When the NDA government was sworn in, the public health sector kept its fingers crossed. The win was declared a mandate for a proactive government that would deliver on its promise of inclusive development. However, healthcare is one sector where new hopes are taken with a pinch of salt because it is often not a priority area. But less than two months later, the government announced the introduction of four new vaccines into the Universal Immunisation Programme (UIP): A rotavirus vaccine for diarrhoea, the injectable polio vaccine (IPV), rubella and a Japanese encephalitis vaccine for adults.
Many have criticised this move as expensive and unnecessary, arguing that the vast resources allocated to the vaccine scale-up would have been better spent on the health infrastructure. These voices say that these vaccines address only one of the many problems that cause the incidence of diseases, such as diarrhoea, for example. They also claim that our resources are better spent ensuring better sanitation and universal access to clean drinking water, encouraging better hygiene practices and establishing an environment less prone to disease.
Which is all well in a tiny population where this may be dealt with in a short span of time, but not in India, the country with the world’s largest burden of childhood disease, where 1.4 million children under the age of five die every year. When we consider the scale of the challenge facing us, what we need is to work at all levels, keeping both the long and short terms in mind.
The value of an all-round redress of public health shortcomings is better understood when we discuss some basics. Does India have a functional public health system that addresses all its healthcare needs, and do we have available the optimum standards of sanitation and hygiene that can prevent childhood disease? No. Who suffers most in the absence of a health system? The poor, of course. One element of a properly functioning healthcare system is universal access to vaccines. Are all essential vaccines affordable to all people? No. And that is why we need free vaccines for all citizens under the UIP, and that is also why we cannot shy away from a move so necessary on the grounds of expense.
Examples such as Rwanda show that the emphasis on primary healthcare is needed to initiate a massive reduction in infant and under-5 mortality rates. Rwanda also adopted the rotavirus vaccine in 2012, and was the first developing country to adopt the pneumococcal conjugate vaccine (PCV) in 2009. The result: These steps combined helped Rwanda bring its under-5 mortality from 182 per 1,000 live births to 55 since 2000.
A scale-up in the UIP entails a hike in expenses; however, this is no reason to derail the growth of such a vital public health initiative. It only opens another avenue for debate: Budgetary allocations to healthcare need to increase. This at least is a point that people on either side of the debate can agree upon. What we need is proactive support for newer and more comprehensive public schemes such as the National Health Insurance Scheme being considered by the government, which aims to reduce out-of-pocket expenses on health services ranging from detection, diagnosis and treatment of communicable and non-communicable diseases to immunisation, family planning, maternal and child health, sexual and reproductive health, and cataract surgeries among others.
The earlier government was criticised for its lack of decisiveness on vital policy matters. But no sooner did the new government take a step in the right direction than criticism ensued, this time because they had been decisive for a change.
Damned if we do, damned if we don’t.
Sanjay Jaiswal is a Member of Parliament from West Champaran
The views expressed by the author are personal