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Dear everybody The WHO has suggested universal immunization with Hepatitis B vaccine in countries with intermediate prevalence. The Indian Academy of Pediatrics has dutifully recommended it to pediatricians in the country and to the government. Pediatricians have in turn been advising the vaccine. The vaccine costs about Rupees 750 for 3 doses. The India Development Report 1997 (Ed. Kirit S Parikh Oxford Press Delhi 1997) suggests that a third of the population earn less than Rupees 57 per capita per month. The major killers here are diarrhea, respiratory infections and malnutrition. Basic amenities like safe drinking water are not available to the majority. Does the WHO really want universal immunization with Hepatitis B as a priority over the provision of clean drinking water? At what stage of infrastructure development in a country does Hepatitis B prevention by vaccination take priority? Is there any study about this? How does one compute the cost effectiveness of Hepatitis B vaccination . One way to compute cost effectiveness would be to look at the cost of a liver transplant and the cost of vaccinating n number of people to prevent the need for that transplant. If the cost of the latter is less than the former it can be called a cost effective intervention. But surely the WHO is aware of the ground realities in developing countries. Liver transplant is not an option for 99.99% of the population. For one person dying of liver failure hundreds of others die of diarrhea. The interventions (like provision of clean drinking water) required to save these hundreds would cost a fraction of what is required for Hepatitis B vaccines. Is it right that developing countries are advised to spend their meager resources on this expensive Program of universal immunization with Hepatitis B vaccine? The WHO is manned by the best brains in the world. There must be very sound reasons for their recommendation. I am however curious to know their reasoning. I put my question to them via Email. I have not heard in reply. Probably the Email did not reach the right person. I wonder if any one in this discussion group can help with the answers. Jacob M. Puliyel Head Department of Pediatrics St Stephens Hospital Tis Hazari Delhi110054 India Email [log in to unmask] >From Puliyel Visit http://www.geocities.com/EnchantedForest/Cottage/7316 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%