VACCINATION SUCCESS STORIES

Key points

• India's success with immunization is an achievement not only for the country but also for the world.
• India has consistently contributed to the global Sustainable Development Goals (SDGs) by focusing on the immunization of newborns, infants, children and pregnant women.
• Under its Universal Immunization Programme (UIP) India provides vaccines against 11 diseases nationally and one disease sub-nationally, targeting close to 2.7 crores newborns and 2. 9 crore pregnant women every year.

Smallpox Vaccine

• Vaccination is one of the most cost-effective public health interventions, which saves lives by protecting people, especially children from dreadful vaccine-preventable diseases.
• Since the discovery of the smallpox vaccine over two centuries ago, vaccines have effectively reduced the burden of diseases such as polio, measles, tetanus, whooping cough, influenza and lately, Covid-19.
• A recent study in the medical journal The Lancet estimates that vaccines have prevented up to 3.7 crore deaths in the last 20 years in low and middle-income countries alone.

From polio to Covid-19

• India has a long history of successful vaccination with historical accounts of inoculation dating back to the 18th century.
• After being declared smallpox-free in 1977, India launched the Expanded Programme on immunization (EPI) in 1978 and introduced the BCG and OPV vaccines.
• Since then, India's immunization programme has steadily improved in reach and the arsenal of childhood vaccines provided under its umbrella.

Mission Indradhanush 

• Newer vaccines, better infrastructure and innovative strategies to improve both demand and supply of vaccines have been integral components of programme expansion.
• Along with the government-driven eradication plan, a multi-faceted communication approach helped the entire population achieve public ownership to be polio-free in 2014.
• Since 2014, immunization activities have been intensified with catch-up rounds such as Mission Indradhanush to ensure that full immunization coverage of  >90 per cent is achieved and sustained across the country.
• In 2016, India became the first country in Asia to launch the Rotavirus vaccine under the UIP.

Pneumococcal Conjugate Vaccine (PCV)

• In 2017, the Pneumococcal Conjugate Vaccine (PCV) was introduced and scaled up using Made-in-India vaccines to prevent rotaviral diarrhoea and pneumococcal pneumonia in children.
• PCV produced in India costs around Rs 200 per dose, making it affordable and accessible to protect young children from pneumococcal pneumonia in India and other parts of the World.
• Despite the Covid-19 pandemic, the vaccine was scaled up to all states of the country in 2021.
• Additionally, the introduction of the pentavalent vaccine in the routine vaccination protects against five diseases with no added infrastructure costs and fewer missed doses for individual vaccines.

National Family Health Surveys

• Data from the National Family Health Surveys (NFHS) provide direct evidence of India's success;
• Childhood vaccination rates have consistently improved over the last two decades with the proportion of children who are fully vaccinated reaching 76 per cent as per the latest 2019-21 survey.
• As India and the world set themselves up to eliminate measles by achieving a sustained vaccination coverage of 95 per cent, the data from India look promising.

Measles vaccination

• Measles vaccination rates have increased from 59 per cent in 2006 to 88 per cent in 2021.
• Mass immunization campaigns have prevented tens of thousands of measles deaths in children.
• India launched an ambitious Measles-Rubella (MR) vaccination drive and vaccinated over 3 crore children in three years.
• All the diseases prevented and lives saved also translate into economic and social benefits.

Covid-19 vaccination

• India has achieved remarkable feats with childhood vaccination and continues to do so with covid-19 vaccination.
• India has overcome challenges across time and geography to reach much of its population, ensure last-mile delivery, finance a sustained large-scale operation at the government level and develop and sustain trust among the people.
• During the pandemic, lockdowns led to disruptions in routine immunization services and the closure of health facilities. 
• While the global collaboration to bring out vaccines at an unprecedented speed and also an "infodemic-fueled" vaccine hesitancy in people who previously trusted vaccines.

Vaccination Services

Electronic Vaccine Intelligence Network (eVIN)

India's success

 Public-Private Partnership

• Since its Independence, India has built up its biomedical enterprise including research and development and manufacturing capacity.
• A fruitful public-private partnership has helped bolster this development.
• The indigenously produced Rotavirus and PCV vaccines and the speed with which India was able to indigenously produce two Covid-19 vaccines are examples of the return on these investments.

Cold chain systems

• India also built its delivery infrastructure by establishing cold chain systems and by developing and training a community health cadre of workers who established last-mile services.
• Today, India is the single largest producer of vaccines in the world, providing quality vaccines at low cost and helping immunize other LMICs.
• It is estimated that almost two-thirds of the children in the world receive at least one vaccine manufactured in India.

Communication Campaigns

• The infrastructural developments were accompanied by an improvement on the demand side through social and behavioural communication campaigns.
• Such campaigns target all segments of the population to generate awareness about vaccine-preventable diseases and built trust and confidence in vaccinations.

Childhood Immunization

• Studies with pregnant and breastfeeding women across various states in India have a continued positive attitude towards childhood immunization mostly because of accurate knowledge about vaccines and their benefits and vaccine-preventable diseases.
• This awareness can be attributed to sustained communication campaigns as part of  UIP.
• India uses various available platforms of communication to convey consistent and accurate information.

Community health workers 

• Community health workers such as ASHAs and Anganwadi workers go door-to-door to provide information and identify the missed-out children and pregnant women for any due dose.
• They have been a cornerstone of the polio endgame through their role in vaccination and active surveillance.

• While national leaders and celebrities spreading messages through mass media has proven to be useful, engagement with local community influencers who are "closer" to people has also tremendously helped build vaccine confidence.
• As media outlets proliferated, the government incorporated dissemination through new channels such as mobile messaging and social media as part of its evolving communication strategy.

Conclusion 

• Despite multiple challenges, vaccination is indeed one of India's public health success stories.
• As the world aims to bring about improved uptake of and equity in Covid-19 vaccination, policymakers and public health practitioners can learn from India's vaccination programmes.
• Advocacy, capacity building, investment in research and manufacturing, community engagement, mass and social media engagement and social mobilization have helped India reach its current vaccination coverage.