding capsules and tablets would not preclude the need for them in the future but deepen one’s dependence on them, furthering the possibility of profit for the manufacturers. And by running the vitamin A campaign, the government may actually becoming a tool of corporate profit while reneging from its more serious responsibility.
Even a brief perusal of the natural sources of vitamin A – which include sweet potato, spinach, leafy vegetables, pumpkins, papayas and mangos – should suffice to demonstrate the commercial motive behind the campaign. Instead of fulfilling its obligation to ensure balanced diet for pregnant and breast-feeding mothers as well as children, or ensuring proper hygiene for the children, the government opted for a band-aid measure which would also ensure visibility in the media. An awareness programme regarding balanced diet and hygiene or the gradual improvement of diet and hygiene could hardly provide for such populist mileage.