Comprehensive review of immunization services nationwide.

The first five months of the year have seen numerous irregularities and incidents related to vaccines and expanded immunization programs. This week, the Ministry of Health will conduct a comprehensive review of immunization services nationwide, according to Nguyen Van Binh, Director of the Department of Preventive Medicine (Ministry of Health).



Mr. Nguyen Van Binh - Photo: L.ANH

- This inspection is being led by the Ministry of Health's inspectorate, with the Department of Preventive Medicine providing specialized personnel for coordination. Many issues will need to be considered, such as vaccine storage procedures. Simply having a refrigerator isn't enough; many other requirements are needed, such as how to arrange vaccines, where to store measles vaccines, where to store tetanus vaccines, and regulations regarding vaccine storage temperatures...

* Recent inspections following the vaccine incident have indicated that the vaccination service was good. However, even in Hanoi, the mistake of administering insufficient doses of vaccine revealed that the vaccination procedures were not being followed. Do you believe that the procedures are still lax in practice?

- The positive conclusions are based on the points inspected, not on a 100% positive assessment nationwide. If that were the case, what would be the point of inspection? The country has 10,000 communes and wards, 10,000 vaccination points, not including service vaccination points. However, one shouldn't assume that if Hanoi is like this, other localities are worse, because Hanoi isn't necessarily better. In reality, the cold chain for the vaccination point system has been quite well-equipped in recent years, and the vaccination procedures have been specifically guided by the Expanded Immunization Program. Since 2012, after some cases of severe reactions after vaccination, the Department of Preventive Medicine has requested the program to strengthen training on these procedures for localities.

* Regarding Vietnam's temporary suspension of the Quinvaxem 5-in-1 vaccine due to numerous adverse events, the World Health Organization (WHO) in Vietnam recently stated that the Quinvaxem vaccine in Vietnam is safe. Does this mean that the re-testing of the vaccine has been completed and Vietnam will resume using Quinvaxem?

- The WHO's assessment of safety is based on documentation provided by the vaccine manufacturer to the WHO. The final conclusion must await the results of testing in the UK, expected by the end of June. Over the past period, the National Institute for Vaccine and Biological Products Testing has also tested several batches of Quinvaxem and has not detected any abnormalities. However, testing in Vietnam has only covered a few parameters, while testing in the UK covers all parameters comprehensively. We have also provided the WHO expert team with complete documentation regarding each case of severe adverse reaction after vaccination. After receiving the expert team's conclusions and the vaccine testing results from the UK, the Ministry of Health's expert council will convene to decide whether to continue using Quinvaxem or discontinue its use altogether. The WHO will also participate in this meeting.

* The rate of adverse reactions to Quinvaxem has been very high recently; in the first three months of the year, there were 14 cases of severe reactions, with 5 deaths. In your opinion, would using this vaccine again pose a danger?

- If we consider the total number of Quinvaxem vaccines imported, the rate of severe adverse events is less than 1/1 million doses as recommended by the WHO. While the rate of severe reactions after Quinvaxem vaccination is over 0.6/1 million doses, considering the number of cases of reactions in a short period of three months in 2013, the number of severe reactions is high, and the Ministry of Health has reported to the Government to temporarily suspend the use of this vaccine pending independent verification.

If this vaccine is deemed safe, a panel of experts will meet with the participation of the WHO to review it. If the testing confirms its safety, we cannot insist that it is unsafe, because who's to say that using a different vaccine will guarantee 100% no post-vaccination reactions? Recently, someone asked why there are fewer post-vaccination deaths abroad than in Vietnam. In fact, every day in Vietnam, up to 80 children under one year old die from various causes, and in 4 out of 5 cases of death after receiving the Quinvaxem vaccine since the beginning of 2013, expert panels have assessed that the vaccine and vaccination services were not related, with only one case still unclear. Of course, when assessing vaccine safety, they evaluate both the rate of local and systemic reactions, not just the mortality rate. A safe vaccine is one that does not allow for a mortality rate due to post-vaccination risks.

* Following a series of incidents in the vaccination program, what will the Ministry of Health do to restore the credibility of a major program that is currently suffering and causing concern?

- The Ministry of Health has decided to assign the Ministry's Inspectorate to lead the inspection, with the Department of Preventive Medicine coordinating the review of vaccination services. The expanded immunization program will strengthen training on professional skills and procedures. The problem is that the Ministry of Health's inspections only cover a few locations; provinces and districts must inspect their local vaccination facilities regularly. Regarding vaccine sources, in addition to Quinvaxem, a group of experts is preparing alternative vaccines, ready for the possibility of completely discontinuing Quinvaxem. As far as I know, during the nearly one month of temporarily suspending Quinvaxem, the number of children brought in for vaccination with the 5-in-1 and 6-in-1 vaccines as a replacement for Quinvaxem has increased.

According to Tuoi Tre - TH