Around the world, vaccines are considered to be one of the most cost-effective solutions for preventing child mortality and morbidity. The Universal Immunisation Programme (UIP) started in 1985 by the government of India has helped India make remarkable progress towards reducing child mortality rates in the country. Through the UIP, India has achieved the momentous elimination of diseases such as polio, smallpox and, recently, maternal and neonatal tetanus.
However, despite achieving a decline in child mortality, serious challenges still remain. The progress of full immunisation coverage seemed to have become stagnant. Immunisation coverage, which was 61 per cent in 2009, increased only to 65 per cent by 2013. That is, between 2009 and 2013, the rate of expansion in immunisation coverage was merely 1 per cent per year. At this rate, India will take another 25 years to achieve 90 per cent immunisation coverage.
Even a single child without the necessary vaccination has the potential to make other children in the vicinity vulnerable, and there are 89 lakh such children in our country who have missed one or more doses of vaccines. A survey conducted to gauge awareness of vaccines among parents found that, in more than 60 per cent of instances, parents were either not aware about the benefits of immunisation or had apprehensions regarding its side effects. Therefore, in order to make the community aware of the importance of vaccination, a nationwide intervention was needed. To achieve the objective, something had to be done — not different, but differently. And thus, the initiative of Mission Indradhanush was envisaged to scale-up immunisation in India.
The Indradhanush initiative was launched in December 2014 to further boost the reach of the routine immunisation programme, with the ultimate aim of immunising every Indian child by 2020. To begin with, 201 high-focus districts, across 28 states, with poor immunisation coverage were identified. Of these high-focus districts, 82 were located in high-focus states, namely, Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh, which alone accounted for the highest number of unimmunised and partially immunised children in the country.
The first round started on April 7, which also happens to be World Health Day. With meticulous micro-planning and the mobilisation of more than 5,00,000 trained frontline workers, the focus of the initiative was to build sustainable health systems. By keeping communication at the centre stage and enabling better monitoring and sharing of feedback between all levels of the health system, a sense of primacy and urgency was inculcated right from the top management down to the frontline healthcare workers. Under the first phase
of Mission Indradhanush, four special vaccination drives were conducted in high-focus districts in the months of April, May, June and July. Generally, under routine immunisation over a four-month period, about 13 lakh immunisation sessions are held throughout the country.
But with the impetus from Indradhanush, 40 per cent more sessions were conducted, where 21 lakh pregnant women and about 20 lakh children were fully immunised.
Running a robust delivery mechanism is another challenge in scaling-up immunisation in a vast and diverse country such as India. Last year, under routine immunisation, more than 400 million doses of vaccines were delivered to 2.7 crore children that protected them against life-threatening diseases. This is much more than the combined number of packets delivered annually by top logistics companies such as DHL and FedEx.
What makes the process even more challenging is the fact that vaccines have to be kept at a particular temperature — right from the moment they are manufactured to the time they are administered to children. To streamline the vaccine-delivery system, an innovative cold supply chain management system is being implemented to enable health workers to monitor and ensure that vaccines are delivered even to the remotest corners of the country without getting spoilt.
By filling the gaps in routine immunisation through innovative strategies and solutions, Mission Indradhanush has become an important intervention that has helped scale-up immunisation for full coverage in India. The initiative has helped accelerate the momentum of immunisation, setting in motion the aim to achieve 90 per cent immunisation coverage by 2020.
Building on the success of the first phase, the second phase begun on October 7. Week-long intensive activities to cover those children who were missed during the routine immunisation rounds are being taken up from October to January next year. A total of 352 districts have been selected for this phase across the country. The same level of preparedness and meticulous planning, with keen attention to the monitoring of each round, characterises this round too.
India stands committed to covering each and every child with the protection of full immunisation.
The writer is Union minister for health and family welfare.
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