Vaccination is a proven and one of the most cost effective child survival interventions. All countries in the world have an immunization programme to deliver selected vaccines to the targeted beneficiaries, specially focusing on pregnant women, infants and children, who are at a high risk of diseases preventable by vaccines. The number of vaccines in the immunization programmes varies from country to country; however, there are a few selected vaccines against Diphtheria, Pertussis, Tetanus, Poliomyelitis, Measles, and Hepatitis-B which are part of immunization programmes in most of the countries in the world.
Though a proven cost-effective preventive intervention, the benefits of immunization is not reaching many children who are at the maximum risk of the diseases preventable by these vaccines. Majority of the children who do not receive these vaccines live in developing countries. Studies have revealed that children are left uncovered by the routine immunisation programme either because the parents and guardians are unaware of the drive, or there is some element of apprehension or fear due to vaccination. Both these can be effectively addressed through an awareness campaign which underlines the critical importance of vaccination, and removes any apprehension harboured by the parent or the guardian.
Indian Scenario
2.7 Crore children are born in India every year. Approximately 18.3 lakhs children die before their fifth birthday. It is the low income families who lose the most children to disease. India records 5 lakh child deaths annually due to vaccine preventable diseases. Despite high childhood mortality rates due to vaccine preventable diseases, 30 percent of Indian children miss the benefits of full immunization every year. That is, an estimated 89 lakhs children across the country that either get only a few vaccines or no vaccines at all. One out of every 3 children in India does not receive all vaccines that are available under UIP. Five percent of children in urban areas and 8 percent in rural areas are unimmunized.
The Government of India recognizes immunization as one of the most cost effective interventions to prevent child deaths. India’s Universal Immunization Programme is one of the largest public health interventions in the country with an extensive vaccine delivery system with 27000 vaccine storage units in 35 states across the country. 80% of vaccination takes place in the outreach sessions, held in thousands each year in more than 6 lakh villages and other urban belts.
Universal Immunisation Programme (U.I.P.)
It is one of the largest in the world in terms of quantities of vaccine used, the number of beneficiaries, the number of Immunisation session organised, the geographical spread and diversity of areas covered. The national policy of Immunisation of all children during the first year of life with DPT, OPV and BCG to complete the series of primary vaccination before reaching the age of one year was adopted in 1978 with the lunching of EPI to increase the Immunisation coverage in infancy to 80%. Universal Immunisation programme UIP was launched in 1985 in a phased manner. The measles vaccine was added in 1985 and in 1990 Vitamin A supplementation was added to the program.
The Vaccination Schedule under the UIP
1. BCG (Bacillus Calmette Guerin) 1 dose at Birth (upto 1 year if not given earlier)
2. DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6weeks,10weeks and 14 weeks and two booster doses at 16-24 months and 5 Years of age
3. OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one booster dose at 16-24 months of age
4. Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.
5. Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age
6. TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age
7. TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year
8. In addition, Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006-10 and has now been incorporated under the Routine Immunisation Programme.
India expanded its immunization programme with the introduction of three new vaccines in 2014. There is an urgent need to ensure that the benefit of complete vaccination is provided to all children in the country.
Challenges
In spite of all positive changes, there are ongoing challenges and shortcoming in the programme. The coverage with vaccines in National Immunization Programme is suboptimal and there are inter- and intra-state variations in the coverage. There are wide variations in the proportion of partially immunized and unimmunized children within states and districts. Data recording and reporting is suboptimal and disease surveillance system desires improvement. It is critical to address these reasons and identify the districts where focused efforts, systematic immunization drive and additional resources will be required for reaching all children with all available life-saving vaccines.
The challenges faced in delivering lifesaving vaccines to the targeted beneficiaries need to be addressed from the existing knowledge and learning from the past. Though the preventive efforts from diseases were practiced in India, the reluctance, opposition and a slow acceptance of vaccination have been the characteristic of vaccination history in the country. The operational challenges keep the coverage inequitable in the country. The lessons from the past events have been analysed and interpreted to guide immunization efforts.
Mission Indradhanush
The result is the ‘Mission Indradhanush’ launched on 25th December, 2014 with an aim to cover all those children who are partially vaccinated or unvaccinated. ‘Mission Indradhanush’ is a nationwide initiative with a special focus on 201 high focus districts. These districts account for nearly 50% of the total partially vaccinated or unvaccinated children in the country. Mission Indradhanush will provide protection against seven life-threatening diseases (Diphtheria, Whooping Cough, Tetanus, Polio, Tuberculosis, Measles and Hepatitis B). In addition, vaccination against Japanese Encephalitis and Haemophilus influenza type B will be provided in selected districts of the country. Vaccination against tetanus will be provided to the pregnant women.
Between 2009-2013 immunisation coverage has increased from 61% to 65%, indicating only 1% increase in coverage every year. To accelerate the process of immunization by covering 5% and more children every year, the Mission Mode has been adopted to achieve target of full coverage by 2020. High-focus 201 districts will be taken up for implementation in the first phase. Of these, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and nearly 25% of the unvaccinated or partially vaccinated children of India are in these 82 districts of four states. Moreover, 297 will be targeted for the second phase. The Mission focuses on interventions to rapidly increase full immunization coverage of children by approximately 5% annually and to expand full immunization coverage from 65% in 2014 to at least 90% children in the next five years. Four special vaccination campaigns will be conducted between March and June 2015 and this will cover all children less than two years of age and pregnant women for Tetanus Toxoid vaccine. This immunization campaign will be conducted for a period of 7-10 days every month for four consecutive months.
Micro plans developed to make the Mission mode successful will draw on the lessons learned from the Polio eradication towards systems strengthening, vaccine cold chain management, regular surveillance and monitoring of the plans to reach each and every left out and uncovered child. The government has sought technical support from various external agencies like WHO, UNICEF and Rotary to achieve the goals of this programme.
Understandably, the implementation of vaccination programme and ensuring that the benefits of vaccines reach to each and every possible beneficiary is a challenging task. Mission Indradhanush depicting seven colours of the rainbow, aims to cover all those children by 2020 who are either unvaccinated or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. The Mission Indradhanush initiative is a call for action by the Government of India to intensify efforts to expedite the full immunization coverage in the country. Full immunization will rescues lakhs of children from disease mortality and morbidity and is essential for social development.
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