Immunisation for a healthier India

Years ago when I was a medical student, I used to read in the books ‘proverbs’ like “Count your children after measles”. When we started doing paediatric residency 33 years ago, we would be scared looking at all the polio cases in one hospital.

We would see at least 10 polio-affected children per week while two to three children would die of polio affecting their brain stem, or Bulbar Polio. If someone had said then that we will eliminate polio in a few years’ time, we wouldn’t have believed it.

By the year 2000, the world was almost free of polio. India was declared “polio free” five years ago (2014) after having not reported any cases of polio infections for the last three years as per WHO rules. It has taken much longer for India to become polio free compared to a lot of other countries for various reasons. Currently the world is free of small pox and polio (except for pockets in Pakistan, Afghanistan and Nigeria) — all thanks to vaccinations.

Immunisation of children is one of the key interventions to protect them from life-threatening conditions, which are preventable. It is one of the largest preventive health programmes in the world and a major public health intervention in the country. It was first introduced in India in 1978 as Expanded Programme of Immunisation (EPI) and was later expanded as the Universal Immunisation Programme (UIP), whereby the government provided vaccination to prevent seven vaccine preventable diseases — Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B, Haemophilus influenzae type b (Hib) and Diarrhoea.

Ahead of the elections, the BJP manifesto also mentioned the recently announced Mission Indradhanush — an immunisation programme of 3.39 crore children and 87.18 lakh pregnant mothers, and promised to ensure further immunisation of pregnant women by 2022.

It is necessary to understand that India is on the verge of eliminating many deadly diseases such as the dreaded “Pyogenic Meningitis” (brain infection), which would once kill approximately three children per week, and affect children almost every day, It is 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 such as “chronic diarrhoea” and “acute on chronic diarrhoea” and deaths due to severe dehydration on the way to the hospital and due to severe pneumonia. All this has led to significant reduction in the infant mortality rates in the country.

What India needs?

Multi-stakeholder partnerships still need to be strengthened. There is a need to get parents and medical professionals along with the media to work together to educate the public about scientific issues related to immunisation and project the benefits of vaccinations.

India can substantially reduce immunisation 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 diseases.

Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world’s unimmunised children. Fewer than 44% of India’s young children receive the full schedule of immunisations. This deficit can be fulfilled when all major private hospitals can be fully integrated and involved with governments at national and state levels to immunise every child.

While significant investment by the government has been made under the UIP, 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 regarding the benefits of vaccines and their potential could greatly boost confidence in vaccines and the immunisation programme.

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 are essential steps in India’s road to development.

(The writer is founder chairman and neonatologist, Cloudnine Group of Hospitals, Bengaluru)