(The Gist of Kurukshetra) VACCINES: A CRUCIAL PILLAR OF PUBLIC HEALTH

[APRIL-2018]

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 side effects?

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 phased manner.

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Courtesy: Kurukshetra