Despite easy availability of vaccinations, here's why millions of Indian children still miss out
The medical fraternity across the globe celebrated the week between 24-30 April as 'World Immunization Week'. While there is no denying the fact that immunization has proven to be the most important public health intervention to reduce illness, disability and death from vaccine-preventable diseases, there needs to be a concerted effort to cover those children that are still being left out of the initiative because of various reasons.
The most glaring shortcoming in countries like India is that while there is ample free supply of vaccines available under the national health programme, still a substantial number of children remain uncovered.
Experts say, that globally, immunization programmes have been estimated to prevent 2.5 million deaths every year. The Universal Immunizations Programme (UIP) in India catering to 27 million children, is one of the largest in the world, saving the lives of 4,00,000 children annually. Although the immunization coverage in the country has increased from 35% in 1992-93 to 62% in 2015-16, an estimated 7.2 million children still miss out on essential vaccines and are at risk of death from diseases which are entirely preventable.
“For a country that claims to be fast moving towards the list of developed countries, this is unacceptable. We must move ahead to cover all these children with emphasis on giving them all the basic vaccines,” points out Dr Joseph Mathew, an eminent expert at the Advanced Paediatrics Centre at Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh.
There are many reasons why many children are left out. Experts point out that the problem mainly pertains to the residents of the poor areas that constitute the high-risk group. These are areas where construction workers, daily wage labourers and other poor sections reside. Migration of labour from one place to another, their economic compulsions on not being able to turn up on days fixed at small centres for vaccination, at times the vaccine administering staff not being present because of various reasons, adds up to it.
Dr Joseph underlined that to make the initiative a complete success, a key role will have to be played by the Anganwadi and ASHA workers. He said that these are the people who need to be strengthened as they are the ones who work from door to door and have a complete knowledge of the communities.
But it is a well-known fact that it is the Anganwadi and ASHA workers who are themselves a the receiving end. One can come across their agitations for better wages and better work conditions on daily basis.
Experts also point at certain anomalies in counting the children for their surveys and statistics. For example, many times children of labourers living in slums are not counted because their Aadhaar card or birth certificate is of another state. Hence they remain the faceless aspect of the scenario.
The experts debunk the socio-political campaign against certain communities that they resist vaccination because of religious reasons. Dr Bhavneet Bharti who is also a paediatrician said, “In my personal experience I have not come across people from any community resisting vaccination because of religious reasons. There are individual concerns like the phobia of injections but nothing on religious lines".
Experts point out that vaccination is also important because viruses are mutating and becoming antibiotic resistant. This is a new challenge that has emerged with people resorting to rampant misuse of antibiotics that is now posing a major problem. Earlier, the infections used to be treated by using simple antibiotics, but nowadays the antibiotics do not respond to viruses.
“Earlier, we used to give routine antibiotics to the typhoid patient at our OPD. But now the situation has changed. We are observing that the fever is not receding even after 10 or 15 days of treatment, which means that antibiotics are not working,” pointed Dr Sanjay Verma.
Underlining the judicious role of antibiotics, Dr Joseph said, “Viruses are evolving and the antibiotics are no longer effective. The genetic makeup of virus evolves when it is suppressed for a long time and then the virus finds the mechanism to fight against the antibiotic for its survival.”
He also clarified that immunization does not ensure complete prevention from a disease but from few of the many organisms that cause the disease.
The theme of 2018 'World Immunization Week' is ‘Protected together, #VaccinesWork’ and it aims to highlight that collective action is needed to ensure that every person is protected from vaccine-preventable diseases.
Affiliates from the Chandigarh Chapter of Indian Academy of Pediatrics (IAP) along with the Department of Pediatrics at PGIMER have been deliberating on the issues of reach and access to cover the entire child population under the UIP that provides protection against Tuberculosis, Diphtheria, Tetanus, Pertussis, Measles, Rubella, Polio and Hepatitis B.
The governments in Himachal Pradesh and Haryana have added new vaccines for pneumococcal and rotavirus in their programme and this will soon be extended to other states.
Experts further explained that all children who have missed certain vaccines can receive these under the catch-up schedule recommended by the doctor. They asserted that all the vaccines included in the immunization programme have been extensively tested and are safe from all major adverse effects. However, minor side-effects like pain and fever may occur for which treatment is available at all hospitals.