The government of India’s Mission Indradhanush has the potential to be a real game changer for child health in India. Its ambitious goal is to reduce the number of children who die or get sick by increasing access to vaccines. But can a country that is currently home to 6.9 million under-immunised children — a third of the world’s total — really reach a point where 90% of its infants are fully immunised, and all within just five years?
There will be huge challenges involved, not least in putting in place the infrastructure needed to boost immunisation coverage to this level. But that is not to say it can’t be done, and if anyone can pull it off, India can. It has a track record in overcoming seemingly insurmountable immunisation challenges and reaching every child, first with the eradication of smallpox and more recently with polio.
But now with Mission Indradhanush comes a new opportunity, and one with a twist that has the potential to save far more lives than originally intended. That’s because, the immunisation infrastructure needed to make this a success will not just increase coverage of the eight diseases — which includes BCG (tuberculosis), polio, measles and diphtheria-tetanus-pertussis, Hepatitis B, Haemophilus Influenzae type b (Hib) — currently offered as part of India’s Universal Immunisation Programme (UIP). It will also provide useful building blocks to improve access for a host of other vaccines and health interventions too.
Just take the first phase of Mission Indradhanush, for example, where 400,000 high-risk settlements have been identified and 201 high-focus districts across the country. By definition, these will be made up of communities that are hard to reach or highly marginalised, such as people living in urban slums, construction sites, brick kilns or nomadic communities. What this means is that those children that are not receiving UIP vaccines are also unlikely to have access to other vital health interventions, such as nutritional supplements, deworming treatments and other life-saving vaccines not currently included in the UIP.
So by providing a means of reaching these hard-to-reach children, Mission Indradhanush could really make an impact on child mortality in India, which today stands at nearly 1.3 million child deaths every year, or roughly one-fifth of the world’s total. Just consider pneumonia and diarrhoea. These are the two biggest killers of under-fives in the world and account for a quarter of all these deaths in India. Yet if all children in India had access to pneumococcal conjugate vaccine and rotavirus vaccine, neither of which are currently included in the UIP, then the number of vaccine-preventable deaths could be dramatically slashed. The same is also true of the human papillomavirus (HPV) vaccine, which prevents the leading cause of cervical cancer, killing more than 67,000 women in India each year, more than any other country in the world. The point here is that Mission Indradhanush is not just about the currently used vaccines. It is about bridging gaps to the most vulnerable populations.
Like any bridge, these need to be built strong and secure. But in a country as vast and complex as India, with 27 million infants born every year, this will be a huge undertaking — not just being sure these children are immunised but that it is sustainable year after year. The priority, therefore, must be to first identify and then remove any barriers or bottlenecks preventing an increase in immunisation coverage and equitable access to vaccines in high-risk areas.
Through India’s recent success in ridding itself of polio, we know that it is possible and that there are ways to reach each and every child. So in effect we have a template from which we can learn.
Working with the government of India and partners, such as Unicef and the World Health Organization, the challenge is to have the right equipment in place at every point along the supply and cold chain, to ensure that vaccines are kept viable during their long journeys, to ensure that the human resources are in place and well trained and able to feed accurate and reliable data back up the supply chain, so as to identify any potential bottlenecks immediately so they can be dealt with effectively.
It is a vast undertaking, but initial progress has been very promising. Since Mission Indradhanush was launched earlier this month reports suggest that 1.6 million children have been vaccinated, 16% from populations previously unreached.
However, it is still early days. Success will not come overnight and will require continued political will to make it happen. The Centre clearly recognises immunisation as being the most cost-effective health intervention and is committed to it. That is why it launched this project in the first place — not to mention its plans to introduce four new vaccines to its UIP, and the recent national scale-up of the five-in-one pentavalent vaccine.
So if at the end of this five-year period India does manage to successfully reach its goal it will mark a significant turning point for India, ushering in a new era of health and prosperity for generations to come. Because immunisation is not just about saving lives and preventing illness, it is an enabler, giving children a chance to live their life to its full potential, free from disease.
Seth Berkley is CEO of Gavi, the Vaccine Alliance. The views expressed by the author are personal.