Mission Indradhanush (MI), one of the largest public health programmes in the world, and one of the greatest health-related accomplishments of the Indian government, was championed and strategised by the Ministry of Health & Family Welfare in 2014. Since then, immunisation seems to have taken centrestage as a crucial pillar of public health and as a development-promoting agenda. Several countries are positioning immunisation as an important component of the Sustainable Development Goals 2030. Hashtags such as #VaccinesWork on popular social media platforms are driving the debate surrounding vaccines — are they needed? How many are needed? Are there any side effects?
The importance of vaccines in India cannot be overemphasised. But the story of India is one of diversity and complexity. With the second-largest population (1.3 billion approximately), around 27 million children are born every year here. India also has the largest burden of under-five mortality, more than what prevails in some of the poorest countries in the world. Nearly 39 children under the age of five years die for every 1,000 live births each year — pneumonia and diarrhoea are the leading killers. Approximately 0.1 million children die due to rotavirus-induced diarrhoea alone, which is around 50 per cent of all deaths attributed to diarrhoea. Evidence shows that unimmunised and partially-immunised children are most vulnerable to diseases and disability, and are at three to six times higher risk of death than fully immunised children. A large percentage of under-five mortality in India can be averted through vaccination.
As far as the vaccination programme is concerned, India faces a threefold challenge: Low full immunisation coverage (65 per cent), limited basket of vaccines and, issues regarding quality and logistics of vaccine management for such a vast and diverse country. It is indeed heartening to know that the government has taken multiple steps to boost the scope of immunisation.
India’s full immunisation coverage (FIC), which used to be 61 per cent in 2009, improved to 65 per cent in 2013 at a meagre increase rate of 1 per cent per year. It was then realised that with the prevailing 1 per cent annual increase in immunisation, it would take a long time to cover the whole country. At that tardy pace, India would have taken 25 years more to achieve 90 per cent full immunisation coverage.
To hasten the full coverage to at least 90 per cent till 2020, the Ministry of Health & Family Welfare launched Mission Indradhanush (christened after the seven colours of the rainbow, termed as Indradhanush in Hindi) in 2014. Under this, seven vaccines would be given to all those children and pregnant women who have missed out or are left out under the routine immunisation rounds. It would cover all far-flung areas. MI has used the Annual Health Survey (2011-12), District Level Health Survey (2007-08), Coverage Evaluation study (CES-2009), Rapid Survey on Children (RSOC, 2013-14), Integrated Child Health and Immunisation Survey (INCHIS) data (2015-16), and risk analysis methods to identify and monitor the progress in the initial 201 high-focus districts.
To bring sharper focus onto the least vaccinated areas, MI has been transformed into “Intensified Mission Indradhanush” (IMI) that aims to reach those rural and urban slums that have under-performed during MI. One hundred and ninety high-focus districts and urban areas across 24 states have been selected for such intensified efforts. There is a sharper focus on surveillance activities and to create partnerships with states, community-level departments and ministries for grass roots implementation and monitoring. Mission Indradhanush has led to an impressive increase of close to 7 per cent in full immunisation coverage in one year as compared to 1 per cent increase per year in the past. This is apart from the Universal Immunisation Programme (UIP) which targets to vaccinate about 27 million children against 12 deadly diseases every year, more children than any other similar programme in the world through more than nine million immunisation sessions conducted annually. We now aim to achieve 90 per cent immunisation by December 2018.
The efforts seem to be bearing fruits. The under-five mortality rates have declined considerably from 126/1000 live births in 1990 to 39/1000 in 2017, much faster than the global rates. Much of this can be attributed to the successful immunisation programme in India. On a global scale, MI/IMI is meant to reduce India’s contribution to the global burden of disease, including deaths in children under five, thereby achieving SDG-3 by 2030.
The journey of Universal Immunisation Programme (UIP), which India embarked upon in 1985, has thus been further bolstered by Mission Indradhanush/Intensified Mission Indradhanush. An immunisation programme, anywhere in the world, is the most cost-effective public health intervention. It is the basic and foremost right of children across the globe, that they receive a safe and effective “shot in the arm” in a timely manner. This is the minimum which any country must deliver to save their children from vaccine preventable diseases.
The writer is additional country director, UNDP, and former joint secretary, ministry of health & family welfare, Government of India