Millennium Post

Immunising India: daunting task

Diseases impair the normal state of a human being interrupting or modifying its vital functions. None, especially children, is immune from them. Right from birth, they engulf or chase humans. Most of us are ignorant or unmoved till we are afflicted. That vaccines can prevent diseases takes time to register in many minds.

Immunisation is one of the most effective methods of preventing childhood diseases. India has made significant achievements in preventing and controlling vaccine-preventable diseases (VPDs) under the Universal Immunisation Programme (UIP)- possibly one of the largest in the world in terms of quantities of vaccines used, number of beneficiaries (27 million infants and 30.2 million pregnant women), geographical spread (29 States and 6 Union Territories) and manpower involved. Polio eradication is a milestone.

The Immunisation Programme gained momentum in 1985 and was expanded as the UIP. Since then, various initiatives have been taken to improve immunisation coverage. Its key inputs have been strengthening and expanding the cold chain system, establishing a network of outreach immunisation sites, alternate vaccine delivery model, capacity-building of health functionaries and medical officers and intensified polio control measures.

Vaccination, or Routine Immunisation (RI) as it is known now, is a major public health intervention that prevents around four lakh child deaths a year in India. More than 500 million dollars are spent every year to immunise children against VPD that includes the polio eradication programme. Under the UIP, a key area under the National Rural Health Mission (NHM), since 2005, Government provides vaccination to prevent seven VPDs- Diphtheria, Pertussis (whooping cough), Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B.

The country is advancing new strategies to increase immunisation coverage, especially in tribal areas and urban slums, and reach more children with quality vaccines. Cold chain is the most important component to ensure that quality vaccine reaches every child to be immunised. Some recent developments are: introduction of new and underutilised vaccines and the national vaccine policy.

The Pentavalent vaccine, introduced nearly two years ago, provides protection to a child from five life-threatening diseases- Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib. DPT
(Diptheria+Pertussis+Tetanus)and Hep B are already part of routine immunisation; Hib vaccine is a new addition. Together, the combination is called Pentavalent. Hib vaccine can prevent serious diseases caused by Haemophilus influenzae type b (Hib) like pneumonia, meningitis, bacteremia, epiglottitis, septic arthritis etc. The five-in-one vaccine reduces the number of pricks to a child, and provides protection from all five diseases.

Notwithstanding health improvements over the last thirty years, lives continue to be lost to early childhood diseases, and inadequate newborn care. More than two million Indian children die every year before reaching the age of 5 every year- four every minute- mostly from preventable illnesses such as diarrhoea, typhoid, malaria, measles and pneumonia. Every day, 1,000 Indian children die because of diarrhoea alone. Infant mortality in India is high- 63 deaths per 1,000 live births. Most infants die in the first month of life; up to 47 per cent in the first week itself, according to UNICEF.

Infant Mortality Rate showed a rapid decline during the 1980s, but the decrease has slowed during the past decade.

Despite new initiatives, RI, now into the 30th year, is being bogged down by issues at the programme and implementation levels. Vaccine storage due to power unavailability or breakdowns and cold chain continuity till the end point still hamper delivery in remote areas. Other major obstacles are- limited availability of human resources, vaccines and logistics management system, poor micro-planning at the implementation level, Weak Vaccine Preventable Diseases (VPD), Adverse Events Following Immunisation (AEFI), surveillance systems, lack of effective monitoring and supportive supervision structures, poor waste management systems and limited data on disease burden.

Concerted efforts in organisation and carefully-sewn strategies ensured the last mile coverage in the fight against polio. In polio eradication, micro-planning helped as it provided valuable data about the specifics of a particular place. However, unlike polio, where drops were given orally, injectable vaccines create panic.  Like in the case of polio, families refuse to routinely immunise their children against other diseased in many states. Parents are ignorant of or do not visualise the risk and also suspect repeated immunisation rounds. Many believe rumours that link the vaccines to ‘side effects’ and superstitions. Doctors clarify that side effects are not AEFI. All these impediments were overcome during polio campaigns and need to be repeated with a new approach.

Scare stories in the media, especially in the vernacular press, about vaccinations also affect to a large extent the RI programme; particularly when they are careless about the integrity and expertise of the sources they use when reporting on alleged vaccine controversies. At a two-day regional media workshop, organised by UNICEF in mid-October in Raipur, discussions brought to the fore communication gaps existing between the media and governments, local authorities and doctors. In-depth interfaces with doctors and officials from the state government, UNICEF, WHO and NGOs highlighted misconception on the two sides.

Health workers are the mainstay of the RI as they are intensely involved in implementation.  They require constant advocacy training in view of their interaction with doctors, panchayat heads, politicians, parents of children, educators and not-for-profit organisations.

The author is an independent journalist
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