Why India must expand its immunisation coverage
It is rare in public policy to find simple, cheap interventions that have such compelling and phenomenal returns. Expansion of immunisation over coming decades can help (and save) many livesUpdated: Jun 08, 2019 18:05 IST
Of all of the things that a government can do to influence the lives of citizens, immunisation is one of the most effective, cost-efficient investments. And a new, non-partisan report shows that expanding India’s immunisation programme would be a phenomenal investment. This is according to new research undertaken by India Consensus at the behest of the NITI Aayog.
Along with other countries, India has signed up to the ambitious sustainable development agenda. With 169 targets, the goals call all nations to eliminate poverty, eradicate diseases, improve governance and institutions, reduce environmental destruction and achieve much more by 2030. Obviously, no country can do all of these things at once. Therefore, the NITI Aayog identified 100 programmes that support the targets, and asked India Consensus, a partnership between Tata Trusts and Copenhagen Consensus, to utilise its network of economists and experts to assess the costs and benefits. A sharp focus could make a phenomenal difference. Say, for example, that India were to decide next year to spend ₹50,000 crore more on achieving the goals. Focusing on just 12 of the most phenomenal programmes identified by India Consensus to date would create extra benefits for India worth ₹20 lakh crore. The India Consensus study for the NITI Aayog is a world-first, fast-track effort. It is yet to be released, but already we are able to share with readers today one programme that achieves phenomenal returns for every rupee spent.
This is the Routine Immunisation Programme, one of the key interventions for protecting children from preventable life-threatening conditions. It is in fact one of the largest immunisation programmes in the world. The programme was introduced in India in 1978; it was expanded 1989-90. Under the Universal Immunisation Programme, the government is providing vaccination to prevent seven vaccine-preventable diseases: Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B, Haemophilus influenza type b (Hib) and Diarrhoea.
Studies have shown that delivering six vaccinations (tuberculosis, diphtheria, tetanus, pertussis, measles and polio) can deliver one year of healthy life for only Rs 650. In terms of what this means for society, every rupee spent achieves benefits worth some Rs 50. For Hepatitis B, Hib and rotavirus vaccines, the cost to deliver one year of healthy life is between Rs 400 and Rs 26,00, with returns to society ranging between 14 and 75. Such figures make it clear that expanding the immunisation programme is likely to be a phenomenal investment. This analysis is for the expansion of coverage. However, it is also important to look at programmes that increase the demand for vaccines. A cost-benefit analysis undertaken for India Consensus in Rajasthan suggests that a phenomenal rating is also warranted for these types of programmes. Adapting the findings from a randomised controlled study in the same state, rolling out immunisation camps and incentivising women with lentils and hot meals would lead to almost 68,000 more fully vaccinated children per year. The cost of this would be Rs 3,600 per child, with roughly two-thirds of the cost being the incentives, 20% being medical expenses, and the rest being the private costs for the women. This intervention would lead to 827 lives saved per year while also delivering the equivalent of 8,675 years of healthy life.
It is rare in public policy to find simple, cheap interventions that have such compelling and phenomenal returns. Expansion of immunisation over coming decades can help (and save) many lives.
First Published: Jun 08, 2019 18:05 IST