23 Sep

Vaccination programs in India

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Contents

• Introduction
• Various Initiatives
• Factors behind low Immunization coverage
  • Vaccine Hesitancy
• Efforts to deal with challenges

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Introduction

Immunization programs are critical components of government’s commitment of Universal Health Coverage. It is integral to India’s efforts of reducing the burden of vaccine preventable diseases and achieving universal care for children.

Various Initiatives

• The government had launched Expanded Program for Immunization in 1978 which was further replaced by Universal Immunization Program (UIP) in 1985. It is the largest Immunization Program in the world, with the annual coverage of 2.6 crore infants and 2.9 crore pregnant women. Through this India has achieved groundbreaking success in eradicating/eliminating life threatening vaccine preventable diseases like smallpox, Polio, Maternal Neonatal Tetanus etc.
  • But despite a lot of efforts and improvements, the immunization coverage had been slow to increase with a coverage of 62% according to NFHS-4 released in 2015-16.

Key Factors behind low Immunization Coverage

• Rapid and Unplanned urbanization
• Large migrating and isolated population is difficult to cover
  • Difficult terrains, areas under LWE etc. are also difficult to cover.
• Lack of awareness among uninformed masses and unaware population leads to low demand of immunization
• Inequality in vaccine administration – Socio-economic status-based vaccine disparity with the disadvantaged and underserved groups being left out.
• Vaccine Hesitancy:The reluctance or refusal to vaccinate despite the availability of vaccines is known as vaccine hesitancy. Vaccine hesitancy threatens to reverse progress made in tackling vaccine preventable diseases.
  • Factors behind Vaccine Hesitancy
    • Misinformation -> Vaccine may cause the diseases. Though this may be true, the chances of getting diseases will be much higher in the absence of vaccinations. Vaccine caused diseases are very rare.
    • Poor Health Facilities also makes people trust them less
    • Anti-vaccination campaigns in countries like the USA is also becoming a key reason for this.

Way Forward

• Systematic analysis of causes
• Information Campaign
• Improving the health facilities.

Rumor Mongering/ Misinformation among some population also prevents full coverage.

• • For e.g., rumors about safety of measles-Rubella vaccination impacted the coverage in TN in 2017. Earlier, rumors about Polio vaccine in Kashmir had impacted the coverage.
  • The COVID-19 pandemic also saw the rise of vaccine hesitancy among the educated and privileged for reasons of misinformation.

Impact of COVID-19 on routine vaccination:

• As per the Lancet Report, 23 million children globally missed out routine immunization in 2020 because of COVID-19 pandemic. This was due to lockdown restrictions, shortage of healthcare workers and diversion of resources to address the pandemic.

Various Efforts to deal with above challenges:

• MoH&FW have employed an effective approach – such as involving the community, seeking the support from other ministries and partner agencies, establishing an organized surveillance system, and employing mass campaign management strategies to reach every unreached child for vaccination.
• Mission Indradhanush was launched by the MoH&FW in 2014. It is a strategic endeavor under UIP with an aim to target under-served, vulnerable and inaccessible population
  • It covers 8 vaccines (Diphtheria, Whooping Cough, Tetanus, Polio, Measles, Childhood TB, Hepatitis B and Meningitis. ) across the country, 2 vaccines (Pneumonia and Hemophilus influenza type B) in selected states and 2 vaccines ( Rotavirus Diarrhea and Japanese Encephalitis) in selected districts.
  • MI contributed to an increase of 6.7% in full immunization coverage after the first two phases of Mission Indradhanush.

Intensified Mission Indradhanush (IMI) was launched in Oct 2017 – to achieve a coverage of 90% with focus towards districts and urban areas with persistently low levels.

In Dec 2019, Government has launched Intensified Mission Indradhanush 2.0 (IMI 2.0) to be implemented between Dec 2019 – March 2020 to deliver program that is informed by the lessons learnt from the previous phases and seeks to escalate efforts to achieve the goal of attaining a 90% national immunization coverage across the country.

Intensified Mission Indradhanush 3.0 aims to reach those children and pregnant women who have been missed out of the routine immunization program. The first phase ran from 22nd Feb 2021 for 15 days.

Way Forward:

• Restore the routine Immunization Program: Improving access to immunization is critical to achieving SDGs. Therefore, there is an urgent need to take efforts to restore the routine immunization program with all precautionary measures, according to the guidelines of WHO.
• Dealing with vaccine hesitancy – Health education, counselling etc.
• More R&D in vaccine science in India -> More funds, Better HR etc.
  • India can emerge as the world leader in developing vaccines for Tropical Neglected diseases

Conclusion

• Vaccines are truly critical intervention in the journey of attaining the goal of disease-free India and is key to safeguarding our present and building a healthier tomorrow for our future generations.
• India has recently achievement a milestone of providing 100 crore vaccinations. While basking in this achievement, we shouldn’t forget the traditional immunization which was ignored during COVID-19 pandemic.