As an encephalitis outbreak rages in northern India and neighboring Nepal, a vaccine in China could have been used to keep more than 360 children from dying and hundreds more from likely suffering a lifetime of mental and physical disabilities.
But borders and politics complicate the issue, making access impossible without money and a strong political will, researchers say.
The children are dying from Japanese encephalitis, found only in Asia. Though closely related to West Nile virus, this illness isn't as widely known as other mosquito-borne diseases such as malaria or dengue fever. But it is the leading cause of viral encephalitis and neurological infection in Asia, typically attacking the poor and the young -- children aged one to 15 who live near rice paddies in rural areas.
The outbreak in India's most populous state, Uttar Pradesh, began last month and has left more than 1,000 hospitalized, while more children die each day. In Nepal, the disease has been spreading since April in the country's south, across the border from Uttar Pradesh.
Blinding headaches, seizures, nausea and high fever usually precede death, with the situation becoming so dire in India that doctors are using makeshift oxygen masks fashioned from cardboard cones and tubing on child victims after hospitals ran out of the real thing.
While drastically underreported, about 50,000 cases of Japanese encephalitis are recorded each year, including 15,000 deaths, according to the World Health Organization (WHO). Of the survivors, up to 75 percent suffer disabilities, including paralysis and mental retardation. The disease has no cure or effective treatment.
The Chinese vaccine, made from a weakened form of the virus, has been used widely within the communist country since 1988. Last year, about 200 deaths were reported nationwide, according to the Chinese Ministry of Health.
American Dr Scott Halstead, research director at the Pediatric Dengue Vaccine Initiative, has seen firsthand how well it works. He conducted a study in Nepal in 1999 that showed one injection of the Chinese vaccine was effective almost immediately with no side effects.
So far only South Korea, Nepal and Sri Lanka have licensed the Chinese vaccine, while others rely on limited supplies of another type of vaccine derived from mice brains. It is more expensive, causes more side effects, requires multiple doses and takes at least a month after the last dose to be effective, said Dr Julie Jacobson, director of the Japanese Encephalitis Project at the US-based nonprofit PATH.
The WHO in May adopted a 10-year global strategy to increase immunizations for different diseases worldwide, including Japanese encephalitis. But the Chinese vaccine has not yet been added to its list of prequalified vaccines, which could be a deterrent for some countries waiting for the UN health agency's nod of approval. It also keeps UN agencies in Asian countries from procuring the vaccine.
The WHO's Joachim Hombach in Geneva said he expects to see the Chinese vaccine or others now under development added to WHO's list in two to three years. He said the Chinese manufacturer has not yet asked WHO to prequalify the vaccine, but it has recently been reviewed and the WHO has published recommendations on it.
"If the product is not prequalified, it doesn't mean you cannot use it. It doesn't mean the product is bad," he said. "It just means we have not seen it."
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