Recording over 6.8 million cases in more than 200 countries, the coronavirus pandemic has undoubtedly become the most widespread infectious disease outbreak, leaving SARS, Ebola and H1N1 influenza far behind. Across the globe, countries have deployed aggressive containment measures, including stringent lockdowns, domestic and international border-sealing and trade restrictions. Tourism, hospitality, public transport, manufacturing and other such “non-essential” services have been affected in most countries, which are likely to have a resounding impact on domestic economies.
In two dozen countries, national routine immunisation programmes have been paused. In India, too, routine immunisation has been suspended to help ease the burden on the already overstretched health system and to help limit transmission. Of course, this temporary halting is critical to recalibrate efforts to arrest the spread of Covid-19, but it is also deeply concerning. My fear is, this temporary suspension could place children at risk and disrupt the significant momentum we have achieved through our immunisation efforts in the country. Let me elaborate.
Since its inception, the Universal Immunisation Programme (UIP) — one of the largest public health programmes in the world — has protected millions of children from vaccine-preventable diseases like diphtheria, pertussis, measles, pneumonia, diarrhoea, etc. From offering protection against 6 vaccine-preventable diseases in the mid-eighties, today, the UIP has expanded to provide protection against 12 such diseases! New vaccines like measles rubella, pneumococcal conjugate, inactivated polio and rotavirus have been introduced to improve the health of our children. In fact, our UIP targets to serve more than 26 million newborns and about 27 million pregnant women every year. Concerted efforts have helped us beat polio, maintain our polio-free status for over half a decade and eliminate maternal and neonatal tetanus — which were all responsible for significant child morbidities.
Mission Indradhanush is testament to the Government’s commitment to reach and protect the most vulnerable through targeted immunisation. In just 3 years, the mission fully immunised over 8 million children. Today, the Government has strengthened its mission to leave no-one behind, through intensified mission Indradhanush. We have also made strides in strengthening our systems to better monitor and manage vaccine stocks, logistics, temperature tracking, all of which are essential to ensure that vaccines are accessible to everyone.
Of course, these are just a few of the encouraging results of a more robust UIP and the benefits of new vaccines. But it would be safe to say that, through dedicated efforts of the government and partners, we have managed to considerably improve child health in the country.
So how has the current suspension affected us?
Unfortunately, vaccine-preventable diseases have not taken a break. For instance, globally, there has been rising concern about how the current situation could lead to a spike in vaccine-preventable diseases such as measles. In fact, WHO and others predict that more than 117 million children across the world could miss out on essential vaccines needed to protect against measles. Women are also missing out on a vaccine that protects against rubella — an infectious disease that if contracted by pregnant women could cause spontaneous abortions, fetal deaths and serious congenital defects. These are grave concerns, especially since India, in the recent past, has already witnessed several outbreaks of measles and rubella. Similarly, while we are a polio-free country today and there’s much to celebrate, the recent outbreaks of vaccine-derived polio in parts of the world is a sobering reality. We need to ensure that children receive the inactivated polio vaccine on time to avoid the possibility of such an outbreak in India.
The temporary suspension has also significantly affected vaccine management systems and logistics, including activities that were underway to produce new and existing vaccines. While I am certain that all activities to sustain and expand the immunisation programme will eventually resume, the disruption caused by Covid-19 may lead to delays in restoring full capacity.
This pause has also dealt a severe blow to our plans of scaling up pneumococcal conjugate and rotavirus vaccines across the country. A quarter of our children still die of pneumonia and diarrhoea, yet we may have to wait longer than earlier expected to ensure everyone has access to these life-saving vaccines. The on-going economic downturn affects us all, including vaccine manufacturers, impacting overall production and distribution.
Let’s explore the possibility of declaring vaccinators as first line responders. With protective gear and mobile technology, they could effectively sustain immunisation activities while practicing the mandated physical distancing.
Intersectoral collaborations will be critical to immunisation infrastructure — scientists, researchers, policymakers, economists, and civil society organisations and private organizations have to come together to design a roadmap to cover lost ground.
Even as all hands are on deck to develop a Covid-19 vaccine, we need to collectively carve out a meticulous risk management, financing and executive plan to ensure that once an emergency vaccine is available, everyone has access to it.
(The writer is former Director General, ICMR)