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A shot in time

India’s expenditure on vaccines should count as sound investment in a healthy future.

Updated: July 22, 2014 12:30:07 am
Immunisation continues to be one of the most cost-effective interventions. Immunisation continues to be one of the most cost-effective interventions.

BY: Seth Berkley

India’s expenditure on vaccines should count as sound investment in a healthy future.

Plans by Prime Minister Narendra Modi to introduce four new vaccines to India’s Universal Immunisation Programme (UIP) have been welcomed across the globe as one of the most significant leaps in India’s public health policy in 30 years, and rightly so. These vaccines are currently available in India only on the private market, beyond the reach of poor children living in unsanitary conditions. But some sceptics have labelled the move as both unnecessary and costly. This is a view that is not only wrong but also shortsighted.

The addition of these new vaccines to India’s existing immunisation programme is not just an example of great leadership but also makes good economic sense. Introducing new vaccines does not just prevent death and disease, it also maximises the lifetime potential of children and the economic health of families, and the communities and countries in which they live.

This is particularly the case in India, home to the largest number of unimmunised children in the world: 6.8 million, or roughly a third of the world’s total. Granted this is partly due to the fact that India has the largest birth cohort in the world of 27 million children each year, but also because it has a particularly large gap in the health status between its rich and poor. Immunisation can help bridge that gap. By introducing the rotavirus vaccine as one of the new vaccines, for example, the Centre hopes to radically reduce the 80,000 child deaths and one million hospitalisations it estimates are caused by diarrhoea each year. These are children who could be going to school to improve their chances of a productive life. Disease doesn’t just claim lives, it impoverishes them, too.

Currently, organisations like Gavi, Unicef, WHO, the World Bank and the Bill & Melinda Gates Foundation are working with governments, industry and civil society organisations in preparation for the largest scale-up of immunisation coverage. The goal of immunising an additional 300 million children across the globe between 2016 and 2020 will take an additional $9.5 billion. But donors, including the government of India, are willing to invest in this venture because they know that it won’t just save lives but is also expected to generate between $80-100 billion in economic benefits. They recognise that saving a life today reaps long-term benefits for families, communities and countries.

Back of the envelope calculations by naysayers on the cost of vaccines fail to take this into account. Some have argued that the money spent on vaccinations could go towards primary healthcare services and mobilising health workers. But India has already done that, with enormous success, achieving what many believed was simply not possible — eliminating polio. What’s more, in doing so, India created a vast infrastructure that has been used for a range of health services, from neonatal and maternal care to improving nutrition. There is an opportunity to build on this success and use the existing infrastructure and outreach that helped wipe out polio to increase India’s immunisation coverage for other vaccines.

To a large extent, this process has already begun, with India’s national scale-up of its pentavalent vaccine. With Gavi support, eight states have already rolled out this 5-in-1 vaccine with the remaining states set to introduce it by April 2015. Adding rotavirus, rubella and injectable polio to India’s routine childhood immunisation programmes, and adult Japanese encephalitis (JE) vaccine for adults in disease hotspots, will take this further. It is worth noting, with the exception of JE, all these vaccines are produced indigenously.

Modern vaccines can indeed be more expensive than the old and there will always be other areas that also need funding. But immunisation continues to be one of the most cost-effective interventions. Not just because an ounce of prevention is worth a pound of cure, but because immunisation makes economic sense. It is a case of an investment versus an expenditure.

The writer, a medical epidemiologist, is CEO of the Gavi alliance.

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