Before we go into technical jargon or say business case that is required for HEV vaccine to make its place in WHO pq ed list so we can use this vaccine in public or get it enough in private market - let me walk you through noise of this disease and call for this vaccine in Nepal. Of other countries, I can not objectively tell or write now. But i can guess, same must be the case and scenario on other South Asian countries, where HEV outbreaks occurs yearly in impoverished population.
I Google - ed "HEV in News in Nepal" - I came across pretty long list of online news or even oped pieces. One stand out among those i read and is written by Dr. Buddha Basnyat in Nepali Times. This opinion piece (#Issue 591 - Feb 2012) strongly states on possible public health use of HEV vaccine (in Nepal) comparing with SA 14 - 14 - 2, live attenuated vaccine against Japanese encephalitis (JE) also produced and licensed in China. This vaccine was also not WHO pq ed at the time when Nepalese health authority decided to use it country wide in endemic districts. This JE vaccination started in campaign mode and later introduced into routine immunization. This way, JE vaccination has been a successful program in controlling and preventing debilitating serious brain viral infection. Now, we see such a visible public health impact that anybody when travels to Terai districts can hear such stories of success. Myself - I have been part of this public health activities initiated by government of Nepal along WHO - Nepal. The strength that lies hidden in this endeavor is the background surveillance of Acute Encephalitis Syndrome (AES), which provided clear picture as to the epidemiology of this disease, so policy makers were able to provide direction for the country. If so is the case for HEV vaccination in Nepal, my only question is " Do we have such robust background surveillance data to guide our policy makers so they can take policy decision?" Otherwise, i can agree to what Mr. Basnyat point of view, when another HEV vaccine which was tested in Nepalese population - why not make Hecolin (Chinese vaccine) available for public health use here in Nepal?
Only constraint that I see personally is lack of comprehensive surveillance data to back up our argument for introducing HEV vaccine in the community especially vulnerable population. So, for me, I would love to see comprehensive epidemiological picture of HEV across the country. Therefore, one way would be to review all the literature so far published and use modelling tools, or conduct surveillance (active vs. passive) based on availability of budget aligning with interested parties to gauze and weigh the gravity of HEV problem in Nepal. Let us see how far does this go or else may be, there must be a way to extrapolate the findings of other country experience and create public demand for this vaccine. In that case, the recent outbreak of HEV in Biratnagar could be one scenario, we can build one, so what do you say??
Still, to be honest, i am clear on the gravity of HEV problem in terms of time, place and person, except I myself have suffered this HEV infection !! In science, your personal story may help you to connect with the wider audiences but i feel, we need evidence and solid network of those organizations who wants to contribute in this endeavor of prevention and control of this disease, which i call it - "Fire that catch up in the cliff, and spread through large geography without our knowing !!"
