April 24 to 30 is World Immunisation Week
Vaccines are special life saving, cost-effective and one of the most successful global health interventions. Vaccines help individuals, community and even entire populations to stay healthy. Vaccines produce an immune response that is similar to the one produced by natural infection without putting the individual at risk of the disease or its complications. Regular vaccinations have helped in bringing about significant decline in preventable diseases, disabilities and deaths across the world.
Every year it is estimated that among under 5 year olds, about 2.5 million deaths are averted and an additional 1.5 million deaths can be avoided with improved global vaccination coverage. Immunisation is one of the key health programmes that have been accepted by the United Nations. In May, 2012, 194 member states of the world health assembly came forward and developed “The Global Vaccine Action Plan”, a framework to provide universal access to immunisation. The UNICEF, WHO, Central Governments, State Governments and the medical fraternity have a key role to play in achieving these goals. There are currently thirty vaccine preventable diseases.
In India, the Ministry of Health and Family welfare has been actively promoting immunisation. The Ministry had introduced the Expanded Programme of Immunisation in 1978, which was then modified to Universal Immunisation Programme (UIP) in 1985. The programme creates awareness and provides key interventions for protection of children from life threatening conditions by providing vaccination. Currently the programme mandates vaccines preventing seven deadly diseases namely Diphtheria, Pertussis (whooping cough), Tetanus, Poliomyelitis, Tuberculosis, Hepatitis-B and Measles across all states.
Vaccines like Rotavirus, Rubella, Injectible Polio, Pneumococcal and Japanese B encephalitis vaccines have also been added under the UIP in selected states. The concocted effort has resulted in India making some inroads in preventing a few of the preventable diseases. The effective implementation of global vaccination campaigns ensured the eradication of small pox. India was even declared Polio-free in 2014. However, with wild Poliovirus still circulating in Pakistan and Afghanistan, occurrences of polio has been recorded in few of the states. The effort also has resulted in an increased DPT coverage from 72% to 83% and elimination of maternal and neonatal tetanus. The WHO lauded India for successful execution of the Measles-Rubella (MR) campaign in February 2017.
At the state level also there has been a significant improvement in immunisation coverage. According to the Department of Immunisation - Directorate of Health and Family Welfare and the Immunisation programme by BBMP, the immunisation coverage in Karnataka during 2018-19 has improved over the past few years
with 101% target achievement for full immunisation in the last year (compared to 62.6% in 2015-16 - NFHS-4 survey).
The stress on limiting the spread of preventable diseases and promoting herd immunity has resulted in extending immunisation coverage to even adult population. Physicians have been encouraging adults to receive protection from Pneumococcal, Influenza, Measles-Mumps-Rubella (MMR), Varicella, Hepatitis A and Hepatitis B vaccines. Human Papilloma Virus (HPV) noted to be a significant cause for cervical and genital cancers could be prevented with HPV vaccines. For adolescents and adults including pregnancy vaccinations, in addition to or as an alternative to TT (Tetanus toxoid), Td (with Diphtheria) or Tdap (added Pertussis) vaccines are now recommended.
Despite commitment from the health providers and authorities, maintaining effective cold chain and usage of disposable single-use needles, lacunae in utilisation of available facilities are worrisome. Some of the reasons for this are lack of awareness, social-economic problems and financial constraints. Addressing the demand side barriers like financial constraints, opportunity costs, knowledge and prioritisation can improve the situation.
Fear of immunisation is another aspect that affects the coverage. This is mostly due to unsubstantiated rumors on Internet or false propaganda. Vaccine hesitancy should be addressed by good immunisation practices, education and training of health workers, creating local community awareness, improve
voluntary participation by campaigns, health camps, media support and social network to pass on factual messages, which ultimately will benefit the whole community.
(The writer is Consultant - Dept of Pediatrics and Neonatology, Mazumdar Shaw Medical Centre, Narayana Health City)