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Right to health and informed consent: Why 'revisit' Mission Indradhanush?

By Deepika* 

Extending on to the subject of Misleading ads and acting responsibly, another aspect that needs highlighting is our right to health and to be made aware of quality of products, as pointed out by the Supreme Court.
The Supreme Court has declared that the fundamental right to health encompasses the right of a consumer to be made aware of the quality of products being offered for sale by manufacturers, service providers, advertisers, and advertising agencies.
In the order dated May 7, the Court commented on the responsibility of celebrities and influences who endorse products in advertisements.
"We are of the firm view that advertisers/advertising agencies and endorsers are equally responsible for issuing false and misleading advertisements. Such endorsements are routinely made by public figures, influencers, celebrities etc. go a long way in promoting a product. 
"It is imperative for them to act with a sense of responsibility when endorsing any product and take responsibility for the same, as reflected in Guideline No. 8 of the Guidelines, 2022 that relates to advertisements that address/target or use children for various purposes and Guideline No. 12 that lays down the duties of manufacturers, service providers, advertisers and advertising agencies to ensure that the trust of the consumer is not abused or exploited due to sheer lack of knowledge or inexperience. 
"Guideline No. 13 requires a due diligence to be undertaken for endorsement of advertisements and requires a person who endorses a product to have adequate information about, or experience with a specific good, product or service that is proposed to be endorsed and ensure that it must not be deceptive."
Right to be made aware of quality of products being offered cannot be complete without considering the aspect of Informed Consent. Per the NCBI, Informed Consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention.
The following are the required elements for documentation of the Informed Consent discussion: (1) the nature of the procedure, (2) the risks and benefits and the procedure, (3) reasonable alternatives, (4) risks and benefits of alternatives.
Children cannot provide Informed Consent. Parents must permit treatments or interventions.
Looking back, what had happened in the 2009 HPV case was the gross violation of Informed Consent. The HPV vaccine was administered to tribal girls through a camp approach in the hostels and school campuses. In many instances, the wardens of the residential schools and hostels were asked to provide consent or permission for vaccination, while parents were not informed.
Recently, 131 girls were injected with the HPV vaccine at AIIMS Bhopal and there are many more such instances even when the Health Ministry officials have categorically stated that the vaccine will not be included in the National Immunisation Program due to concerns around side effects. So, were these 131 girls and many more who are being vaccinated with the HPV vaccine along with their parents/guardians been informed of the concerns that the Health Ministry has voiced? Highly unlikely!
Going back to children’s covid vaccination which was rolled out in January 2022 in India, there were norms around children/teenagers not requiring parental consent to be vaccinated. These norms or the confusion that surrounded it might have led many teenagers to get vaccinated without consulting their parents when the product in question had only “emergency use approval” and necessitated weighing the risks and benefits.
Similarly, schools are regularly organising vaccination campaigns to vaccinate students with flu, tetanus, TD vaccines etc, and also administering deworming tablets to students. Though some of the schools do seek parental consent, the circulars issued by schools have no mention of the associated risks. 
How are the parents supposed to provide a sound Informed Consent when information about risks and side effects are hidden from them? These circulars sound more like sermons and are subtle coercive techniques to force the parents to get their children vaccinated.
Also, it was known by members of the polio eradication committee that the vaccine itself can cause polio -- a condition called VAPP or vaccine associated paralytic poliomyelitis. This known side effect was deliberately hidden from the public and parents of the vaccinated children, with full knowledge of WHO and UNICEF.
Forced Vaccination is another issue which needs to be addressed as it violates bodily rights along with violation of Informed Consent. Children have died due to forced vaccination despite refusal by parents, notices have been sent to centres which did not meet vaccination targets when vaccination is non mandatory etc.

Reasonable alternatives

Informed Consent contains the element of “Reasonable Alternatives” which means that the parents have the right to choose alternative protection/treatment or none at all but is there any room for that in the current health policies is a question that needs answering.
In the National Education policy 2020, it is mentioned that all school children shall undergo regular health check-ups especially for 100% immunization in schools and health cards will be issued to monitor the same. Health cards like ABHA etc. are not only a violation of the right to privacy but provides significant barrier to the principle of Informed Consent.
Considering that right to Informed Consent (along with Right to Education and Right to Privacy) is our fundamental right, it should render the government’s target of 100% immunisation null and void and Mission Indradhanush needs to be revisited.
In essence, Informed Consent is a collaborative process allowing patients and healthcare providers to make decisions together when more than one reasonable alternative exists, accounting for the patient’s unique preferences and priorities.
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*Digital marketing and content management professional with keen interest in public health policies

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