GPs raise concerns over vaccines

The unavailability of a number of vaccines in the private sector is causing concern among family doctors, although the Health Division says there is nothing to worry about.

Family doctor Wilfred Galea said there was the remote risk of the re-emergence of diphtheria (a form of severe throat infection) because a vaccine administrated by private doctors until a few years ago was no longer available privately as it has not been registered locally.

Dr Galea explained that this was a booster vaccine for polio and tetanus given to young adolescents as part of their schedule of vaccines. Up to around three years ago, private doctors were administering a formulation of the vaccine that also included a low dose of diphtheria to stimulate the immune system against this disease.

Diphtheria, said Dr Galea, was still active in a number of countries, and international travel could trigger its re-emergence in Malta.

However, the division said that although some vaccines were not easily found on the market, all the necessary ones were available through the national health scheme, adding that "there is no immediate threat to public health".

The division said a vaccine containing diphtheria, tetanus and polio antigens, which is used as a booster in three to four-year-old children, became unavailable in retail pharmacies around two years ago but a similar vaccine was currently being used through the National Immunisation Service.

When questioned about this, Dr Galea said it was the vaccine for adolescents that was unavailable.

He explained that vaccines protect not only the individual but help provide herd immunity, since the greater the number of people that are immune to a disease, the less chance there is for a virus to disperse.

"If we do not maximise immunity and this goes down, in a few years' time, we might be faced with a low herd immunity and a population that is more susceptible to a disease," he said.

Dr Galea also expressed concern that another vaccine, with a low dose of diphtheria, tetanus, polio and pertussis, which had been approved in other EU countries, had not yet been registered locally.

To this, the division spokesman replied that a vaccine containing all these antigens had been registered and was available on the local market. However, they did not specify whether they were referring to the low-dose vaccine, which is Dr Galea's object of concern.

Try as they might, family doctors are finding it practically impossible to find yet another vaccine on the market, the anti-tetanus vaccine. Dr Galea said doctors were having to refer patients to health centres to be able to get this shot.

The division confirmed that no marketing authorisations for preparations containing tetanus toxoid - used for active immunisation against tetanus infection or for booster purposes after injury - had been issued. As a consequence, the active ingredient had been included in the list for the simple registration system according to an EU directive.

The division said however that the toxoid is available through the NHS and government pharmaceutical services.

Dr Galea's concerns were echoed by Malta College of Family Doctors president Pierre Mallia.

He also pointed out that traditionally, doctors used to keep a number of vaccines in their clinics to administer to patients, especially prior to the annual influenza season. This helped to keep the price of vaccines down because doctors would buy them wholesale and patients only paid the wholesale price plus the doctor's fee.

Doctors were however no longer allowed to buy medicines directly from the agent so the patient had to pay the retail price as well as the doctor's fee.


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