(General Studies II – Health – Issues relating to the development and management of Social Sector/Services relating to Health, Education, and Human Resources)
- 2024 marks 50 years since the launch of the Expanded Programme on Immunization by the World Health Organization in 1974.
- India initiated its EPI in 1978, later renamed as the Universal Immunization Programme (UIP) in 1985.
Impact of EPI & UIP –
- Vaccines have saved millions of lives and prevented billions of hospital visits. Every dollar spent on vaccination ensures a 7 to 11-fold return.
| Universal Immunization Programme (UIP) – UIP is one of the largest public health programmes targeting around 2.67 crore newborns and 2.9 crore pregnant women annually. It is part of National Rural Health Mission. – Under UIP, immunization is provided free of cost against 12 vaccine preventable diseases- Nationally against 9 diseases – Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B Sub-nationally against 3 diseases – Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis. – A child is said to be fully immunized if child receives all due vaccine as per national immunization schedule within 1st year age of child. – The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015. – Mission Indradhanush (MI) was launched in December 2014 and aims at increasing the full immunization coverage to children to 90%. A total of six phases of MI have been completed covering 554 districts across the country. – The Government of India has rolled out an Electronic Vaccine Intelligence Network (eVIN) system that digitizes the entire vaccine stock management, their logistics and temperature tracking at all levels of vaccine storage – from national to the sub-district. – National Cold Chain Management Information System (NCCMIS) has been brought in to track the cold chain equipment inventory, availability and functionality. – New vaccines introduced as part of UIP – Inactivated Polio Vaccine, Rotavirus vaccine, Measles Rubella vaccine, Pneumococcal Conjugate Vaccine and tetanus and adult diphtheria vaccine. |
- In 1974, vaccines prevented six diseases; now, vaccines for 13 diseases are universally recommended, with research ongoing for vaccines against 125 pathogens.
- The coverage of children receiving three doses of DPT (protects against diphtheria, tetanus, and pertussis) increased globally from 5% in the early 1970s to 84% in 2022. In India, the coverage reached 76% in 2019-21.
- Immunization programmes in low- and middle-income countries, including India, have higher coverage than other health programmes. In India, 85% to 90% of vaccines are delivered through government facilities.
Challenges in Immunization Coverage –
- Healthcare Infrastructure: The lack of adequate healthcare facilities and trained healthcare professionals, particularly in rural and remote areas, is a major barrier to immunization.
- Equity in Access: Despite the Universal Immunization Programme (UIP), there are significant disparities in immunization coverage across different states, urban and rural areas, and among different socio-economic groups.
- Decline in recent times: UNICEF’s ‘The State of the World’s Children’ 2023 showed a decline in childhood immunization coverage in 2021. In 2022, 14.3 million children were zero dose, and 6.2 million were partially immunized.
- Adult Immunization: While children are the primary focus of immunization programs, adults also need vaccines for diseases like influenza, pneumonia, and hepatitis. However, adult immunization is often overlooked.
- COVID-19 Impact: The COVID-19 pandemic has severely disrupted routine immunization services, leading to a decline in vaccine coverage
- Awareness and Acceptance: Misinformation and lack of awareness about the importance of vaccines often lead to vaccine hesitancy. This is further compounded by fears about side effects and distrust in the healthcare system.
Policy Recommendations –
- Strengthen vaccine supply chains with reliable cold chain infrastructure: The government should invest in upgrading cold chain infrastructure by expanding the Electronic Vaccine Intelligence Network (eVIN), which monitors vaccine stocks and storage temperatures, should be expanded to cover all states.
- Expand Access and Coverage: Through measures like deploying mobile vaccination units to reach remote and underserved areas, like the ‘Teeka Express’ in UP, which provides regular immunization services and catch-up campaigns, especially in backward and hard-to-reach regions.
- Integrate with Other Health Services: Incorporate immunization services into existing health programs such as maternal and child health services, etc. to enhance accessibility. E.g.- Janani Suraksha Yojana (JSY) can be integrated with immunization drives.
- Enhance Public Awareness and Education: Develop culturally sensitive and locally relevant communication campaigns to educate communities about the importance and safety of vaccines. E.g. – Intensified Mission Indradhanush (IMI) utilized mass media campaigns and community engagement, which can be emulated in all other programs.
- Combat Vaccine Hesitancy: Address myths and misinformation about vaccines by involving trusted healthcare professionals and community influencers in awareness campaigns. Provide clear, evidence-based information to counteract misconceptions. E.g.- The successful Pulse Polio Programme model. which overcame vaccine hesitancy, can be implemented across the board.
- Strengthen Health Workforce Training and Capacity: Through regular training programs and incentivizing performances. E.g.- ASHA (Accredited Social Health Activist) workers receive incentives for achieving immunization targets in their respective areas.
- Improve Data Collection and Monitoring: Establish and maintain digital immunization records for tracking individual vaccination status, etc. E.g.- The MoHFW’s initiative of the Health Management Information System (HMIS) can be improved.
- National Technical Advisory Group on Immunization (NTAGI) should provide recommendations for adult and elderly vaccinations. HPV vaccines for teenage girls are a good start; similar steps are needed for wider adult immunization.
The 50th anniversary of the EPI is a pivotal moment to expand immunization programmes. The focus should be on zero-dose children, reducing vaccine inequities, and offering vaccines to adults and the elderly. It is time to make the EPI an ‘Essential Program on Immunization’.
