NEW DELHI : Despite increasing its focus on vaccination coverage for children, the Union government continues to face challenges in curbing instances of vaccine-preventable diseases (VPD) in India. Now, the ministry of health and family welfare has launched Intensified Mission Indradhanush (IMI) 2.0 to achieve the countrywide target of full immunization. The drive will be conducted between December 2019 and March 2020.
According to World Health Organization (WHO) figures for VPDs, such as diphtheria, Japanese encephalitis, measles, and tetanus, India has not shown a persistent decreasing trend.
According to the latest available data with the apex health agency for India, the cases of diphtheria increased from 3,380 in 2016, to 5,293 in 2017, to 8,788 in 2018. For Japanese encephalitis the numbers went up from 1,627 in 2016, to 2,043 in 2017, to 1,707 cases in 2018. Measles cases increased from 17,250 and 12,032 in 2016 and 2017, respectively, to 19,474 in 2018. All tetanus cases, which includes adults, have also increased from 3,781 in 2016 to 4,946 in 2017 to 7,000 in 2018.
“The main aim of IMI 2.0 is to tackle the vaccine preventable diseases in the country. Government has done a lot of work in IMI. Now the IMI 2.0 will cover low performing areas in the selected districts (high-priority districts) and urban areas. Special attention will be given to un-served/low-coverage pockets in sub-centre and urban slums with migratory populations till 2020,” said Pradeep Haldar, deputy commissioner (immunisation), ministry of health and family welfare.
India still accounts for the largest number of children who are not immunised at 7.4 million. The health ministry puts the national average for full immunization at 62%.
However, public health experts said the major shortfall from the government’s end in controlling VPDs in India is that while it has been focussing on improving the coverage of the immunisation programme, the policies lack critical and comprehensive assessment of the impact of the programme even five years after its launch.
“Another big issue is target-oriented programme, which incurs performance pressure leading to chances of over reporting and not including resistance/refusal areas where success rate is low. While going ahead, we should have an integrated model, which can deliver robust routine immunization programme, supported by public health surveillance wherein we measure the output by counting every case of VPD,” said Naveen Thacker, executive director and co-chair, Strategic Advisory Group, Immunization International Pediatric Association.
Thacker said campaigns to increase coverage should be used to strengthen the health system, and should be achieved in a time-bound manner. “Private sector should be involved actively to report all cases of VPDs and give a better understanding of true vaccine coverage. Social determinants and behavioural insights behind vaccination acceptance should be studied from the grass root level and data used locally. Better communication and counselling skills tailored to local beliefs are needed to deal with barriers to seek vaccinations. Besides, healthcare professionals should be well equipped with interpersonal communication skills.”
For maximising the inputs and taking the mission forward, the government has looped in several ministries under MI 2.0, which will focus on children and pregnant women who have missed the vaccination in previous rounds.
“Mass immunization can be an effective measure to control infectious epidemic outbreaks of diseases like diphtheria, chickenpox, whooping cough, etc., which causes infant and child mortality in high-density populations. We have examples of combating deadly diseases like smallpox and polio through mass vaccination. It would be good to engage NGOs to reach the last mile and give our population the protective shield of vaccination at least against VPDs,” said Neelam Gupta, chief executive officer, AROH Foundation, which is working with the government for health and social upliftment.
Moreover, experts said India still lacks a robust system to track VPDs. Also, common lists are not maintained to assess various VPDs in India vis-a-vis the immunisation drive.
There are various challenges to immunization in India, including funding and scarce staff, especially in poor-performing states. Various studies have also shown gaps in predicting demand, logistics and cold chain management that eventually result in high rates of wastage.
“The government’s immunisation budget has doubled in 2017 compared to 2013. The trend is growing, with the New Health Policy 2017 indicating almost doubling of the public health expenditure to 2.5% of GDP by 2025,” said a Gavi spokesperson.