New Delhi: As we celebrate World Immunization Week from April 24-30, authorities in India believe that lack of awareness is still a major challenge in our country. The World Immunization Week aims to highlight the collective action needed to protect people from vaccine-preventable diseases.
"India has overcome almost all infrastructural and human resource challenges. India's vaccine industry is currently facing the challenge of a lack of awareness. There are misgivings about the vaccine and illiteracy in some sections of people regarding vaccines. People think that vaccines have been produced to lose potency and other things. We have to come together against all these challenges. Challenges right now are not with production, manufacturing and distribution of vaccines, but it is the false propaganda that has become a major challenge,” Dr RV Ashokan, president of the Indian Medical Association (IMA) told ETV Bharat.
Renowned physician-scientist and former Director General of the Indian Council of Medical Research (ICMR) Dr Balram Bhargava said that India has had a very strong universal immunisation programme for over 60 years with a robust infrastructure.
"India has demonstrated to the world that today it is not only the pharmacy of the world but a vaccine superpower," said Dr Bhargava, who is also the chief of the Cardiothoracic Centre, AIIMS.
Goal of World Immunization Week:
The goal of World Immunization Week is for more children, adults – and their communities – to be protected from vaccine-preventable diseases, allowing them to live happier, healthier lives. Themed 'Humanly Possible: Saving lives through immunization,' this year’s World Immunization Week will celebrate 50 years of the Essential Programme on Immunization (EPI).
What is EPI:
The EPI is an initiative launched by the World Health Organization (WHO) in 1974. It stands as a global endeavour to ensure equitable access to life-saving vaccines for every child, regardless of their geographic location or socioeconomic status. Over the past five decades, EPI has evolved and achieved remarkable milestones that reshaped the global health landscape. Building on the momentum of the smallpox eradication effort, EPI was initiated with the goal of providing universal access to life-saving vaccines for children worldwide.
Today, every country has a national immunization programme, and vaccines are universally recognised as among the safest, most cost-effective, and successful public health interventions to prevent fatalities and enhance the quality of life.
At its inception, according to WHO, EPI focused on protecting all children against six childhood illnesses, including tuberculosis, diphtheria, tetanus, pertussis, polio, and measles.
"Today this number has grown to 13 universally recommended vaccines across the life course, and 17 additional vaccines with the context-dependent recommendations," WHO said.
India’s role in EPI:
The Expanded Programme on Immunization was launched in India in 1978 with the objective to reduce morbidity and mortality from diphtheria, pertussis, tetanus, poliomyelitis and childhood tuberculosis by providing immunization services to all eligible children and pregnant women by 1990. It was renamed as Universal Immunization Programme in 1985 when its reach was expanded beyond urban areas.
In 1992, it became part of the Child Survival and Safe Motherhood Programme and in 1997 it was included in the ambit of the National Reproductive and Child Health Programme. Since the launch of the National Rural Health Mission in 2005, the Universal Immunization Programme has always been an integral part of it.
UIP’s perspective:
Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close to 2.67 crore newborns and 2.9 crore pregnant women annually in the country. It is one of the most cost-effective public health interventions and is largely responsible for the reduction of vaccine-preventable under-5 mortality rate. Under UIP, immunization is provided free of cost against 12 vaccine-preventable diseases including Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenzae type B, Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis.
Major milestone of UIP:
The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015.
Immunisation and child care:
Immunization, a key to child survival, is one of the most cost-effective ways to protect children’s lives and their futures. India's immunization programme, (UIP) is one of the world’s most extensive public health programmes. Every year, nearly 26 million newborns and 34 million pregnant women are targeted for immunization, and over 13 million immunization sessions are held nationwide to vaccinate children and pregnant women. As per UNICEF, over the last two decades, India has significantly improved health outcomes, particularly child health and immunization.
India’s fight against MR:
As per records, India has vaccinated over 348 million children between 2017 and March 2023 through a nationwide measles-rubella vaccination campaign. Measles cases dropped by 62 per cent between 2017 and 2021, from 10.4 to 4 cases per million population, while rubella cases decreased by 48 per cent, from 2.3 to 1.2 cases per million population.
As per the WHO, India is moving towards last-mile coverage for MR elimination, and catch-up campaigns are being undertaken across the country. In a series of MR campaigns across targeted districts in the states of West Bengal, Delhi, Haryana, Rajasthan, Jharkhand and Mumbai in Maharashtra, over 30 million children were vaccinated with the measles and rubella vaccine from November 2022 to May 2023.
Measles-Rubella (MR) vaccine:
India is committed to the goal of measles elimination and rubella control and to achieve this goal MR vaccine was introduced in the country through a campaign mode in a phased manner in 2017. The MR campaign targets around 41 crore children in the age group of nine months to 15 years (covering ⅓ of the total population of the country) followed by two doses in routine immunization at 9-12 months and 16-24 months. Rubella component is now under routine immunization as MR vaccine.
Experts' opinion:
The IMA president Dr RV Ashokan said that India’s immunization programme is a success. "However, it’s not only an immunization programme, India is, in fact, expanding the frontier. For example, this year we included Human papillomavirus (HPV) vaccines for cervical cancer. When something like Covid came we were the vaccine supplier for the whole world," Dr Ashokan said.
According to Dr Ashokan, India has overcome challenges like reaching out to the last person.
"However, lack of awareness is a major challenge at present. The cold chain that is required to keep many of the vaccines in good condition, India has been able to create such cold chains across the nation for 140 million people" said Dr Ashokan.
India's Universal Immunization Programme (UIP), initiated in 1978, stands as an extraordinary public health endeavour. The program’s scale is phenomenal as 27 million newborns, over 100 million children aged 1-5 years, and 30 million pregnant women receive vital vaccinations. In addition, we are the global vaccine producer that not only meets domestic needs but also exports vaccines, said Dr Tamorish Kole, renowned public health expert and past president of the Asian Society for Emergency Medicine.
"India’s UIP is a testament to resilience, commitment, and the pursuit of a healthier future. The dedication of our health workforce, who tirelessly deliver vaccines even in remote areas, is critical to our success," Dr Kole stated.
