As the Union Budget approaches, and there are whispers of fund cuts for some departments, all eyes will be on allocations for the Universal Immunisation Programme (UIP), which is looking at a nationwide rollout of the costliest vaccine in the government programme till date.
Pneomococcal conjugate vaccine (PCV), the costliest vaccine in the UIP basket, currently covers only about 50 per cent of the 26 million birth cohort in Himachal Pradesh, Madhya Pradesh, Haryana, Bihar, Uttar Pradesh, and Rajasthan.
According to government estimates, a countrywide rollout of PCV would require additional funding of Rs 1,000 crore, or about 50 per cent of the approximately Rs 2,000 crore that is spent on UIP (minus shared costs such as staff salary, establishment costs, etc).
PCV was first brought into the UIP basket in 2017 but cost concerns have been among the reasons for its still-partial rollout, officials say.
The vaccine is a mix of several bacteria of the pneumococci family, which are known to cause pneumonia — hence ‘conjugate’ in the name. Pneumonia caused by the pneumococcus bacteria is supposed to be the most common.
At present, the vaccine being used in the UIP costs approximately $2.95/dose, which makes PCV costlier than other UIP vaccines such as rotavirus vaccine ($1/dose), pentavalent vaccine ($0.69/dose), and measles vaccine ($0.308-$0.318/dose).
According to internal data collected by the Health Ministry, as of September 2019, almost 1.3 million children has received all three doses of PCV across 159 districts in the six states, with approximately 8.1 million children targeted for 2019-20.
Cost challenge set to rise further
The cost challenge for India’s immunisation programme is set to mount further in near future. GAVI, the Vaccine Alliance, an international organisation which brings together public and private sectors to create equal access to vaccines for children, is set to withdraw its support for India from 2022. The $500-million, five-year support ends in December 2021. Also, accelerated improvement in vaccination coverage achieved through Mission Indradhanush and Intensified Mission Indradhanush means that immunisation funding will now have to account for 90% coverage targeted for March 2020, rather than the 67% coverage of 2015-16.
A senior official said: “There is currently an Indian manufacturer in the market but they are yet to get approvals for India. When that happens and how they price it will to a large extent decide the course of the PCV rollout. At current costs we are looking at at least Rs 800-900 crore for a countrywide rollout of PCV. The money is worth far more in real terms because of the disease it prevents, but we have to see if we have that kind of money.”
Serum Institute’s Pneumosil has raised hopes of a $2 entry into the government programme, but it is early days still.
A study by the Public Health Foundation of India and a consortium of UK universities published in the peer-reviewed, open-access online scientific journal ‘PLOS ONE’ estimated: “In 2010, 0.56 million severe pneumococcal pneumonia episodes and 105 thousand pneumococcal pneumonia deaths had occurred in children younger than 5 years of age in India. The annual incidence of severe pneumococcal pneumonia in India was estimated to be 4.8 episodes per 1,000 children younger than 5 years. The top five contributors to India’s pneumococcal pneumonia burden in terms of number of cases and deaths were Uttar Pradesh (1,33,167 cases; 27,785 deaths), Bihar (91,578 cases; 23,202 deaths) Madhya Pradesh (52,250 cases; 13,043 deaths), Rajasthan (43,911 cases; 11,889 deaths) and Jharkhand (28,969 cases; 6,296 deaths).”
Since 2014, five new vaccines, including against two of the leading causes of deaths in children under five in India — pneumonia and diarrhoea – were introduced under the UIP, one of the largest such programmes in the world. Rotavirus vaccine (RVV), which protects against a severe form of diarrhoea, was scaled up in all states last year.
The government’s comprehensive Multi-Year Plan for 2018-22 details a comprehensive financial plan to fully immunise 26 million children and 30 million pregnant women with life-saving vaccines.
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