Strengthen Immunisation Of Children In India

Years ago when I was a medical student, I used to read in the books the “proverbs” like “Count your children after measles and when we started doing Paediatric residency 33 years ago – we used to see so many polio cases in one hospital – all of us we used to get scared of the polio. Literally we used to see at least 10 polio affected children per week and 2 to 3 children used to die due to polio affecting their brain stem – we used to call it as Bulbar Polio. If someone had said at that time that we will eliminate polio in a few years time, we wouldn’t have believed it.

Come to year 2000, the world was almost FREE from Polio and India was declared as “POLIO FREE” 5 years back after having been FREE of Polio infections for 3 years as per WHO. It has taken much longer for India to become Polio FREE compared to lot of other countries for various reasons. Currently the world is FREE of Small Pox (the deadly disease we used to see as children) and Polio (except for pockets in Pakistan, Afghanistan and Nigeria) – all thanks to the vaccinations. 

Immunisation of children is one of the key interventions for protection of children from life threatening conditions, which are preventable. It is one of the largest immunization programme in the world and a major public health intervention in the country.  It was first introduced in India in 1978 as Expanded Programme of Immunization (EPI) and was later expanded as the Universal Immunization Programme (UIP). Under this initiative the Government of India is providing vaccination to prevent seven vaccine preventable diseases i.e. Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B, Hiaemophilus influenza type b (Hib) and Diarrhea.

Ahead of the elections, the BJP Lok Sabha election manifesto too that was announced recently mentioned Mission Indradhanush, programme immunization of 3.39 crore children and 87.18 lakh pregnant mothers and promised to ensure further immunization of pregnant women by 2022.

It is necessary to understand that India is on the verge of eliminating many deadly diseases – the dreaded “Pyogenic Meningitis” (Brain infection)which once upon a time used to kill approximately 3 children per week, is almost every day has become a rarity now because of the HiB (Haemophilus Influenzae type B) vaccine. Recently the addition of Rotaviral and Pneumococcal vaccines have virtually eliminated diseases we used to dread in our training days called “chronic diarrhea” and “acute on chronic diarrhea” and deaths due to severe dehydration on the way to the hospital and deaths due to severe pneumonia – that the current government has even included these vaccines which are being provided under GAVI to the poorest of the poor in the country in the 4 states of Haryana, Madhya Pradesh, Uttar Pradesh and Rajasthan, with significant reduction in the infant mortality.

Some countries like Germany and Switzerland have NOT seen Polio or Diphtheria or Tetanus for over 3 decades which have made vaccinations slightly unpopular among few groups – leading to “unimmunized children “who are susceptible to any of these diseases – which is leading to outbreak of many diseases especially Measles in these countries. Hence some countries like USA have even started formulating rules – not to allow children without immunization records to be admitted to the schools as that puts other children under risk, if these catch those diseases. Some of these blogs are being read by a minority and this anti-vaccination groups are causing more damage to their children than anyone else.

What does India Need?

This question is multi stakeholder partnerships still need to be strengthened. There is need to involve parents to medical professionals and media to work together to educate the public about scientific issues related to immunization and project the benefits of the vaccinations. India can substantially reduce immunization deaths through an integrated package of interventions. Exclusive breastfeeding and adequate nutrition help make children healthier and less vulnerable to diseases like pneumonia and diarrhoea. Immunisation and other strategies, like improving water and sanitation and reducing exposure to air pollution, help prevent disease. 

Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world's unimmunized children. Fewer than 44 percent of India's young children receive the full schedule of immunizations.  This deficit can be fulfilled when all major private hospitals can be fully integrated and involved with governments at national and state level’s to immunize every child.  While under the Universal Immunization program significant investment by the government has been made education and awareness initiatives for the population have to be strengthened.  Poor education levels, which are consistently correlated with the likelihood that individuals will not complete vaccination schedules, pose a major barrier to expanding vaccination rates in rural areas. Communication about the benefits of vaccines and the potential could greatly boost confidence in vaccines and the immunization program. Other priorities include implementation of a combination measles-rubella vaccine, targeted use of possibly a pneumococcal and rotavirus vaccine.                              

Addressing India’s disturbingly high child mortality rate and some key measures outlined above, is an essential step along India’s road to development.