Fewer children are dying in India after birth and we know why. More women are delivering babies in health facilities and more children are getting vaccinated against infectious diseases that killed children before their fifth birthday, shows data from the National Family Health Survey-4, India’s most comprehensive health report released after a decade.
Though infant mortality rates are down to 41 (per 1,000 live births), from 57 in 2005-06, an unacceptably high number of children continue to die of avoidable causes.
One in five under-5 deaths in the world occur in India, with close to half of these deaths occurring from vaccine-preventable and treatable infections such as pneumonia and diarrhoea, which will go down with pneumococcal and rotavirus vaccines being added to the universal vaccination programme this year.
Vaccines are the quickest and the most cost-effective way to being down disease and death. Routine immunization, even with its sporadic delivery over the past two decades, has helped bring down annual under-5 deaths from 3.3 million a generation ago to 1.3 million deaths.
But India still loses 17,000 children under-5 deaths each day.
“Globally, in 1950, 28 of every 100 children died before their fifth birthday, but by 1990, this number had fallen to nine, and has now further fallen to four. This reduction has been largely facilitated by childhood vaccines,” said Ramanan Laxminarayan, senior research fellow at Princeton University.
With India rolling out four more vaccines this year — PCV against polio, rotavirus vaccine against diarrhoea (in Andhra, Haryana, Himachal Pradesh and Odisha), measles-rubella vaccine (Tamil Nadu, Karnataka, Puducherry, Lakshwadeep and Goa), and pneumococcal vaccine against pneumonia — under-5 deaths are expected to fall sharply.
The bigger challenge is to bring down deaths from causes that are not vaccine-preventable so that children do not die of birth-related complications such as asphyxia, sepsis and other infections.
“Last year, India lost one million children within a year. My goal, and the foundation’s goal, is by 2030, the number should fall at least by half if not more,” said Nachiket Mor, director, Bill and Melinda Gates Foundation (BMGF) India.
“Clearly, vaccines are an important component of it but we have multiple areas we try to address the issue. One could argue that before polio, India did not fully understand all the supply chain issues, but with India’s success in the routine vaccination programme -- the numbers are not 100% but we’ve crossed 70% with many vaccines – we need to look at the large gaps in terms of access to treatment… these gaps still remain,” said Mor.
More than half of India’s children are born in a public health facility, which makes the quality of care at the hospital or health centre critical for the mother and newborn health. “What is happening in the facility is very important. Immunisation is not our (BMGF) new priority strategy now, that’s our older programme and continues to get support in terms of increasing coverage. The vaccines are out there. The key strategy now is trying to understand at the level of the facility, when delivery happen and when the baby leaves the facility, what is the level of treatment options available (to prevent maternal and child mortality and under-nutrition),” said Mor.
The Gates foundation is working in Bihar and across 25 districts in Uttar Pradesh to improve women and newborn care at public health facilities. “Around 40% of India’s 27 lakh births taken place in Uttar Pradesh and Bihar and stillbirth rates, maternal deaths, asphyxiation at birth and sepsis are very high. We have 200 nurse mentors in Uttar Pradesh who go from facility to facility to provide additional training and guide the nurse through the process,” said Mor.
Made in India
A strong pharmaceutical sector and 21 major vaccine-manufacturing companies that produce 60% of the world’s vaccines, India is not short of tools to lower disease and death. The quality meets global standards. Last month, India’s National Regulatory Authority of India and affiliated institutions got World Health Organisation (WHO) approval for meeting the global indicators for unified international standards of quality, safety and efficacy.
The evaluation was from lab to delivery, including clinical trials and adverse events after vaccination. “It will go a long way in re-affirming India’s role in global health, including the strength of its pharmaceutical sector and drug regulatory capacity,” said Dr Henk Bekedam, WHO Representative to India.
Despite all the vaccines used in the universal immunization programme being manufactured in India, the country has had its share of conspiracies around vaccines, with misled parents denying their children polio drops for fear of impotence, MMR for fear or autism, measles for damaging immunity and memory, HPV from side effects that range from depression to death, and all vaccines for fear of big pharma dumping unwanted products in India.
The newest controversy around foreign influence was fuelled by the National Technical Advisory Group on Immunization (NTAGI) secretariat moving to the National Institute of Health & Family Welfare from the BMGF-funded Immunization Technical Support Unit at the Public Health Foundation of India. “There is no financial link of NTAGI with BMGF or any other organisation as the body consists of independent experts,” said the Union health ministry in a statement.
“From infectious disease perspective, the vaccine complement is fully available. Clearly, there are some hesitancy type constraints that we have to make sure don’t prevent us or delay us further,” says Mor. Delays mean India will continue to lose young mothers and babies to preventable and treatable diseases, which is unacceptable given its enviable strength in pharmaceuticals and human resources.