Tuesday, September 22, 2009

Sensationalist Hyperbole from the NY Times, Re vaccine adjuvants

Andrew Pollack is an MIT-trained engineer, who has covered the business and science of biotechnology for the New York Times since 2000. I don't know how qualified he is to comment on aspects of biology and medicine, or indeed how far he understands the topics that he speaks about. But it irritates me greatly when I see sensationalist tripe, such as, "Are Americans obligated to use an unproven vaccine to help protect people in other countries from the flu pandemic?" with which Pollack opens his commentary in yesterday's NY Times - curiously titled, 'Benefit and Doubt in Vaccine Additive' - on the use of adjuvants in vaccines in the United States.

The question is, or rather is meant to be, a loaded one; note the use of the key terms - 'obligated', 'unproven vaccine', and 'protect people in other countries' - that are guaranteed to rouse the rabbles and sit well with the proponents of anti-vaccination lunacy in the US. Let me first take the words that were surely utilized to engender a sense of outrage, and tickle the xenophobia inherent in many of that lunatic fringe: 'obligated', and 'protect people in other countries'.

As far as vaccines are concerned, there is no 'obligation' for the people of this country - but it does make eminently good sense. Consider the case of the influenza virus, which has been has been one of the major causes of morbidity and mortality, especially among young children, since 1918. The commonly circulating strain of the virus (the seasonal 'flu') is not virulent enough to cause mortality, but the virus is able to mutate at a very high rate leading to the emergence of highly virulent strains, which have a range of hosts, including humans, horses, pigs, sea mammals and birds, and more importantly, some of which are able to cross the species barrier (for example, bird to human, avian influenza A H5N1). When a new (mutated) influenza virus appears against which the human population has no immunity, it has the potential of causing a pandemic. Pandemics caused by influenza A viruses in the past have been associated with high morbidity and mortality, as well as loss of livelihood.

It does not take great intelligence to understand that geographical barriers are largely meaningless nowadays, what with the tremendous increase in global travel, urbanization, as well as overpopulation; any epidemic, particularly the ones due to the hypervirulent new influenza strains (including those crossing over from animals) is likely to disseminate globally rather quickly, leading to disease and deaths in large numbers, as we have seen several times in the past few years, making the occurrence of the next pandemic just a matter of time. Therefore, the 'protect people of other countries' argument does not wash at all.

Tuesday, September 15, 2009

It is a sad, sad world...

We read this stuff - it is always someone else's problem - we feel an appropriate moral outrage and then jump back into our own individual ponds. Life goes on. But some time, some day, I would like to see this atrocity end; some day I would like to find the perpetrators of such atrocities brought to justice, unable to claim clemency in the name of that great facilitator of all social evils, namely, 'culture and tradition'.

A 12 year old Yemeni girl, Fawziya Ammodi, died during a painful childbirth in Amman.

A pre-teen of 12! Just a time when she would have stood at the threshold of high school in India; a time when Indian parents would tell her to be careful about the boys around, when she would enjoy - but not say anything, beyond a look here and a smile there, about - the first attentions of the shy, nerdy boy in her class, when she would giggle with her friends about the gawkiness and immaturity of most the boys around, when she would still be enthralled with tall, dark and handsome heroes and, of course, Nancy Drew.

It would be a very similar experience for a 12-year old vibrant, vivacious girl anywhere in the civilized world. Apparently not in Yemen.

Born into an impoverished family in Hodeidah, Fawziya Ammodi was forced to drop out of school, and married off to a 24-year old man last year. More than half of all young Yemeni girls are married off before the age of 18 - many times to older men, some with more than one wife, a study by Sanaa University found. Marriage means the girls are no longer a financial or moral burden to their parents.

Fawziya struggled for three days in labor, before dying of severe bleeding at a hospital on Friday, the September 11; her baby did not survive either - which is not surprising because 12-year old girls usually aren't physically developed enough to cope with childbirth, at least not with the relative ease of a grown-up.

UNICEF issued a statement Monday saying: "Child marriages violate the rights of children in the most deplorable way. The younger the girl is when she becomes pregnant, the greater the health risks for her and her baby... Girls who give birth before the age of 15 are five times more likely to die in childbirth than women in their 20s. Child marriage denies girls of their childhood, deprives them of an education and robs them of their innocence... More must be done to address the underlying causes in order to prevent tragic deaths like those of 12-year-old Fawziya and her baby."

This is not the first incident of this sort in Yemen. Child brides are commonplace in Yemen, especially in the Red Sea Coast where tribal customs hold sway. In 2008, 10-year-old Nujood Ali was pulled out of school by her own parents and married to a much older man who beat and raped her within weeks of the ceremony. To escape, Nujood hailed a taxi - the first time in her life - to get across town to the central courthouse where she sat on a bench and demanded to see a judge. After a well-publicized trial, she was granted a divorce. But in Yemen, she is still fighting to reclaim her life from official apathy and her parents' greed.

I felt incredibly sad at the misfortune of this stranger, a 12-year old who would not walk, talk or run around ever again. Child marriages still take place in many parts of northern India, despite the best efforts of many non-governmental organizations working in conjunction with the central government. Poverty, illiteracy, and of course, 'culture and tradition' are the excuses proferred in all these cases, while female children continue to be abused and die.

The CNN article (linked above) ends with a factoid of the kind that makes my blood boil: "The Yemeni parliament tried in February to pass a law, setting the minimum marriage age at 17. But the measure has not reached the president because many parliamentarians argued it violates Shariah, or Islamic law, which does not stipulate a minimum age." Incidentally, it is the same Shariah, by which Nujood's ex-husband had to be compensated, not prosecuted! Nujood was ordered to pay him more than $200 - a huge amount in a country where 15.7% of the population lives on less than $1 a day, according to the UN Developments Program.

I wish for a saner world, where the so-called 'culture and tradition' and that wellspring of ignorance and abuse called religion do not exist. Fantasy, I know. And it hits closer to home than you think.