Immunisation Coverage Rate

  • The current national full immunisationcoverage rate stands at 87 percent, still behind the target set under the Mission Indradhanush (MI) Programme.
  • However, MI has helped increased India immunisation coverage from 67% in 2014 to the 87% in till the current date.
  • According to government data, 260 lakh children are born every year and an estimated 31 lakh out of them would not receive complete rounds of vaccination in the first year of their life due to various reasons.
  • The Government will launch the second phase of nationwide immunisation drive, i.e. Intensified Mission Indradhanush 2.0, to mark the 25 years of Pulse polio programme.
  • Intensified Mission Indradhanush 2.0 aims to achieve at least 90% pan-India immunisation coverage by 2022.

Timeline of Immunization Programmes in India

Expanded Programme on Immunization (EPI)

  • The EPI was initiated in India in 1978 with the objective to reduce morbidity and mortality from diphtheria, pertussis, tetanus, poliomyelitis and childhood tuberculosis by providing immunization services to all eligible children and pregnant women by 1990. Measles vaccine was included when the EPI was accelerated by launching the Universal Immunization Programme (UIP) in 1985-86.

Universal Immunization Programme (UIP)

  • In 1985, the EPI was modified as UIP. It became a part of Child Survival and Safe Motherhood Programme in 1992 and is currently one of the key areas under National Rural Health Mission (NRHM) since 2005.
  • The program now consists of vaccination for 12 diseases- tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, hepatitis B, diarrhoea, Japanese encephalitis, rubella, pneumonia (Heamophilus Influenza Type B) and Pneumococcal diseases (Pneumococcal Pneumonia and Meningitis).
  • Hepatitis B and Pneumococcal diseases were added to the UIP in 2007 and 2017 respectively.

Pulse Polio Programme (PPP)

  • With the global initiative of eradication of polio in 1988 following World Health Assembly resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995.
  • It aimed to immunize children through improved social mobilization, plan mop-up operations in areas where poliovirus has almost disappeared and maintain high level of morale among the public.

Mission Indradhanush (MI)

  • It was launched in 2014 with aim to strengthen and re-energize the programme and achieve full immunization coverage for all children and pregnant women.
  • It aims to cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against vaccine preventable diseases.
  • The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B. In addition to these, vaccines for Japanese encephalitisand Haemophilusinfluenzae type B are also being provided in selected states.
  • MI has been implemented in low coverage pockets and has been expanded during (i) Intensified Mission Indradhanush (ii) Gram Swaraj Abhiyan and (iii) Expanded Gram Swaraj Abhiyaan.

Intensified Mission Indradhanush (IMI)

  • To further intensify the immunization program, the Intensified Mission Indradhanush (IMI) October, 2017.
  • It aims to reach each and every child up to two years of age and all those pregnant women who have been left uncovered under the routine immunisation program.

Constraints in Immunization Program

Huge Population

  • India vast population with relatively high growth rate is a barrier in itself. Approximately 27 million children are born in India each year – the largest birth cohort in the world – but less than 44% receive a full schedule of vaccinations.

Poor Social Mobilization

  • Poor populations and those with lower levels of education are most vulnerable to impacts of low levels of advocacy and communication. Low levels of awareness, communication and information sharing amongst frontline workers as well as poor human resource is another constrain in immunization program.
  • Insufficient and ineffective health communication along with lack of promotion or follow-up are two of the main health systemconstrains behind low coverage in immunization, preventing parents from initiating or following throughwith their child’s vaccination schedule.

Poor Data Management

  • There are big gaps in quality of data being reported, its analysis and use for decision making and thus leading to inadequate information to support National Technical Advisory Group on Immunization (NTAGI) and UIP to design and implement strategies to improve immunization quality and coverage.
  • Inadequate surveillance data quality and reporting rates result in poor surveillance of vaccine preventable diseases(VPDs).There is lack of disease burden data on many important VPDs in India that results in the perception that the disease is not important public health problem.
  • Lack of baseline surveillance data also is a bottleneck in monitoring the impact of vaccination.

Weak Human Resource Capacity

  • The program suffers set back due to limited technical and operational human resource capacity and quality at various levels in UIP.
  • The lack of human resource capacity and poorly defined roles and responsibilities at various levels have a cascading effect on all other areas of program performance, including monitoring and evaluation, supply chain and logistics management, and strategic communications.
  • Lower quality of monitoring and supportive supervision of the program leads to reduced efficiency and effectiveness of interventions at all levels of programming.

Lack of Delineated Accountability Systems

  • A major problem is the lack of institutionalized and uniform accountability structures, focused on performance review at each administrative level i.e. central, state and district levels. Country has Multi Year Strategic Plan for UIP but its implementation is not monitored in absence of a monitoring and accountability structure.
  • Moreover, in absence of a robust system for data analysis, interventions and follow up these are not very effective.

Infrastructure Issues and Vaccine Logistics Management

  • There is limited cold chain infrastructure and capacity in many states – even for routine UIP vaccines.Infrastructure issues include poor infrastructure of vaccine stores and transportation systems. There is a lack of standards for vaccine stores at different levels and insufficient temperature monitoring system at all vaccines storage points from Government Medical Store Depots (GMSDs) to last cold chain point level, state, and regional stores.
  • There exist difficulties in procuring the right quality of cold chain equipment on time with adequate after sale support. There is a paucity of repair kits and spares cold chain technicians and inequitable cold chain point (last vaccine storage site) distribution.

Way Forward

  • A crucial step towards delivering ‘Health for All’ is building trust in vaccines and in the healthcare system. WHO recommends scaling advocacy efforts to improve understanding of the ‘Value of Vaccines’ and urgency of meeting the Global Vaccine Action Plan (GVAP) goals.
  • Community-based information provided by trusted sources can help address issues confronting vaccine hesitancy at large. Communities need to appreciate immunisation as their fundamental healthcare right, and not as government propaganda thrust upon them.
  • In order to achieve 100% immunisation rate in the country, it becomes imperative that all the available technologies for vaccine delivery are optimally used to improve efficiency.
  • In this regard, it is very encouraging to see the use of eVIN technology (electronic vaccine intelligence network) as an example of India leading the world in indigenously developed technology that digitises vaccine stocks and monitors the temperature of the cold chain through smartphone applications.
  • The road to achieving GVAP 2020 is through efficient vaccine delivery technologies that provide high and equitable coverage to the most under-served populations of the world.
  • One of the most crucial elements in building equitable and sustainable immunisation coverage is intensification of domestic financing. To meet the goals of India’s UIP, improved financing will be essential not only to meet current targets but also to lower long-term healthcare costs.
  • Healthcare authorities should be encouraged to craft, defend and champion immunisation budgets while closely monitoring disbursements and immunisation programme activities, both at the national as well as the local level.
  • In addition, civil society organisations that can effectively advocate for greater commitment to vaccines and immunisations should be engaged proactively, and leveraged for increased effectiveness of delivery systems.
  • The future of healthcare lies in collaboration, innovative solutions and intelligent delivery designs. With a keen focus on the immunisation drive, the Centre is making remarkable progress in building a stronger healthcare environment across the country. And this will most certainly pave the way for a stronger and healthier India.

 

Source : Civil Services Chronicle Online, October, 2019