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The latest WHO position paper on Hib says ‘Hib vaccine should be included in all routine immunization programmes’5. This suggests that Hib vaccine should be included in the immunization programme universally, irrespective of an individual country’s disease burden, not withstanding of natural immunity attained within the country against the disease, and not taking into account the rights of sovereign States to decide how they use their limited resources. The mandate and wisdom of issuing such a directive, for a disease that has little potential of becoming a pandemic, needs to be questioned.

The directive has come after a number of failed attempts to convince the scientific community of the need for this vaccine in Asia6, 7. We present this as a case study on the visible and invisible pressures brought to bear on governments to deploy expensive new vaccines.