New Delhi: Every year, the last week of April is observed as World Immunisation Week. Dr Vivek Virendra Singh, Health Specialist Officer in Charge, Chief of Health, UNICEF talks to team Banega Swasth India about the importance of immunisation, the significance of Immunization Week and how it helps ensure every child survives and thrives.
As we celebrate World Immunization Week, what role has immunisation played so far in saving lives?
Dr Vivek Virendra Singh: The world celebrates World Immunization Week in the last week of April every year to galvanise the support for one of the most cost-effective global health interventions, which has added life to the population at large. Think of it globally, modern medicine has been able to add some life to the individuals, but at the population level, it is just two simple public health interventions – improvement in the water and sanitation and immunisation which has been with us for two centuries now and has added life to the years at the population level. That’s the importance of immunisation and we use this week to galvanise our stakeholders for this public health intervention.
How important are booster doses? India has just rolled out boosters for all eligible adults while other countries did it earlier, is the timing right for India’s booster dose announcement?
Dr Vivek Virendra Singh: I think yes. India has a very robust system of taking scientific evidence into all its policies and especially for COVID there is NTAGI – National Technical Group on Immunisation, which takes into account all the scientific evidence and that’s how it is being recommended. We do not know which variant and how much does the immunity last so I would urge everyone who is eligible for a precautionary dose to step out and take the dose. We have seen in the third wave how we were affected less in terms of the severity of the disease and I think it was mainly possible due to the two doses that most of the population had, so I think people should be stepping out and taking booster doses whenever they are available.
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India is a hub of vaccine manufacturing. But how do we fare when it comes to vaccine administration? According to you, how successful has India’s overall immunisation programme been?
Dr Vivek Virendra Singh: The theme for this year is ‘long life for all’ and vaccines now provide that opportunity. So answering your question on how do we fare in terms of vaccine program and administration. So think of it like, in 1978, when India started its extended immunisation programme giving three antigens. From 1978 to today, in 40 years, now the country is currently administering antigens for 12 diseases. These antigens over the years, for a population of the size of India, 2.9 crore mothers and 2.6 crores of the cohort of children that are newborns receive these vaccines each year through our immunisation programme.
From the production to the delivery on the frontlines, imagine India conducts about 1.2 crore vaccination sessions, with the help of 1.5 lakh healthcare workers and maintaining the quality of the vaccines, right from the production and to the frontline for these numbers, so India has a unique system, where its cold chains, I don’t know if people know that there are these walk-in coolers and freezers, where you actually walk into a storage unit at a state level, there 740 district level walk-in coolers and freezers and storage units for vaccines in the country. And about 1 lakh equipment which are temperature control equipment where the vaccines are stored and these are connected to a mobile chip-based data loggers which give real-time information on cold chain, maintenance of these vaccines till the time they reach the frontlines. And this intervention of India is now being taken globally by many UN agencies who are helping other countries to strengthen the vaccination programs across the globe.
Right from the production, to the delivery at the frontline, there are a lot of lessons from India’s programme, and you know vaccines for this year’s theme – long life for all – we all know that especially for children, vaccines don’t just add long life to the years, they also add life to the years that is enhanced because of the vaccines. So the children are able to play, let’s say a child is affected with polio, we know what happens to the child, the child suffers suffer from the vicious cycle of diarrhoea, measles, and gets into a cycle of malnutrition. We know how the child will suffer and may not be able to grow at a trajectory he or she is entitled to as a child. We know that the vaccines also add a lot of life to the years so children are not just able to survive but also thrive.
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If we look at the NFHS-5 data, the percentage of children in India taking essential vaccines has improved from 2015-16. Going forward what steps do we need to take to keep up with the pace of vaccination and ensure no one is left behind?
Dr Vivek Virendra Singh: It is a very important point that as of date, with the increasing number of antigens that are available in the vaccination programmes, most of the kids getting. I think the priority must be shifted on those who are not getting it than on all success of those that we have been able to reach. For that, there is a global call in the strategy moving forward to the 2030 goals, which is calling for all stakeholders to converge their energy in reaching the children that are called zero dose children because imagine in today’s times, with the kind of health system and investments that the countries have made and we have seen that in India as well, it is absolutely not right that some kids still get left out. And they get left out for various reasons which can be both from the demand-side and community or family side or could be from the supply side.
But the government is seriously working on not just celebrating the steady progress that has been made but also reaching the unreached. I must highlight that India started a campaign called Mission Indhradhanush in 2014 to reach the unreached. So there were districts that were specifically marked with low immunisation coverage and this data was not through surveys but through the health management information systems. And this is continued since 2014 and now we are in phase 4 of the mission, where the country is again going to target 416 districts, which began with about 200, to try and grow and reach the unreached and this is where we will need the support from all the stakeholders. Be it an institution or individuals, if you feel that there are communities where the children have not received all the antigens or have not received immunisation for some reason, we need to go out and see if there are cases that may be left out and raise awareness that vaccination may be something which is available in all public health facilities.
In India 95% of all immunisation happens in public facilities which is a very important point that the quality of the vaccines in India, there is so much confidence in it that even small private sectors take the vaccines from the district office or the state immunisation office. So the will is there, there is availability in the system, we just need to come together and ensure that no child is left behind.
COVID-19 has shown us the importance of vaccination in controlling the spread of the disease and mortality. What are some of the other diseases that need vaccines to put an end to it?
Dr Vivek Virendra Singh: We know that the world is working on many of the elimination and eradication goals, but yes, covid has taught us that wherever the vaccines are available we must use them. I would put them slightly differently, covid has taught us how healthy population groups are imp for resilience for such pandemics in future. When we say healthy population groups, vaccines play a very important role. For whatever antigens are available, that a population that has good immunisation coverage, which is given from childhood to now adolescents, and adults, if the population in any country is well vaccinated for the antigens available, obv they will be more healthy and resilience in the country.
The world is working on many other elimination targets, we know that India was able to achieve the polio eradication in 2014, and then the tetanus elimination target. But measles is another disease marked for elimination, but we are doing fairly well there and is something we need to take further advantage of. Similarly, the newer vaccines that are now coming, we have seen how most of these pandemic potentials are these influenza type viruses, so there is the pneumonia vaccine which is now available and which is also in the immunization programme, so these vaccines are something for which we will have to increase the uptick in the future.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.