CHILD IMMUNISATION IN INDIA

Source: IndianExpress

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Context

• The slight dip in India's childhood immunization numbers in 2023, as reported by the World Health Organization (WHO) and UNICEF estimates of national immunization coverage (WUENIC), indicates a need to intensify efforts despite the numbers being relatively stable compared to previous years.

Details

Key Statistics

• DPT Vaccine Coverage:
  • 2023: Coverage of the diphtheria, pertussis, and tetanus (DPT) vaccine was at 93%, a slight decrease from 95% in 2022.
  • Pandemic Impact: During the first two years of the pandemic, coverage had dropped to 85% from 91% in 2019.
  • Global Comparison: The 2023 global average for DPT vaccine coverage stood at 89%, indicating that India's coverage, despite the dip, was still above the global average​​.
• Zero-Dose Children:
  • 2023: India had 1.6 million zero-dose children (those who have not received any routine immunization), up from 1.1 million in 2022, but significantly lower than 2.73 million in 2021.
  • 2019: There were 1.4 million zero-dose children in 2019, showing an increase in 2023​​.
• Under-Vaccinated Children:
  • 2023: There were 2.04 million under-vaccinated children, slightly lower than the 2.11 million in 2019.
  • DPT Third Dose Coverage: This stood at 91% in 2023, a two percentage point drop from the previous year, but much higher than the 2023 global average of 84%​.

Implications

• Call to Intensify Efforts:
  • Experts emphasize that the slight drop in vaccination numbers is not a cause for concern but a call to enhance immunization efforts.
  • Reaching higher coverage rates (above 90%) requires targeted strategies focusing on detailed planning and addressing specific challenges such as migratory populations, seasonal variations, and reaching remote areas during adverse conditions like floods​​.
• Population Impact:
  • India's large population means that even a small percentage drop translates to a substantial number of under-vaccinated or zero-dose children.
  • This highlights the critical need for sustained and intensified immunization efforts to ensure all children receive necessary vaccines​​.

India's journey in child immunization

India's journey in child immunization has evolved significantly since independence, marked by various policies, acts, and schemes to ensure the health and well-being of its children.

Historical Overview

• Early Initiatives (1950s-1980s):
  • Expanded Programme on Immunization (EPI): Launched in 1978, this was one of the earliest efforts to provide immunization services in India, focusing on diseases like tuberculosis, diphtheria, pertussis, tetanus, polio, and measles.
  • Universal Immunization Programme (UIP): Initiated in 1985, UIP aimed to cover all children by providing free vaccines against six vaccine-preventable diseases. Expanded to include six vaccines: BCG, OPV, DPT, Measles, and later Hepatitis B, Haemophilus influenzae type b (Hib), Japanese Encephalitis, and Rubella. By 1989-90, UIP became part of the Child Survival and Safe Motherhood Programme (CSSM)​​.
• 1990s-2000s:
  • Pulse Polio Immunization Programme: Launched in 1995, this program aimed to eradicate polio by providing oral polio vaccines (OPV) to all children under five. India was declared polio-free by WHO in 2014​.
  • National Rural Health Mission (NRHM): Launched in 2005, NRHM aimed to provide accessible, affordable, and quality health care to rural populations, including improving immunization coverage​.
• 2010s:
  • Mission Indradhanush: Launched in 2014, this mission targeted unvaccinated and partially vaccinated children in high-risk areas, aiming to accelerate immunization coverage. It resulted in a significant increase in full immunization coverage from 67% to 83% by 2018​.
  • Intensified Mission Indradhanush (IMI): Launched in 2017, IMI aimed to reach every child under two years of age and pregnant women who had been left out of the routine immunization program​.
• Recent Developments (2020s):
  • Indradhanush 2.0: Rolled out in December 2019, this phase targeted 272 districts across 27 states to further enhance immunization coverage, focusing on areas with low immunization rates​​.
  • Rotavirus Vaccine and Pneumococcal Conjugate Vaccine (PCV): These vaccines were introduced under UIP to prevent severe diarrhea and pneumonia in children, respectively​​.
  • Intensified Mission Indradhanush 4.0 - 2022: Conducted to cover unvaccinated and partially vaccinated children, especially those missed due to the COVID-19 pandemic disruptions.
  • Intensified Mission Indradhanush 5.0 - 2023: Extended focus to children up to five years to cover those missing doses of measles-rubella (MR) vaccine, preparing for MR elimination​​.

Key Policies and Acts

• National Health Policy (1983, 2002, 2017): Each iteration of the policy has emphasized the importance of immunization in reducing child mortality and improving child health.
• National Health Mission (NHM) - 2013: Includes Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) as one of its components, focusing on improving immunization coverage.
• Integrated Child Development Services (ICDS) Scheme: Launched in 1975, ICDS provides health, nutrition, and immunization services to children under six years and pregnant/lactating mothers.
• National Vaccine Policy (2011): This policy aimed to develop a comprehensive framework for vaccine production, procurement, and immunization service delivery​ ​.

Statistics and Impact

• UIP Coverage: According to the National Family Health Survey (NFHS-5, 2019-21), full immunization coverage was 76.1%, indicating that nearly one in four children missed essential vaccines. However, the Health Management Information System (HMIS) portal showed an improved coverage of 89% for 2021-22​​.
• Zero-Dose Children: The WHO-UNICEF estimates showed a reduction in zero-dose children from 2.7 million in 2021 to 1.1 million in 2022. Despite progress, many children, particularly in states like Bihar, Madhya Pradesh, Maharashtra, Rajasthan, and Uttar Pradesh, remain unvaccinated.

Challenges

• Reaching migratory and marginalized populations remains a challenge.
• Ensuring consistent coverage during natural disasters and seasonal migrations.
• Maintaining high coverage and addressing vaccine hesitancy and misinformation​​.

Way Forward for India's Child Immunisation Program

Strengthening Health Infrastructure

• Capacity Building
  • Rwanda's Health Worker Training: Rwanda has significantly improved its immunization coverage by training a large number of community health workers. These workers are trained to provide vaccinations and educate communities about their importance, resulting in higher vaccination rates.
  • Ethiopia's Health Extension Program: Ethiopia’s Health Extension Program trains health extension workers who provide immunization services at the community level, leading to improved vaccination coverage in rural areas​.
• Cold Chain Management
  • Kenya's Solar-Powered Cold Chain: Kenya has implemented solar-powered refrigerators to store vaccines in remote areas. This innovation ensures that vaccines remain effective by maintaining the required temperatures even in areas without reliable electricity .
  • Brazil's National Immunization Program: Brazil has a robust cold chain infrastructure that includes refrigerated trucks and warehouses, ensuring that vaccines are stored and transported at optimal temperatures .

Addressing Vaccine Hesitancy

• Public Awareness Campaigns
  • Australia's "No Jab, No Pay" Policy: Australia implemented the "No Jab, No Pay" policy, which withholds certain welfare benefits from parents who do not vaccinate their children. This policy, combined with public awareness campaigns, has led to higher vaccination rates .
  • UK's Immunisation Awareness Campaigns: The UK uses targeted media campaigns to address vaccine hesitancy, providing clear and accurate information about the benefits and safety of vaccines .
• Community Engagement
  • Nigeria's Polio Eradication Efforts: Nigeria’s success in eradicating polio was largely due to engaging community leaders and traditional rulers who helped promote vaccination and overcome resistance .
  • Bangladesh's Immunisation Drives: In Bangladesh, community health workers engage with local leaders and influencers to advocate for vaccinations, significantly improving coverage in rural areas.

Enhancing Outreach

• Mobile Vaccination Units
  • Pakistan's Mobile Vaccination Teams: Pakistan has deployed mobile vaccination teams to reach children in remote and conflict-affected areas, ensuring that all children receive necessary immunizations .
  • Nepal's Outreach Clinics: Nepal uses mobile clinics to reach mountainous and hard-to-access areas, providing immunization services to children who would otherwise be missed .
• School-Based Programs
  • Japan's School Vaccination Programs: Japan has a successful school-based vaccination program where children receive vaccinations as part of their regular school health checks, ensuring high coverage rates .
  • USA's School Vaccination Requirements: The United States has laws requiring vaccinations for school entry, which has been effective in maintaining high immunization coverage .

Leveraging Technology

• Digital Tracking Systems
  • Estonia's E-Health System: Estonia uses an advanced e-health system to track vaccinations, ensuring that all children receive timely immunizations and enabling healthcare providers to access vaccination records easily .
  • Zambia's Electronic Immunization Registry: Zambia has implemented an electronic immunization registry to track and monitor vaccination coverage, improving data accuracy and coverage .
• Telemedicine
  • Canada's Telehealth Services: Canada uses telehealth services to provide consultation and follow-up for immunizations, especially in remote areas, ensuring continuity of care .

Public-Private Partnerships

• Indonesia's Partnership with Gavi: Indonesia’s partnership with Gavi, the Vaccine Alliance, has improved vaccine procurement and distribution, enhancing immunization coverage nationwide .
• Uganda’s Collaboration with NGOs: Uganda collaborates with various NGOs to improve immunization outreach and service delivery, especially in underserved areas .

Monitoring and Evaluation

• Regular Surveys and Audits
  • United Kingdom's Annual Immunisation Surveys: The UK conducts annual immunisation surveys to monitor coverage and identify gaps, allowing for timely interventions .
  • Australia's Immunisation Coverage Reports: Australia publishes regular reports on immunisation coverage, which help in assessing program performance and making informed decisions .
• Feedback Mechanisms
  • Sweden's Health System Feedback: Sweden has a robust system for collecting feedback from healthcare providers and the public, which is used to improve immunization services .
  • Finland's Public Health Feedback Systems: Finland uses feedback from healthcare workers and the public to continuously improve its immunisation programs and policies .

Innovative Approaches

• Use of Drones
  • Ghana's Drone Delivery Program: Ghana has successfully used drones to deliver vaccines to remote areas, ensuring timely access to immunizations .
  • Vanuatu's Drone Initiative: Vanuatu has implemented a drone program to deliver vaccines to its many islands, improving immunization coverage .
• Artificial Intelligence (AI)
  • USA's Predictive Analytics for Vaccine Demand: The United States uses AI to predict vaccine demand and optimize distribution, ensuring efficient use of resources .
  • UK's AI in Public Health Surveillance: The UK employs AI in public health surveillance to identify areas with low immunization coverage and plan targeted interventions .

Must Read Articles:

EPI

Mission Indradhanush

UIP

Sources:

IndianExpress

PRACTICE QUESTION Q: Consider the following statements regarding child immunisation in India: The Universal Immunisation Programme (UIP) in India aims to provide free vaccines to all children against vaccine-preventable diseases. The Pentavalent vaccine introduced under UIP protects against diphtheria, pertussis, tetanus, hepatitis B, and Hib (Haemophilus influenzae type b). India has completely eradicated polio through its immunisation initiatives under the UIP. Which of the statements given above is/are correct? a) 1 and 2 only b) 2 and 3 only c) 1 and 3 only d) 1, 2, and 3 Answer: d)