Vaccination as a public health intervention has
proved to be one of the most successful examples of cost-effective
prophylactic program to control many of the infectious diseases in the
world. It has prevented innumerable childhood diseases and averted
disabilities by protecting children from debilitating diseases [1].
‘Close the Immunization Gap’ was this year’s theme for World
Immunization Week celebrated from 24th to 30th April 2015. After
successful eradication of small pox, we have embarked on to the journey
to eradicate poliomyelitis from the earth, and we are almost at it.
Deaths from measles have declined by 71% worldwide [2]. This has been
possible only because of immunization. These programs have changed the
picture of public health, and it has been possible only because of the
collective and cohesive effort of our world leaders to unite and
contribute, irrespective of their political and social systems or levels
of their development.
However, our achievements are far from the full
potentials of immunization. Between 2009 and 2013, immunization coverage
has increased from 61% to 65%, indicating only 1% annual increase. A
World Health Organization study on immunization coverage published in
2014 revealed that global vaccination coverage – the proportion of the
world’s children who receive recommended vaccines – has remained steady
for the past few years.
Unfortunately, one-fifth of the world’s under-five
mortality occurs in India, and a substantial number of these deaths are
due to vaccine preventable diseases. Even though we have managed to have
a wider use of vaccines in the last decade resulting in prevention of
infectious diseases, we still can do much more by ensuring that everyone
can access immunization. A coverage evaluation by WHO and UNICEF
estimated that 87%, 73%, 70% and 74% of the children in India till the
age of 24 months were vaccinated with Bacillus-Calmette-Guerin (BCG)
vaccine, three doses of oral polio vaccine (OPV) and Diphtheria-Pertussis-Tetanus
(DPT) vaccine, and a dose of measles vaccine, respectively [3]. A 13%
drop from BCG to measles shows that a significant chunk of children in
contact with service providers miss out on subsequent doses.
Another factor particular to our country is the
disparity in the vaccine converges in different states. Nearly 25% of
our unvaccinated and partially vaccinated children are in the eighty-two
districts of the four states of Bihar, Uttar Pradesh, Madhya Pradesh and
Rajasthan [4]. This disparity can be addressed only by a concordant
attempt at strengthening routine vaccination in these districts.
Geographical diversity and cultural divergence is a major issue to be
tackled tactfully. Our migrant population has been a challenge and we
should develop a long term plan to include them.
The Mission Indradhanush launched by
the Government of India aims to immunize all children against seven
vaccine preventable diseases (diphtheria, whooping cough, tetanus,
polio, tuberculosis, measles and hepatitis B) by 2020. Indian Academy of
Pediatrics (IAP) has been strong advocate of immunization, and pledges
its support in this endeavor of the ministry. Building up a sound
epidemiological database, developing a surveillance system and
encouraging self reliance in vaccine production should be our strategies
for achieving good vaccine coverage. Our monitoring system for reporting
and following up adverse events following immunization (AEFI) has to be
streamlined and strengthened for any evidence-based decisions. IAP has
been part of the government’s AEFI program, and has also set up a
web-based reporting system wherein the members can report vaccine
preventable diseases and AEFI. This voluntary reporting system will help
establish a robust surveillance system for vaccine preventable diseases
and AEFI in future.
Our community leaders should be made aware of the
life-saving role of immunization programs, and strategies should be
planned with them as partners. Our health workers should be trained in
communication skills to motivate population groups with high dropout
rates, and in areas hitherto unvaccinated. IAP always accorded a high
priority to vaccines and vaccination issues. A subcommittee with
complete autonomy has been assigned the task of framing recommendations
on childhood vaccines and issues pertaining to immunization. Let us
step-up our efforts to achieve immunization’s full potential and thereby
a healthier nation.
References
1. Levine OS. The future of immunisation policy
implementation and financing. Lancet. 2011;378:439-48.
2. Simon E. Assessment of the 2010 global measles
mortalty reduction goal; Results from a model of surveillence data.
Lancet. 2012;379:2173-8.
3. WHO and UNICEF India. WHO and UNICEF Estimate of
Immunisation Coverage 2013 Revision. Available from:
http//www.data.unicef.org/fckimages/uploads/1421190
746_india_rev_13_FINAL..pdf. Accessed June 15, 2015.
4. International Institute for Population
Sciences (IIPS) and Macrointernational. National Family Health Suvey
(NFHS-3) 2005-2006. Mumbai: IIPS, 2008.