Letter to Editor
What is Needed to Progress Toward 100% Routine Immunization in India? Sir, It is emphasized that achieving an adequate level of immunization coverage is the key viable strategy for translating every child’s right to health into reality. Despite considerable efforts and progress made by the Universal Immunization Program since 1985, we are still grappling with the higher burden of vaccine preventable diseases (VPD) as compared with many countries. This is because we are unable to achieve the required level of immunization coverage for the control of VPDs. Evidence from the recent trends [Table 1] have shown that there is still a long way to reach the momentum of 100% routine immunization (RI). Despite an increase in the immunization coverage, the inequities due to poverty, gender, religion, caste, education and geography still persist as barriers to close the coverage gap. Absence of defaulter tracking, existence of the wide gap between various survey data, weak VPD surveillance system, lack of community awareness, apprehension about adverse events following the immunization , poor health system accountability and monitoring were the other recognized barriers that have increased the coverage gap.(1-3) Various innovative efforts have been undertaken and initiated to address these socio-economic barriers. A strategic and targeted high risk approach was undertaken by the Intensive Pulse Polio Immunization to close the equity and service delivery gaps. This approach was successful in bringing the polio eradication phase in India. Similarly, the supplementary measles catch up campaign, which delivered the highly sensitive measles vaccine on a large scale have demonstrated the critical role of information, management and service delivery. The adverse events reported in the piloted states were almost nil. This has also sensitized and tested the capacity of the health system to handle emerging health needs. Innovative strategies such as mother and child tracking system, social mobilization through Accredited Social Health Activist (ASHA), innovative vaccine delivery system and web enabled cold chain management have been initiated to increase the immunization coverage. Many newer and single shot multivalent vaccines were also introduced to address the emerging and re-emerging infectious diseases. Even though, these Indian Journal of Community Medicine/Vol 39/Issue 2/April 2014
innovative initiatives have promising goals, a strong public health approach [Table 2] is required for scaling up and sustainability of these initiatives in the whole country. It is “We” rather than “I” that has created success stories in public health. Hence, focusing on areas that can be integrated, co-ordinated or collaborated becomes essential for effective implementation of immunization programs. Policy changes, legislative mandate for school admission of immunized child, linking immunization with growth monitoring, nutrition (i.e., integration with School Health Program and Integrated Child Development Services) and obstetric care are the other potential strategies to impart the full benefits of immunization.(4) Thus a comprehensive integrated public health approach addressing both supply and demand side is required to enable the system efficiency to match with the social Table 1: Recent trend in the immunization coverage in India# Vaccine BCG OPV3 DT3 Measles Overall
NFHS 1 (1992-1993) 62.2 53.6 51.7 42.2 35.4
NFHS 2 (1998-1999) 71.6 62.8 55.1 50.7 42.0
NFHS 3 (2005-2006) 78.1 78.2 55.3 58.8 43.5
CES (2009) 86.9 70.4 71.5 74.1 61.0
NFHS: National Family Health Survey, CES: Coverage Evaluation Survey, BCG: Bacille Calmette-Guerin vaccine against tuberculosis (TB) disease, OPV3: Oral Polio Vaccine 3rd dose, DPT3: Diphtheria Pertussis & Tetanus 3rd dose, #Adapted from references 1 and 2
Table 2: A comprehensive public health approach toward 100% routine immunization Health system strengthening Capacity building and strengthening of human resources Active disease surveillance Efficient logistic and health management information system Effective vaccine policy Inter-sectoral coordination Department of Education Integrated child development services (ICDS) Local governing bodies Department of social welfare
Community participation Behavior change communication Social mobilization Incentives Legislative mandate for school admission Innovative strategies Targeted supplementary immunization Advanced and safe injection practice technologies Mother and child tracking Innovative vaccine delivery mechanisms
122
Letters to Editor
equity.(5) This will make today’s dream of achieving 100% coverage in RI come true. Senthil Amudhan Rajamoorthy Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India E-mail: [email protected]
References 1.
National Family Health Survey (NFHS-3), 2005-2006. Available from: http://www.rchiips.org/NFHS/volume_1.shtml. [Last accessed on 2012 Dec 18].
2.
UNICEF Coverage Evaluation Survey, 2009 National Fact Sheet. Available from: http://www.unicef.org/india/National_Fact_ Sheet_CES_2009.pdf. [Last accessed on 2012 Dec 18].
3.
Ahmad J, Khan ME, Hazra A. Increasing complete immunization in rural Uttar Pradesh. J Fam Welf 2010;56:65-72.
123
4.
Vashishtha VM. Status of immunization and need for intensification of routine immunization in India. Indian Pediatr 2012;49:357-61.
5.
Amudhan S, Mani K, Rai SK, S Pandav C, Krishnan A. Effectiveness of demand and supply side interventions in promoting institutional deliveries – a quasi-experimental trial from rural north India. Int J Epidemiol 2013;42:769-80.
Access this article online Quick Response Code:
Website: www.ijcm.org.in
DOI: 10.4103/0970-0218.132743
Indian Journal of Community Medicine/Vol 39/Issue 2/April 2014
Copyright of Indian Journal of Community Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
What is Needed to Progress Toward 100% Routine Immunization in India? Sir, It is emphasized that achieving an adequate level of immunization coverage is the key viable strategy for translating every child’s right to health into reality. Despite considerable efforts and progress made by the Universal Immunization Program since 1985, we are still grappling with the higher burden of vaccine preventable diseases (VPD) as compared with many countries. This is because we are unable to achieve the required level of immunization coverage for the control of VPDs. Evidence from the recent trends [Table 1] have shown that there is still a long way to reach the momentum of 100% routine immunization (RI). Despite an increase in the immunization coverage, the inequities due to poverty, gender, religion, caste, education and geography still persist as barriers to close the coverage gap. Absence of defaulter tracking, existence of the wide gap between various survey data, weak VPD surveillance system, lack of community awareness, apprehension about adverse events following the immunization , poor health system accountability and monitoring were the other recognized barriers that have increased the coverage gap.(1-3) Various innovative efforts have been undertaken and initiated to address these socio-economic barriers. A strategic and targeted high risk approach was undertaken by the Intensive Pulse Polio Immunization to close the equity and service delivery gaps. This approach was successful in bringing the polio eradication phase in India. Similarly, the supplementary measles catch up campaign, which delivered the highly sensitive measles vaccine on a large scale have demonstrated the critical role of information, management and service delivery. The adverse events reported in the piloted states were almost nil. This has also sensitized and tested the capacity of the health system to handle emerging health needs. Innovative strategies such as mother and child tracking system, social mobilization through Accredited Social Health Activist (ASHA), innovative vaccine delivery system and web enabled cold chain management have been initiated to increase the immunization coverage. Many newer and single shot multivalent vaccines were also introduced to address the emerging and re-emerging infectious diseases. Even though, these Indian Journal of Community Medicine/Vol 39/Issue 2/April 2014
innovative initiatives have promising goals, a strong public health approach [Table 2] is required for scaling up and sustainability of these initiatives in the whole country. It is “We” rather than “I” that has created success stories in public health. Hence, focusing on areas that can be integrated, co-ordinated or collaborated becomes essential for effective implementation of immunization programs. Policy changes, legislative mandate for school admission of immunized child, linking immunization with growth monitoring, nutrition (i.e., integration with School Health Program and Integrated Child Development Services) and obstetric care are the other potential strategies to impart the full benefits of immunization.(4) Thus a comprehensive integrated public health approach addressing both supply and demand side is required to enable the system efficiency to match with the social Table 1: Recent trend in the immunization coverage in India# Vaccine BCG OPV3 DT3 Measles Overall
NFHS 1 (1992-1993) 62.2 53.6 51.7 42.2 35.4
NFHS 2 (1998-1999) 71.6 62.8 55.1 50.7 42.0
NFHS 3 (2005-2006) 78.1 78.2 55.3 58.8 43.5
CES (2009) 86.9 70.4 71.5 74.1 61.0
NFHS: National Family Health Survey, CES: Coverage Evaluation Survey, BCG: Bacille Calmette-Guerin vaccine against tuberculosis (TB) disease, OPV3: Oral Polio Vaccine 3rd dose, DPT3: Diphtheria Pertussis & Tetanus 3rd dose, #Adapted from references 1 and 2
Table 2: A comprehensive public health approach toward 100% routine immunization Health system strengthening Capacity building and strengthening of human resources Active disease surveillance Efficient logistic and health management information system Effective vaccine policy Inter-sectoral coordination Department of Education Integrated child development services (ICDS) Local governing bodies Department of social welfare
Community participation Behavior change communication Social mobilization Incentives Legislative mandate for school admission Innovative strategies Targeted supplementary immunization Advanced and safe injection practice technologies Mother and child tracking Innovative vaccine delivery mechanisms
122
Letters to Editor
equity.(5) This will make today’s dream of achieving 100% coverage in RI come true. Senthil Amudhan Rajamoorthy Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India E-mail: [email protected]
References 1.
National Family Health Survey (NFHS-3), 2005-2006. Available from: http://www.rchiips.org/NFHS/volume_1.shtml. [Last accessed on 2012 Dec 18].
2.
UNICEF Coverage Evaluation Survey, 2009 National Fact Sheet. Available from: http://www.unicef.org/india/National_Fact_ Sheet_CES_2009.pdf. [Last accessed on 2012 Dec 18].
3.
Ahmad J, Khan ME, Hazra A. Increasing complete immunization in rural Uttar Pradesh. J Fam Welf 2010;56:65-72.
123
4.
Vashishtha VM. Status of immunization and need for intensification of routine immunization in India. Indian Pediatr 2012;49:357-61.
5.
Amudhan S, Mani K, Rai SK, S Pandav C, Krishnan A. Effectiveness of demand and supply side interventions in promoting institutional deliveries – a quasi-experimental trial from rural north India. Int J Epidemiol 2013;42:769-80.
Access this article online Quick Response Code:
Website: www.ijcm.org.in
DOI: 10.4103/0970-0218.132743
Indian Journal of Community Medicine/Vol 39/Issue 2/April 2014
Copyright of Indian Journal of Community Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
