Seventeen million children missed out on lifesaving vaccines in 2020 – the year the Covid-19 struck the world – leaving them vulnerable to diseases like measles, tetanus and diphtheria. In the same year, the number of completely unvaccinated children increased by 3.4 million and only 19 new vaccines could be introduced. This number is less than half when compared to any year in the past two decades.

While the coronavirus left almost no part of the world unaffected, its indirect effects are also indelible as it put a harsher spotlight on the vulnerability of immunisation systems worldwide. Studies show that disruptions in routine and proactive health services like vaccinations are more likely to increase morbidity and mortality, leaving women and children particularly vulnerable in coming years.

Pandemic-related disturbances have also jeopardised previous gains in immunisation services, with long-lasting implications on the eradication and elimination efforts being made for diseases that are vaccine preventable.

There is an urgent and global need to bring immunisation efforts back on track especially as educational institutions restart physical classes in the shadow of the ravaging pandemic.

Before the pandemic struck, the WHO had devised the Global Vaccine Action Plan (GAVP) to prevent deaths due to diseases that can be prevented through vaccination. This envisaged increasing access to shots, thereby boosting coverage. The plan had been to have all countries increase their vaccination coverage by 90 percent nationally by 2020.

Polio campaign: A case in point
Perhaps, the world – and India currently – can take a leaf out of our polio eradication success story. At a time when the nation was hyper-endemic for polio, with an average of 1,000 children getting paralysed each day, the government of India launched the Pulse Polio Immunisation Programme in 1994. This is when the country accounted for around 60% of the global polio cases. The coverage of the polio drive was so far and so wide that within two decades, India received the ‘Polio-free certification’ from WHO in 2014. The last polio case was reported in Howrah in West Bengal on January 13, 2011.

The blueprint was simple and rooted in basic civic machinery – warranting high commitment at the entry-level led to key stakeholders such as policymakers, frontline workers and community volunteers joining forces and ensuring equitable access to vaccines for everyone even in the remotest parts of the country. This made the eradication of polio possible in India, while also addressing the social and cultural concerns regarding vaccine hesitancy in less developed areas with poor health systems by involving communities and local leaders for micro-level communication and community mobilisation.

And now, the Centre has made polio vaccine doses a part of its annual immunisation programme to maintain population immunity.

As the fastest-growing economy, riding on this success and following the blueprint of polio eradication, India is uniquely placed to attain full immunisation against all preventable diseases for children as well as adults and achieve the United Nations Sustainable Development Goal of “ending preventable child deaths by 2030”.

Complete immunisation will also help the country strengthen its healthcare systems and bring about a holistic universal and preventive approach to avoiding future pandemics.

A job well begun…
One of the biggest and most overarching effects of the novel coronavirus outbreak was its impact on mobility. A Lancet study found that outreach services that are usually used in many low-income and middle-income countries, and entail regular visits to deliver routine vaccination services to communities, particularly those with poor access to health facilities, were heavily hit during the pandemic leading to vaccine coverage inequities.

While global efforts are being made to get back to pre-Covid coverage, the urgency to identify vulnerable populations who have been affected during these disruptions is crucial for full recovery.

India has been running an exhaustive immunisation programme since 1978; it is one of the largest such initiatives in the world and the most crucial public health interventions in the country. Under the Expanded Programme of Immunisation (EPI) or the Universal Immunisation Programme (UIP), vaccines against diphtheria, tetanus, measles, severe childhood tuberculosis and hepatitis B, pertussis, and hiaemophilus influenza type b and diarrhea are provided to kids.

Recently, Mansukh Mandaviya, Union Minister for Health and Family Welfare (MoHFW), stated that due to the government’s immunisation push under Mission Indradhanush 4.0, last year, the number of vaccinated children between the age group of 12 months to 23 months increased by 14.4 percent. Stating the findings of the National Family Health Survey – 5 (NHFS-5), he added that the number of vaccinated children in this age group increased to 76.4 percent in 2019-20 as opposed to 62 percent in 2015-16.

Way forward
As we slowly emerge from the dark shadows of Covid-19, this year, the MoHFW has prioritised 378 districts to implement IMI- 4.0 which will focus on improving immunisation coverage through need-based interventions during vaccine drives based on a comprehensive gap analysis and enhanced accountability frameworks. The gains achieved will then need to be sustained through strengthening health systems and microplanning by incorporating IMI sessions into routine immunisation micro plans.

While acknowledging the impact of these initiatives, emphasis should also be on a supplemental and more aggressive action plan that covers all left-outs and dropouts in select districts and urban cities with low routine immunisation coverage within a specific time frame.

Additionally, understanding the enormousness of the disruptions in immunisation services will evidently provide a window into potential vaccine-preventable disease outbreaks in the future. To work towards a more equitable world, urgent actions are necessary to ensure we not only catch up to our pre-Covid efforts, but surpass them to mitigate the far-reaching impact of the virus. By ensuring a targeted approach towards vulnerable communities, boosted health information systems to spread awareness around immunisation drives, synergising efforts around our globally-acclaimed COVID-19 vaccine rollout programme, and restructuring health systems to build resilience, we can recover and rebuild a healthier tomorrow.

Vaibhav Maloo, MD, Enso Group

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