Crash of the immunization program: consequences of a totalitarian approach.

India's Universal Immunization Program, which was to cover a population of more than 90 million pregnant mothers and 83 million infants living in more than 575,000 villages during 1986-90, has failed dismally. The coverage has been less than one-fifth of the requirement in more than half of the population. The situation in most third world countries, which have even weaker political clout and weaker health service infrastructures, is even more catastrophic. From a purely public health standpoint, the disaster was inevitable. No efforts were made even to define the problem of the six immunizable diseases; there was no question of understanding their natural history; the efficacy of the vaccines used was not well-known; the cold chain, which is meant to retain the potency of the vaccines at the time of inoculation, frequently broke down; there was confusion about the dosage; and even where the program is most successful, ecological conditions will erode much of the benefits from immunization. That such a technocentric program was imposed on the peoples of the third world by their governments was bad enough; even more frightening is that these countries were persuaded to follow the line developed in affluent countries by influential agencies such as UNICEF, WHO, the World Bank, the Rockefeller Foundation, and Rotary International. This is an awe-inspiring manifestation of the power of the affluent countries to impose their will on the weak and helpless peoples of the world. It is a bitter irony that UNICEF and WHO, which sponsored the famous global conference at Alma-Ata, should have lent their weight to a program that is the very antithesis of the Declaration. To embark on such a venture, the exponents had to ignore weighty scientific evidence that raised serious doubts about the program. They had to stoop to suppression of information, disinformation, and distortion of information. What is even worse, efforts will be made to erase this experience from memory, and similar efforts will again be made to launch such ill-conceived programs in the name of the welfare of the oppressed peoples of the world. Scholars who have concern for the oppressed must remain vigilant.