(The Gist of Kurukshetra) VACCINES: A CRUCIAL PILLAR OF
VACCINES: A CRUCIAL PILLAR OF PUBLIC HEALTH
Immunisation seems to have taken centre-stage as a crucial pillar of public
health and as a development promoting agenda. Several countries are positioning
immunisation as an important component of Sustainable Development Goals 2030.
Hashtags such as #VaccinesWork on popular social media platforms are stoking the
debate surrounding vaccines-are trey needed? How many are needed? Are there any
The importance of vaccines in India cannot be overemphasised. But the story
of India is one of diversity and complexity. With the second largest population,
around 2.7 crore children are born every year. India also has the largest burden
of under five mortality, more than what prevails in some of the poorest
countries in the world. The Under-Five Mortality Rate in India is 43/1000 live
births (Sample Registration System (SRS) 2015), while the Infant Mortality Rate
is 34/1000 live births (SR5 2016) and Neonatal Mortality Rate is 25/1000 live
births (SRS 2015). This translates into an estimated 10.8 lakh under-5 child
deaths annually. Vaccine preventable diseases such as pneumonia (15%) and
diarrhoea (12%) are the leading Under-five childhood killers. One child loses
his/her life to pneumonia and diarrhoea every, two minutes. Approximately one
lakh children die due to rotavirus induced diarrhea alone.
India however faces three prominent challenges. Firstly, at 62% (as per the
National Family Health Survey-4 (NFHS-4) in 2016-17), the full immunization
coverage is considered a low level. There was a limited basket of vaccines.
Also, there have been issues regarding the quality and logistics of vaccine
management for such a vast county.
Figures narrate that the full immunisation coverage (FlC) expanded very
slowly at 4% between 2009 and 2013. This means, every year it grew at merely 1%.
For the country to reach coverage of 90%, it would take another 25 years. To
hasten the rate to at least 90% coverage till 2020, the Health Ministry launched
Mission lndradhanush (after the seven colours of the rainbow, termed as
lndradhanush in Hindi) in 2014, where seven vaccines (diphtheria, whooping
cough, tetanus, polio, tuberculosis, measles and hepatitis B, meningitis and
pneumonia due to Haemophilus influenzae type 8; Japanese Encephalitis is also
being provided in selected endemic districts of the country) would be given to
all those children and pregnant women who have missed out or left out under the
routine immunisation rounds, covering all remote, far flung and difficult to
reach areas. it targets those areas where the number of unvaccinated and
partially vaccinated children is the highest. These include populations living
in areas such as urban slums, nomadic sites, brick kilns, construction site,
migrant settlements such as fisherman villages, riverine areas with shifting
populations, underserved and hard to reach populations such as forested and
tribal populations, hilly areas, and areas with low Routine Immunisation
coverage. Till now, more than 2.5 crore children and 68.7 lakh pregnant have
been covered in 528 districts. The first two phases of Mission lndradhanush have
led to an increase of 6.7% in full immunization coverage per year as compared to
1% increase/year in the past. In October 2017, the Prime Minister launched
lntensified Mission lndradhanush with a sharper focus on districts and urban
slums with the slowest progress. A total of 190 high-focus districts and urban
areas across 24 states have been selected for intensified efforts. The aim is to
achieve 90% immunisation by December 2018.
The infant mortality and under-five mortality rates are also declining.
Between 2013 and 2015, an estimated 2.7 lakh children were saved, whereas during
2005-2015, death of one million infants was averted. The Infant Mortality Rate
has declined from 37 in 2015 to 34 per thousand live births in 2016 and shown
8.1% declined as against 5.1 % in the previous period. Whereas, the under-five
mortality rate has considerably declined from 126/1000 live births (1990) to
43/1000 (2016). Much of this success can be attributed to the immunisation
programme in the country.
Full immunisation of a country with a birth cohort as big as India’s, needs
complementing finances also. Governments sometimes don’t have enough in the face
of competing demands. Although as a public policy strategy, investing in the
health of children makes sense. Healthy children grow into healthy and
productive adults, adding value to the demographic dividend of any nation. The
commitment of the government towards this is reflected in the National Health
Policy 2017 where 2.5% of the GDP is envisaged for the healthcare sector, in a