Taking a cue from the success of its polio campaign ‘Do boond zindagi ki…’ (‘Two drops of life’) featuring Amitabh Bachchan, which had caught the people’s imagination, UNICEF, a partner in the government’s immunisation programme, has turned to Madhuri Dixit for the ‘Vaada zindagi ka…’ (‘The promise of life’) slogan to boost its stagnant immunisation coverage.
Despite many efforts, full immunisation coverage in India remains at 65.2%, having grown only by 4% since 2009, leaving nearly one-third of all children born each either partially or totally unimmunised, according to the latest estimates. In numbers, that’s 8.9 million children. India records half a million deaths million deaths annually due to vaccine-preventable diseases among kids below the age of five.
On the other hand, the Universal Immunisation Programme (UIP) is one of the largest in the world, with an annual birth cohort of 27 million. Started in 1985, it provides vaccination against seven life-threatening diseases: diphtheria, whooping cough, tetanus, tuberculosis, measles, polio and hepatitis B. In select states, additional vaccines are provided against heamophilus influenza type B and Japanese encephalitis.
Even so, 1 out of every 3 children does not receive all vaccines that are available under the UIP, while 5% in urban areas and 8% in rural areas are unimmunised. The main reasons for high rates of children dropping out after receiving one or more doses or not receiving any vaccine are lack of awareness in the community or myths about vaccination, a fear of injections and inadequate service-delivery during vaccination sessions.
Increased susceptibility to disease
Evidence shows that children partially or fully unimmunised are most susceptible to childhood diseases and disability, and run a risk three to six times higher of death as compared to fully immunised children. After all, immunisation is one of the most cost-effective public health interventions against childhood death and disability.
The latest statistics also show more than 28% people who had not got their children immunised or were partially immunised “did not feel” the need to do so while another 26% did not even know about vaccines. Close to 11% did not know where to go for vaccination while 9% said the timing of vaccination sessions did not suit them. Finally, a fear of side-effects kept another 8% away; lack of time, 6%; misguided advice, 3%; and unaffordability, 1%.
In the national capital, in fact, 47% of those unimmunised or partially immunised did not feel the need to do so.
The top states are Kerala, with coverage of 82.50%, followed by Uttarakhand at 79.6% and West Bengal at 79.50%. The worst performing states are Nagaland with full-immunisation coverage of 35.6% (45.5% children here are partially immunised while an unbelievable 19% are totally unimmunised. Anyway, it is followed by Tripura and Meghalaya at 48% 48.9% full-immunisation respectively. In Tripura, 38.80% children are partially immunised and more than 13% are not immunised at all. In Meghalaya, 37.40% are partially immunised and 13.70% are not immunised at all.
Hoping that Madhuri Dikshit will do for the Routine Immunisation programme what Amitabh Bachchan did to the Pulse Polio Programme, UNICEF and the Ministry of Health and Family Welfare are certain that her popularity will help.
Mission Indradhanush
Keeping in mind the dismal performance of the UIP, the government launched Mission Indradhanush in December 2014 to boost immunisation coverage. Under this special nationwide initiative, all unvaccinated and partially vaccinated children are to be covered under the UIP by 2020. The mission focuses on interventions to expand full immunisation coverage in India: from 65% in 2013 to at least 90% of kids by 2020.
This will be done through special catch-up campaigns to rapidly increase full immunisation coverage of children by 5% and more annually. Moreover, the Health Ministry has identified 201 ‘high focus’ districts across the country that have the highest number of partially vaccinated and unvaccinated children – as it turns out, they account for almost 50% of all unvaccinated or partially vaccinated children. Of the districts, 82 are in Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan, and nearly 25% of the unvaccinated or partially vaccinated children in India are here.
Within the districts, the mission will also focus on 400,000 high-risk settlements identified by the polio eradication programme. These are pockets with low coverage due to geographic, demographic, ethnic and other operational challenges, where most of the unvaccinated and partially vaccinated children are concentrated. They include populations living in urban slums, around brick kilns, construction sites, and comprising migrating populations like those of fisherman and tribals.