As 6 part of writing series on Viral Hepatitis E (HEV) and Nepal, I am now activating neurons in some part of neo cortex of my brain, so I can write meaningfully to understand better this HEV disease in particular. I am repeating again, why I am so interested to write about this infectious disease is because this is very personal to me !! In HEV series (Part 1), I wrote of myself getting to know this disease closely. When I remember those days of extreme weakness with bouts of vomiting with incessant nausea that gripped your guts, I even now feel the suffering. In HEV seried (Part 2), i have tried to be more objective and I did pretty satisfying job in quickly reviewing all the papers so far published related to HEV in Nepal. It is comforting to know so much have been studied on HEV and now, we do know the basic epidemiology including the genotypic mapping of HEV circulating in Nepal. Notably, some of the human phase of clinical trials were also conducted in Kathmandu among Nepalese population.
However, there is only one voice that we have heard and now i have started to understand why the candidate vaccine meant for HEV is still not there in public health or even in private market arena? In this aspect, I read a short letter in response to a paper published in a leading science journal. Dr. Buddha Basnyat (a senior scientist seriously studying infectious diseases in Nepal) has raised a serious ethical question as to why vaccine industry or research organizations who have invested so much of their time and money to develop HEV vaccine and now, there is no vaccine when there is high demand in the community. In the letter titled Neglected HEV and Typhoid Vaccine, he raises a serious question, " These vaccines against hepatitis E.......are not available, despite their proven efficacy and safety. If GSK, Walter....were not going to develop these vacciness or make them available after their successful testing in Nepal and Vietnam, why were they tested? And if these organizations will not develop them further, is there a responsibility to make them available to others who might?"
In response to this series question, where justice as a fairness so the fruits of science have to be available if they were tested in a population in its development. In next part, I will try to throw light in understanding what is the crux of delay in bringing out HEV vaccine in the community where it is needed the most. So the question comes, is it related with financing or business aspect of vaccine development? or is it related with regulatory or purely scientific challenges that have to be solved so that we can deliver safe, affordable and effective vaccine once and for all?