Burden of Vaccine- Preventable Diseases in India: The Case for Action
Immunization is one of the most effective public health interventions for protection of children, especially under-5 years of age, from life threatening conditions which are preventable. Around 61% of India’s birth cohort (about 26 million, largest in the world) are fully immunized (CES 2009).Immunization hasbeen a major contributor in thedecline of under-5 mortality rate from ~ 233 to ~63 (per1000) in last five decades in India. However, vaccinepreventable diseases (VPDs) are still responsible for over5 lakh deaths annually in India where sufficientcoverage of Routine Immunization (RI) is seriously lacking.This underlines a sense of urgency for further improvement in delivery and development of immunization programme to reach each and every Indian child. Evidence suggests that an effective and equitable immunization programme has the potential to reduce the burden of VPDs andits associated morbidity and mortality.This will contribute to attaining better health outcomes for the communities, and in achievingIndia adapted Millennium Development Goal (MDG) 4, which calls for a two-third reduction in child mortality by 2015 in comparison with 1990 levels.
Addressing the Need: Government of India’s Response
The National Health Policy (2002) of India places importance on the health and wellbeing of women and children by prioritizing interventions that address morbidity and mortality issues. This includes a focus on childhood immunization programs as an effective measure to avert infectious diseases which are vaccine-preventable. Recognizing the importance of immunization in saving lives of children, the Government of India launched the Expanded Program on Immunization (EPI) in 1978, with limited outreach in the urban areas and focus on immunizing children during the first year of life. In subsequent years, more vaccines were added to the program including Oral Polio Vaccine (OPV) in 1979, Bacillus Calmette Guerin (BCG), Diphtheria, Pertussis, Tetanus (DPT), and vaccine to immunize pregnant mothers with Tetanus Toxoid (TT) in 1983.
In 1985, Ministry of Health and Family Welfare (MoHFW), Government of India launched the Universal Immunization Program (UIP), a major public health intervention in the country and one of the largest immunization programs in the world. In the inception phase of UIP, goal was to extend immunization services to cover 85% of all children and 100% of pregnant women by 1990. A key focus was to achieve reduction in mortality and morbidity due to 6 vaccine preventable diseases by increased immunization coverage in the country. It emphasized on improving service quality and scaled-up implementation in all districts through effective management and performance monitoring mechanisms. In addition, self-sufficiency was encouraged by enhancing indigenous vaccine production capacity in the country and establishment of consistent cold chain for storage of vaccines. In subsequent years, several efforts were initiated to strengthen the program. It was given the status of a National Technology Mission (1986), became a part of important initiatives like the Child Survival and Safe Motherhood (CSSM) programme (1992) and the Reproductive and Child Health (RCH) programme (1997). The Immunization Strengthening Project (ISP) implemented from 2000-2003, was designed to included three main components including polio eradication, strengthening RI, and development of strategic framework. The National Rural Health Mission (2005) had
UIP as one of the key strategic interventions. A National Call to Action on Child Survival and Development (2013) focuses on immunization as a strategy to prevent every eligible child from VPDs and to further the objectives of the reproductive, maternal, new-born, child and adolescent health (RMNCH+A) approach. A comprehensive Multi Year Strategic Plan for Immunization (2005) and (2013) was developed to improve access and utilization of immunization services in the country.
Reaching the Unreached: A Call to Action
India has risen to this challenge and has carried out several initiatives to strengthen RI. Despite reasonableprogress, there is still more to be done toachieve universal coverage of immunization services, sustain the gains achieved so far and to cover every single child from pockets of underserved population by enhancing peoples understanding of how immunization provides protection from infectious diseases and the underlying benefitsand risks. This requires improving operational through available and skilled workforce, quality vaccine supply chain and logistics management system, efficient surveillance systems, improved management of adverse events following immunisation (AEFI), intense community engagement and participation of people. To prioritise and revitalise these efforts, a strong political will, continued programmes, andorganised stakeholder support is needed to reinforce and sustain high-quality, equitable and accessible immunization services at national, state, district and sub-district levels to reach the most vulnerable children who need them the most, but often miss out on routine services.