Bridge the vaccination gap

A break in the chain of immunisation will lead to unvaccinated or partially vaccinated cohorts thereby increasing the chances of an outbreak of vaccine-preventable diseases like diphtheria and measles, warns Dr Sumana Y

India’s Universal Immunisation Programme (UIP) has made remarkable achievements since its inception in 1978. It is one of the largest public health programmes which provides free of cost and good quality vaccines against the main vaccine-preventable diseases (VPDs) affecting under-five children. Robust monitoring and surveillance, continued efforts of healthcare teams, community engagement, strengthening of the cold chain, logistics management, and addition of vaccines increasing the coverage of diseases have all been feathers in the cap along the journey. The launch of Mission Indradhanush (MI) and its intensified programmes has increased immunisation coverage by 18.5% since its launch and aims to achieve full immunisation of 90% in the Under 5 cohort. All these efforts combined have brought a tremendous change in the immunisation coverage from 35.4% (NFHS-1, 1992-93) to 76.4% (NFHS-5, 2019-21).

The smooth ongoing process of the well-established routine immunisation coverage was disrupted by the Covid-19 pandemic. Routine immunisation services were affected due to the lockdown, containment of many areas and a surge in cases in the subsequent waves. The focus of the health sector shifted towards the challenging situation of surging Covid infections in the entire population. Most resources from all other health programmes were diverted to manage the Covid pandemic due to the disproportionate burden of hospitalisations and mortality. Parents feared bringing their children to hospitals just for routine immunisations amidst the Covid patient admissions, Covid infections in healthcare personnel and the closure of most of the private clinics were additional factors. Relocation due to the prolonged lockdown phase led to difficulty in tracking the children who missed immunisation. The impact of all these is reflected in the fall of immunisation coverage rate by 26% in the first quarter of 2020 itself (HMIS). This is a huge setback. India was among the top ten countries with the highest number of children who missed basic vaccines. A break in the chain of immunisation will lead to unvaccinated or partially vaccinated cohorts thereby increasing the chances of an outbreak of vaccine-preventable diseases like diphtheria, measles etc.

In order to prevent and curb the rise of vaccine-preventable diseases in children, gaps must be addressed at the earliest. Intensified Mission Indradhanush (IMI) 4.0 has been planned for this year with an aim to bridge the gaps. Extensive IMI rounds will focus on high-risk areas like urban slums, hard to reach areas in rural settings, areas with disruption of immunisation services due to Covid containment protocols and areas with high migrant populations. This will also include flexible session timings with an ‘on-demand vaccination’ strategy in order to ensure better and faster coverage. A revised headcount of all the areas will help in updating the beneficiary list, gathering information about the target population and linking them to immunisation as there has been a lot of shift in the population all over the country due to the relocation and movement of migrants back and forth between rural and urban areas. Doctors and healthcare teams can take the initiative of enquiring about the immunisation status of mothers and children they interface with. It is not just the efforts of the healthcare team, but also a proactive involvement of parents which will ensure success. Parents should bring children for immunisation in case of missed schedules. However, this may be a challenge in rural areas, migrants and families of low socioeconomic status. Strengthening tracking mechanisms through digital means will also help in addition to the routine house visits by the health workers. Digital modes of health education, sending reminders for due vaccinations, and retrieving immunisation records will be faster modes of communication and dissemination in the present times.

Technological advances have made the availability of mobile phones and accessibility of internet facilities to even remote areas possible. Today, most of them, despite their socioeconomic status have a mobile phone as digital modes of payments and transactions have also increased. This provides opportunities for easier and faster communication despite the distance and saves time. Social media platforms can be worthily utilised for spreading messages regarding the importance of catch-up vaccination. Urban immunisation coverage can be enhanced with mobile vaccination booths and doorstep vaccination campaigns in apartment complexes, gated communities and specific residential layouts in liaison with municipal health authorities.

Dealing with challenges always brings out strengths and opens up doors to new possibilities. So, tackling the Covid pandemic situation also paved the way for the successful nationwide vaccination coverage of all age groups in a phased manner. Until the Covid-19 vaccination programme, Under-5 immunisation was the biggest cohort. The accomplishment of this huge task of vaccinating a majority of the population against Covid in the best possible time will be a benchmark. Lessons learned from this can be a guide to revising strategies for wide and faster coverage for the routine Under-5 immunisations. Use of Cowin portal for registration, booking slots for vaccination, generating vaccination records, different methods of vaccination campaigns, and good coordination between public and private sectors for availability and accessibility of vaccines are some of the things that can be emulated by the Universal Immunisation Programme.

(The author is a consultant in the Department of Wellness attached to a Bengaluru-based chain of hospitals.)