This has been a truly extraordinary year for India. Not just because 2014 saw more than half a billion people cast their vote in the world’s largest democratic election ever. But also because it marked the year that India was officially declared polio-free and, starting this weekend (November 1), the year it began its historic national scaling up of the pentavalent vaccine, two events which in time will be viewed as critical milestones for India in its journey to becoming an economic superpower.
The link may not seem obvious at first. After all, India’s burgeoning economy has become one of the engines of economic growth in Asia. But with 27 million children born every year and more than a million people entering India’s workforce each month, a healthy population is essential for growth. This is why it is so important to see vaccination and the fight against infectious disease not just as investment in societal health, but also as vital building blocks for economic growth and long-term prosperity.
When people, and especially children, become sick they need medical treatment and care, both of which cost time and money. But by avoiding illness, infants have a greater chance of growing into healthier children who are able to attend school — claims that cognitive improvements linked to healthcare interventions are now supported with empirical and clinical data. At the same time, instead of needing to care for a sick child and spending money on medical bills, parents can go out to work.
India’s recent success in ridding itself of polio is a very positive step in this direction. Through investment, innovation and mass mobilisation, it was able to achieve very quickly what many viewed as impossible. And now the challenge is to build on that success and the infrastructure it created to ensure that every child is protected from a range of other devastating diseases. For example, by ensuring that each and every child in India receives the five-in-one pentavalent vaccine — which combines routine diphtheria-tetanus-pertussis (DTP) vaccines with those that protect against hepatitis B and Haemophilus influenzae type b (Hib), all in a single shot for free — a new chapter of equity will unfold, allowing all of India’s children to have a shot at fulfilling their potential.
With support from Gavi, the Vaccine Alliance, and the outreach and expertise of Unicef and the World Health Organization, this vital vaccine has been successfully introduced in eight states. But scaling up nationally won’t be easy. In India there are still 6.8 million underimmunised children — not receiving the third dose of DTP — the largest number of any country and roughly a third of the world’s total. And although some parts of the country have high vaccination coverage rates, there are huge disparities.
By taking advantage of the infrastructure, the planning and social mobilisation that brought about the end of polio, it can be done. Starting November 1 with Rajasthan and Madhya Pradesh, the plan is to roll it out to 12 more states by the end of December, accounting for two-thirds of all the infants born in India each year. The remaining 16 states will introduce the vaccine in April next year.
It’s an ambitious plan, but we know it can be done. Partly because of the immense and well-organised readiness efforts that have been put in place, right down from reviewing and inspecting the supply chain and cold storage facilities to ensuring it can cope with the sudden influx, to the training of staff, including the army of community outreach workers who perform such a critical job. But also we have confidence because we have seen it done before. In less than a decade Bihar was able to show that by building on the methods used to beat polio, it was possible to boost the coverage of DTP from just 18% to more than 85%.
Some critics claim this pentavalent vaccine is not needed in India, arguing that Indians have a natural immunity to Hib. Try telling that to the parents of the tens of thousands of children who die from Hib-related diseases every year. Others argue that the incidence of Hib is too low to warrant vaccine introduction. But again the death toll suggests otherwise and highlights another difficulty. One of the challenges with Hib is that the fastidious nature of the bacterium, combined with poor laboratory infrastructure, can make diagnosis and detection extremely difficult, which is why it has gone unreported for so many years.
Today, however, we have very good reasons to believe that there are as many as three million cases of Hib disease in India each year, which result in the deaths of 72,000 children under five. But a solution exists in the form of an available and affordable vaccine. One recent study has predicted that in India between 2012 and 2031 Hib vaccines could prevent more than 200,000 deaths.
But it’s not just about the lives saved, there is also a very important equity issue at stake. Why should so many Indian children go unprotected in a country that has a $900 million vaccine industry? This industry currently supplies vaccines to more than half the world’s children, yet for the majority of those in India it is only available at a high cost via the private sector. Making it available free through India’s Universal Immunisation Programme (UIP) marks a huge step in closing that gap between the haves and have-nots.
Both Prime Minister Narendra Modi and Union health minister Harsh Vardhan recognise this. One of the first things they did after coming to power was to announce plans to introduce four vaccines — rotavirus, rubella, polio injectable and Japanese encephalitis — to India’s Universal Immunisation Programme.
For any emerging economy with a relatively poor public health system, immunisation is economically viable. But for India it is a necessary investment in its future.
Seth Berkley is CEO, Gavi, the Vaccine Alliance.
The views expressed by the author are personal.