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A shot at life: How India plans to immunise all its children

india Updated: Dec 09, 2016 13:55 IST
Sanchita Sharma
Child mortality

A child is vaccinated under Mission Indradhanush. Half of child deaths in India occur because of diarrhoea, pneumonia, sepsis and can be prevented with proper vaccination. (Reuters)

More than one in five deaths of children under five in the world happen in India. More than half these deaths are due to vaccine-preventable and treatable infections, such as pneumonia, diarrhoea and sepsis. If all children are vaccinated, lakhs of lives would be saved each year.

“India’s infant mortality rate is 39, which means that an estimated 9.9 lakh babies die within one year of birth, mostly from preventable causes,” said Union Health Minister JP Nadda. “This is unacceptable. We have to save these newborns.”

To overcome its high child mortality rate, India has added four new vaccines to its flagship universal immunisation programme (UIP) and has committed to providing free vaccines against 10 life-threatening diseases to 27 million children, through more than 9 million immunisation sessions each year.

“India’s infant mortality rate is 39, which means that an estimated 9.9 lakh babies die within one year of birth, mostly from preventable causes.”

Unvaccinated children are three to six times at risk of dying before their fifth birthday, which makes vaccines the most cost-effective public health intervention to prevent disease and death. Immunisation has helped bring down the annual mortality of children under five, from 3.3 million a generation ago, to 1.3 million deaths –which is 17,000 deaths each day. The solution is obvious, but gaps exist. India has the highest number of unvaccinated children in the world, with 89 lakh children not receiving all vaccines and 17 lakh not getting vaccinated at all. Till 2014, only 65% children were fully immunised, measured as having been given three doses of the DPT or pantavalent vaccine (against diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type b), till the age of 2.

Mission mode

Making immunisation a public health priority, the NDA launched ‘Mission Indradhanush’ in December 2014, in order to fully immunise 90% of India’s 26 million children born each year, till the age of five. Four new vaccines have been added, including PCV vaccine, a vaccine against polio, rotavirus vaccine against diarrhoea (rolled out in Andhra, Haryana, Himachal Pradesh and Odisha), rubella against measles, and the pneumococcal vaccine against pneumonia, which will be rolled out in February 2017.

“Reaching children is not impossible. India did it for polio and was certified polio free. India also reached its maternal and neonatal tetanus elimination targets in May 2015, well before the target date of December, 2015.This is a target we can reach ahead of deadline too,” Nadda said.

  • India has the highest number of unvaccinated children in the world
  • 89 lakh children don’t receive all vaccines, 17 lakhs none at all
  • The centre launched Mission Indradhanush in December 2014, to immunise 90% of India’s 26 million children born each year
  • 2.1 crore children have been vaccinated against 10 preventable diseases including polio, tuberculosis, hepatitis B, pneumonia and diarrhoea

Since the first phase of immunisation in April 2015, 2.1 crore children have been vaccinated against 10 preventable diseases -- polio, severe forms of childhood tuberculosis, hepatitis B, diphtheria, pertussis, tetanus, pneumonia and diarrhoea caused byhemophilus influenzae B, and measles across India.

Of them, 55 lakh were fully immunised in 497 districts across 35 states and union territories, shows health ministry data.

New vaccines will help. Rotavirus, for example, is one of the leading causes of severe diarrhoea and death in children under 5 years, killing between 80,000 and 1 lakh of them, hospitalising 9 lakh and causing 32.7 lakh visits to clinics.

Data dashboard

But how reliable is the data? “The surveillance is very vigorous and we’re following parameters and learnings from the pulse polio programme, when vaccines were reached to children who are missed, such a migrant populations working at construction sites, brick kilns, hamlets, dhanis or purbas in hills and areas prone to flooding,” said Dr Pankaj Bhatnagar, technical officer (immunisation) at WHO India, which offers technical support to train health workers in vaccination and to maintain the “cold chain,” so that vaccines do not lose their potency and effectiveness owing to temperature variations during storage, transporting and handling.

Boosting tracking are I-dashboards (immunisation dashboards) that systematically review reported data from across the health facilities in India, analyses and collates it on a monthly basis and shares it with the health ministry, immunisation partners and programme managers across India,” said a union health ministry officer who did not wish to be named.

It also tracks potential vaccine shortages, human resource shortfalls and patterns of vaccine-preventable diseases.

India’s child immunisation programme is forging ahead despite challenges

There is a lack of awareness among many parents about the need for vaccination. (GettyImages)

Mission Indradhanush
Determined to increase India’s full immunisation rate from 65% to 90% by 2020, as many as 2.1 crore children have been vaccinated in three phases since April 2015 across 497 districts, in 35 states/UTs.
The goal of the programme is to fully immunise all children against 10 vaccine-preventable diseases. These include tuberculosis, diphtheria, pertussis (whooping cough), tetanus, polio, hepatistis B and measles. In a few states, children are also being vaccinated against japanese encephalitis, influenza and diarrhoea.
New vaccines added to UIP
Inactivated polio vaccine: As part of its polio endgame strategy, the govt has introduced injectable inactivated polio vaccine (IPV) and bivalent oral polio vaccine (OPV).

Measles Rubella (MR) vaccine: This will be introduced in February 2017, in a phased manner. The vaccine will eventually replace the measles vaccine.

Rotavirus vaccine: Around 18.6 lakh doses of the rotavirus vaccine were administered in three doses, in Andhra, Haryana, Himachal Pradesh and Odisha, till September 2016. It will be gradually rolled out in all states during 2017-18.

Pentavalent vaccine: There will be a select roll-out of this vaccine in February 2017, in five states -- Himachal Pradesh, Bihar, Uttar Pradesh, Rajasthan and Madhya Pradesh. Will replace DPT.

How children in India have been dealing with life-threatening diseases


Challenges remain, such as quacks who work against the government system, or misguided beliefs. Parents are often unaware of vaccination benefits, don’t know where to go . The real challenge, though, is to keep the momentum.

“BCG vaccine (against TB, given at birth) coverage is above 90%, but there’s a sharp fall in the number of children getting vaccinated in the second year of birth,” says Dr Bhatnagar. “The newly instituted district task force for immunisation has introduced an accountability framework, with the district collector also reviewing data (apart from medical officers),” he adds.

“If everyone does their job, no one will be missed.”