Childhood immunisation is an essential right of a child
Public policy is critical in improving this universal right of children
The evening shadows lengthen as 17-year-old Kiran strides confidently onto the narrow street along with the urban ASHA health worker bearing the vaccine carrier. Empowered with knowledge of child rights and the life-saving power of vaccines, Kiran, having grown up without a home herself, is on a mission to find young mothers and infants in her area to ensure that no child is left behind.
On the street corner where the ASHA worker was closing her vaccine carrier and filling in the last of the day’s entries into the register, Kiran helps the young mother understand when the next vaccines are due, and also allays her fears about her baby’s reactions to the shots.
India, where 25 million babies are born every year, has an enormous task when it comes to vaccinating all its children, particularly those who live within marginalised communities. Thousands of youth like Kiran and India’s vast frontline health workforce together form the foot soldiers of India’s approach to bringing vaccines to every child.
The Government of India commendably launched Mission Indradhanush in 2014. The strategy to reach every child was refined in the Intensified Mission Indradhanush programme in 2017 to cover the additional seven million children who were still missing immunisations.
These initiatives have seen an increase in full vaccination coverage among children from 62% in 2015 to 76.4% in 2019. But in 2020, with 3.5 million unvaccinated children during the pandemic, India had one of the highest numbers of unvaccinated children in the world.
A renewed focus now is the three million children in India who did not receive the first dose of the DTP-1 vaccine, considered as zero dose - the world’s most vulnerable children who are susceptible to illnesses and deaths and are deprived of their right to healthy living.
Can immunisation be considered a child right? India accepted the United Nations Convention on the Rights of the Child (UN-CRC) obligations in 1992. Since then, India has committed to safeguarding the rights of children towards their survival, development, protection and participation.
However, the UN-CRC (Article 24) related to child’s right to health needs adoption and implementation. Globally and within India, there has been little focus on promoting immunisation as a child right. It is time to advance the right to access childhood immunisation services, since this is closely related to primary and preventative healthcare sub-goals within Article 24 of the UNCRC that ensure a child’s right to live a healthy life.
Consider immunisation’s ripple benefits. Immunisation is scientifically proven as one of the most cost-effective ways to improve child survival and protect their future development. Vaccines have both direct and indirect benefits. Direct benefits include reducing disease and death among children. Indirect benefits of vaccination include reduced economic burden from infectious diseases in early childhood as well as adulthood, thus breaking the intergenerational vicious cycle of poverty that families would have otherwise incurred, had their child fallen ill or died due to a vaccine-preventable disease. Cognitive benefits include children’s low absenteeism in school, adding to their educational growth and overall development. Vaccines thereby improve children’s physical health, cognition, performance at school and productivity outcomes in adulthood. Ensuring this right for children has multifold benefits for society.
Childhood immunisation should, therefore, be considered an essential right of a child. Public policy is critical in improving this universal right of children. Barriers such as vaccine hesitancy exist, and myths and misconceptions abound, along with alack of access as a result of being left out of official enumeration processes.
Greater recognition and support for these unsung heroes can accelerate the translation of child rights into practice.
To accelerate progress, we recommend strategies aligned with the four pillars of primary health care to ensure that every child has access to life-saving vaccines. First, community participation and ownership, such as direct involvement of street or migrant populations, and of faith leaders and other trusted community members, is a powerful approach to keep the message of health rights centerstage. Second, leveraging digital technology and educational initiatives, vaccine knowledge and health promotion can be introduced into school curriculums, with the idea that children, as future actors of vaccine behaviour, should be engaged in vaccine awareness and their health rights. As an extension, incorporating human rights-related instruments UNCRC articles into medical and legal curricula of professional education systems can spread awareness of this excellent framework of child rights as it pertains to health. Third, intersectoral convergence of government initiatives such as integrating the Village and Health Nutrition Days (VHNDs) (an initiative of the National Health Mission of India) with vaccination outreach camps can be an effective strategy for catch-up immunisation, where remote populations and those hidden in plain sight in urban poor settings can be reached.
Fourth, leveraging support systems such as the G20 presidency platform occupied by India in 2023 could play a pivotal role in bridging vaccine inequities by bringing together countries to share wise practices to pivot health access as not just a choice for the privileged few but a right for all children that will ultimately benefit society.
Rajeev Seth is a senior consultant social paediatrician, Vice President of theIndian Academy of Pediatrics and Managing Trustee, Bal Umang Drishya Sanstha (BUDS)
Aastha Kant is a sociologist at the Maternal and Child Health India program at the Johns Hopkins Bloomberg School of Public Health.
Anita Shet is a paediatrician and director of child health at the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health