Fifty-two-year-old Dr Ramanujan has been a practicing homeopathic doctor for 29 years now. He never got his children vaccinated and claims that till date none of them have suffered from any major viral diseases. Dr Ramanujam himself did not get vaccinated as a child. "There are millions of viruses out there and they have been there since the beginning of mankind. Viruses also mutate over time. How many viruses can we protect ourselves from? Besides some vaccines have side effects, and the effectiveness of some has not been proven," the Chennai-based homeopath says. Dr Ramanujam is one amongst a small population of Indians who don’t believe in vaccination. Their numbers may be small, but their decisions could have a profound effect on the rest of the people. "I am not pro or anti-immunisation, it worked for me, and may not for someone else. I never thrust my choice on anyone. Because I don't have any scientific evidence against vaccines," he is quick to add.   Mission Indradhanush: Immunising kids of migratory workers; Image source: IANS   In most countries, including India, vaccinations are almost followed like a ritual after a baby is born. Vaccines are meant to prevent children from life threatening diseases and some immunization programmes like polio eradication have proven to be hugely successful across the world. What are immunisation and vaccination options in India? 27 million children are provided vaccination against 13 life threatening diseases in India each year under the government's Universal Immunisation Programme. Some of the vaccines provided under the UIP include BCG (Bacillus Calmette Guerin), DPT (Diphtheria, Pertussis and Tetanus Toxoid), OPV (Oral Polio Vaccine),Hepatitis B, and Measles.  Why do some parents delay or refuse vaccinations? Their decisions could be backed by specific scientific data, or individual, religious or psychological reasoning. For Mary James from Ernakulam in Kerala, not vaccinating her children is a practice that was passed on to her from her parents. Mary's three children have been given only oral polio drops. She feels there is no need for other vaccines. "Chicken pox and measles affects once in a lifetime. In a way, the diseases cleanse the body," she says. Her only sister too has not got her children vaccinated. Her religion, however, has got nothing to do with her decision, she says. A latest UN report showed that while the total immunisation coverage in the country increased from 61 to 65.2 percent, it saw a dip in the states of Gujarat, Maharashtra, Meghalaya, Assam and Mizoram. The Women and Child Development ministry refused to accept the results of the results of the survey which had been conducted in 2012-13, questioning the survey's methodology. Fear of autism and other complications Dr Prema, a homeopath based-out of Dindigul in Tamil Nadu, has a three-year-nine-month-old son. An advocate of non-vaccination since her early days of practicing, she did not want her son to be immunised. However, he was "accidentally" vaccinated, but Dr Prema never completed the vaccination cycle. Her son suffers from delayed speech development and she feels that had he undergone the entire ritual of vaccination, he would have been autistic. The 34-year-old doctor said certain studies have proven vaccines adversely affect human immune system and can lead to diseases such as cancer, asthma and even hamper brain development in children.     Few studies point to the adverse effects of Measles, Mumps, and Rubella (MMR) vaccine, and some were disproved later. The controversy over MMR vaccine started in 1998 when gastroenterologist Andrew Wakefield published a fraudulent paper in The Lancet claiming that the vaccine was linked to autism. His research, though was later discredited, triggered confusion and fear among parents, who started associating the vaccine with autism.  In the November of 2014, a group of academicians, practitioners and teachers of pediatrics and public health, wrote a joint letter to Prime Minister Narendra Modi voicing their concerns over the growing number of deaths caused in children in India after being administered with pentavalent vaccine.  The pentavalent vaccine is a combination of five vaccines in one: diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b (the bacteria that causes meningitis, pneumonia and otitis).  The letter quoted several studies and reports pointing out the adverse and even fatal effects of the vaccine. Speaking to The News Minute, Dr Jacob Puliyel, Head of Pediatrics, St Stephens Hospital, Delhi, and one of the signatories of the letter, says that the Pentavalent vaccine has very little utility and the deaths caused by it are completely illogical. "It is not acceptable that children die from a vaccine which was meant to prevent them," he says.   The letter quotes an RTI reply which stated that there have been 76 deaths in India till August 2014 from pentavalent adverse events following immunization (AEFI). "These deaths are like the reaction that happens in adults with penicillin injection. It is the responsibility of the doctor to test each person before administering this penicillin, which is known to produce this reaction occasionally. We have no such test for Pentavalent vaccine and we have no method of preventing these deaths." Dr Puliyel says he does tell parents about the vaccine's adverse effects to help them make informed choices, but could not specifically tell how many parents opt out of immunizing their children. "I am not against vaccinations. In fact immunisation is important, but I am more concerned about how safe the vaccines are. We need vaccines that are good, safe and cost-effective," he says, adding that all his statements are scientifically backed. Do these parents not have an ethical responsibility? Many doctors believe that other than a public reason to vaccinate one’s child, the parent should realize they will be responsible if the child contracts the otherwise avoidable disease. Suhana Devadas, a Bengaluru-based neonatologist is of the opinion that vaccines aren't just important; they are all the more significant in a country like India. "The infant mortality rate here is high, so is malnutrition. The chances of contracting infectious diseases too are higher. Vaccines are a boon to prevent children from such diseases," she says. With inputs from Haritha John