Ironically, India is one of the largest producers and exporters of vaccines yet has one of the highest preventable childhood mortality rates of any country in the world. Over 60,000 children under five die every year in the country from vaccine-preventable diseases.
Given our population and the sheer number of new babies born in India each year, achieving universal immunisation should be the topmost priority for our public health system.
The polio-eradication victory in 2014 remains a point of pride for India and a promise to the rest of the world. Having defeated such a virulent disease in such a huge population, the expectation is that we can do whatever we put our minds to.
April 24-30 has been declared World Immunisation Week by the World Health Organisation (WHO). Recognised as the “most cost-effective investment” in healthcare ever designed, universal immunisation is one of the pillars of the strategic plan for achieving the UN’s Millennium Development Goals, averting 2-3 million deaths every year and untold millions of disabilities. As such, it plays a vital role in helping children develop to their full potential. The WHO estimates that an additional 1.5 million deaths worldwide could be averted if universal coverage were achieved.
But the dream of a disease-free future for the next generation appears to have stalled in India. In spite of its longstanding Universal Immunisation Program (UIP), which provides free vaccines to every child born, the country still has one of the world’s lowest immunisation rates – and that rate itself is suspect.
It turns out it’s not enough just to get the immunisation. Children have to get their periodic shots or their drops on a specific schedule or the efficacy of the immunity they provide is weakened.
According to Nijika Shrivastwa, the lead author of a study conducted at the University of Michigan’s School of Public Health, Ann Arbor, only 18% of India’s children receive the full three-dose course of the vaccine against diphtheria, pertussis and tetanus (DPT), and only a third get the measles vaccine by the recommended age of 10 months.
Matthew Boulton, also from the University of Michigan, has said that 95% of a given population should be vaccinated to control outbreaks of measles. With so many children unprotected, or protected too late, reported cases of measles continue to occur in India with alarming frequency. This has prompted public health officials to introduce a second dose of the measles vaccine to the routine childhood schedule in 2010.
In an email, Dr Srivastava reiterated the world’s disappointment with India’s performance: “Vaccination coverage among Indian children aged 12-48 months remains unacceptably low.” For India, with a record of effective public health initiatives, the standards ought to be higher.
Vaccine-preventable diseases cause serious illness and can be extremely painful. Children who survive them may develop lifelong disabilities like blindness, hearing loss and brain damage. They also miss out on important learning and development while they are ill.
Religious and cultural beliefs do play a role in parents choosing not to have their children immunised, but many parents are also unaware of the benefits of vaccines. While not actively rejecting them, they simply don’t know enough to seek them out.
Some vaccines are easy to access – polio drops are often administered by community health workers going door to door – but others require a trip to a government hospital where conditions are poor and wait times long.
Poor record-keeping adds to the confusion. Every baby born in a hospital in India is given an immunisation card that is supposed to be produced at each visit to a healthcare provider. But if the card is lost, there is no backup record for that child. Families in urban slums or engaged in migrant labour often live in makeshift huts, where safe storage for records is a luxury and where constant moving for work makes regular coverage difficult.
Children born at home or in unregistered private hospitals often fall through the cracks entirely, and are at higher risk of non- or incomplete vaccination compared to children born in institutional settings.
Complacency is yet another factor. Most young parents today have no living memory of a polio outbreak nor have they ever seen a child afflicted with diphtheria or whooping cough. It is hard to feel a sense of urgency about something that seems to be a relic from the distant past.
Immunisation experts agree that simply by vaccinating children on time, India could influence public health and promote optimal child development on a global scale. This is a goal worth striving for.
