Vaccinations for babies are proving to be excellent moneyspinners for doctors, especially the newer ones that have not been recommended by the government and are not part of the national immunisation programme. On a single dose, doctors can make a profit of anything from Rs 200 to over Rs 600 depending on the vaccine being given and the brand chosen. The profit margins are much higher for the non-mandatory vaccines (see table on right).

The Medical Council of India (MCI) has banned doctors from taking a gift of more than Rs 1,000 to ensure that they are not induced by companies to prescribe their products. However, the hefty profit margins being offered to doctors on every single dose could be an even better inducement and cumulatively worth much more than Rs 1,000.

At six weeks of age, by administering the first doses of pentavalent vaccine, the rotavirus vaccine and pneumococcal vaccine, the doctor could make anywhere between Rs 800 and Rs 1,400 per baby. This does not include the vaccination/consultation fee charged by the doctor, which is anywhere between Rs 200 and Rs 500. Many of these vaccines require three doses and hence the profit margin could be as high as Rs 2,400 to Rs 4,200 per baby vaccinated. By the time the baby is 15 months old, vaccines alone could cost parents between Rs 15,000 and Rs 28,000.

This practice had been highlighted in a 2010 study published in the Indian Journal of Medical Ethics. The study was done by Dr Rakesh Lodha of the Department of Paediatrics, AIIMS, and Dr Anurag Bhargav of Jan Swasthya Sahyog in Chhattisgarh.

Health minister Ghulam Nabi Azad had referred to it in April 2010 in his reply to a question in the Lok Sabha on doctors being bribed by pharmaceutical companies. He had said that though companies offered the vaccines to doctors at hugely reduced prices, patients were being charged the full price. However, even two years later, the health ministry has done nothing to address the problem.

"What the doctor is charging is legal since that is the marked price," argues a paediatrician. He maintains that patients are likely to suspect the quality of the vaccine if they are not charged the MRP.

Tanushree, mother of a two-monthold baby, says parents have no idea about the profit margins doctors can rake in on vaccinations. "We just go by whatever the doctor bills us. The doctor opens the bottle, fills the syringe, injects the baby and then disposes the stuff in the dustbin. When do we get to see the MRP?" she asks.

"The doctor did tell us that the vaccines not listed in the immunisation programme are optional. He said they were good for the baby but not mandatory. We trust the doctor to do the best for the baby," says Tanushree. The important question here is whether doctors are betraying that trust.