Dr Davinder Gill, CEO, Hilleman Laboratories, MSD Wellcome Trust gives some insights to Viveka Roychowdhury on the role of technologies like the Electronic Vaccine Intelligence Network (eVIN) which have optimised vaccine outreach and delivery to boost immunisation coverage in India
Why has India only succeeded in achieving 65 per cent coverage in basic immunisation, even though vaccines made by Indian companies are supplied to the world?
Immunisation is one of the most cost-effective public health interventions for the reduction of mortality and morbidity rates caused by infectious diseases. Every year in India, five lakh children die due to vaccine-preventable diseases. Another 89 lakh children remain at risk, because they are either unimmunised or partially immunised against vaccine-preventable diseases. Full immunisation is critical to reduce child mortality and progress on socio-economic indicators. In the past, India’s immunisation coverage has been low because of various factors like, inadequate delivery of health services, a huge population with relatively high growth rate, unique geographical challenges, hard to reach populations, lack of awareness regarding vaccination, among others.
Over the last two to three years, India has made considerable gains in increasing the immunisation coverage. This progress has been made possible due to key interventions by the government including the launch of Mission Indradhanush (MI), new vaccine launches and ensuring vaccine availability by strengthening the logistics management through technological interventions like Electronic Vaccine Intelligence Network (eVIN). These initiatives have helped in narrowing the gaps in the delivery of potentially life-saving vaccines to children, particularly in hard-to-reach areas, where children are most vulnerable.
Identifying and scaling up new innovations — from development and delivery of vaccine – to improving monitoring and information sharing – can have a significant impact in achieving universal immunisation coverage.
How is India’s immunisation coverage compared with other countries in the same cohort vis a vis GDP etc.?
India has the largest birth cohort in the world (more than 26 million a year) and accounts for more than 20 per cent of child mortality worldwide. According to the 2016 Immunisation Report by UNICEF and WHO, full immunisation coverage in India remained at 65 per cent till 2013, while neighbouring countries like Sri Lanka topped the list with 97 per cent followed by Bangladesh at 95 per cent, Bhutan at 92 per cent, Pakistan at 88 per cent and Nepal at 85 per cent. Notably, India was the last country to introduce second shot of measles vaccine in 2015 and stands 75th in line to introduce Rotavirus vaccine in its immunisation schedule. This shows that India needs to keep up with other developing nations as well as its immediate neighbours in safeguarding the health of its children.
What are the reasons for the huge gaps in immunisation coverage on the future productivity of India as a nation?
The solutions to the gaps from vaccine-preventable diseases in developing countries involves successfully implementing strategies that ensure high coverage and minimise drop-outs and missed opportunities. Achieving maximum coverage, however, has been a challenge due to many reasons, including awareness on number and types of vaccines, importance of immunisation, and myths around immunisation, etc.
Out of these, the main challenge is lack of information among beneficiaries. Renewed efforts to strengthen education around timely vaccination are required at a grassroot level so that there are optimal levels of awareness among rural and urban population. This gap can be narrowed down through active participation by the government, paediatricians, private companies and other key stakeholders.
Improper storage of vaccines has led to wastage of precious resources as well as patchy immunisation coverage in the past. What are the other lessons that we have learnt from the past attempts at immunisation coverage?
Poor handling and storage of vaccines, cold chain deficiencies such as inadequate infrastructure, power shortages and poor maintenance lead to an inefficient vaccine management system.
Periodic assessment of vaccine handling and storage practices is instrumental in correcting wrong vaccine management practices and improving level of knowledge on vaccine management. Identifying various capacity gaps (personnel and equipments), which when duly addressed strengthens the nation’s immunisation service delivery, increases vaccination coverage and ensures the administration of potent vaccines to masses.
What is the Electronic Vaccine Intelligence Network (eVIN) and its envisaged role in addressing these challenges?
The eVIN (Electronic Vaccine Intelligence Network) is an ongoing project of Ministry of Health and Family Welfare in partnership with The United Nations Development Programme (UNDP).
It is an indigenously developed technology that digitises vaccine stocks and monitors the temperature of the cold chain through a smartphone application. The technology has revolutionised the way vaccines are stored and managed by streamlining the vaccine flow network. It aims to support the Government of India’s Universal Immunisation Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in the identified states. The project has been recognized by the MoHFW as the global best practise in immunisation.
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