It is not common that India comes in for commending mention when health indices are in question. Mission Indradhanush (MI), a Central government initiative launched three years back in December 2014 with an aim to achieve full immunization, has managed to get its share of attention and international adulation. This is including a reference in a 2017 report of the Johns Hopkins Bloomberg School of Public Health.
Mission Indradhanush was designed as a booster vaccination programme in 200-odd under-served districts with low immunization coverage, to ensure that all children under the age of two and pregnant women are fully immunized against seven life-threatening diseases – tuberculosis, poliomyelitis, hepatitis B, diphtheria, pertussis, tetanus and measles.
The word ‘Indradhanush’ was chosen to represent the seven vaccines that are currently included in the Universal Immunization Programme against these seven diseases – the number has since risen to 12 with the inclusion of vaccines against measles, mumps and rubella (MMR), rotavirus, Haemophilus influenzae type B, pneumococcus and polio. In a select few states and districts, vaccines are also provided against Japanese Encephalitis.
The importance the government is attaching to the programme was clear when last year in October 2017, during the run-up to the Gujarat Assembly polls, Prime Minister Narendra Modi launched the upgraded version of the MI project – the Intensified Mission Indradhanush that aims to reach the last ‘unreached’ child. For the intensified MI, 1,743 districts and 17 cities were identified, aiming to reach ‘full immunization’ by December 2018. According to the National Family Health Survey 4, the vaccination coverage in the country is a mere 65 per cent.
In the three phases of the Intensified MI so far (usually held between the 7th and 14th of each month), health workers have covered approximately 4.5 million ‘unreached’ children – those who have never been vaccinated – and have fully vaccinated approximately 1.2 million children. They have also reached approximately 1 million pregnant women. The four phases of Mission Indradhanush, until July 2017, had reached approximately 26 million children and around 6.8 million pregnant women in 528 districts across the country.
According to the government’s Integrated Childhood and Immunization Survey, the first two phases of Mission Indradhanush led to a 6.7 per cent annual increase in immunization coverage as compared to the 1 per cent increase in the past. At those rates, the country would take a quarter of a century to reach the target of 90 per cent coverage.
MI happened with no additional resources from the Centre. When it was first mooted, states raised the demand for extra vaccines but Dr. Pradeep Halder, often hailed as the brainchild of the immunization programme, argued that since vaccines are procured with the entire birth cohort in mind, those meant for children who are not covered “should be somewhere in the system”. About 10 per cent could be presumed wasted, but the rest the states would have to fish out. They did that and out of this experience was born ‘ eVIN ‘.
eVIN (Electronic Vaccine Intelligence Network) is an indigenously developed technology system in India that digitizes vaccine stocks and monitors the temperature of the cold chain through a smart phone application. The innovative eVIN is presently being implemented across twelve states in India. eVIN aims to support the Government of India’s Universal Immunization Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in these states. The technological innovation is already being implemented by the United Nations Development Programme (UNDP) and has been categorized as a global best practice. Teams from Philippines, Indonesia, Bangladesh and Thailand are now preparing to roll it out in their own countries.
Future Challenges & Opportunities –
The picture is not all that rosy. Health officials have reasons to worry. There is fear that MI is taking the emphasis away from the routine immunisation (RI) project. While MI is only meant to supplement RI, some states have started reporting consolidated figures for RI and MI that not only takes away from a realistic assessment of MI but also raises fears of the booster shot replacing the primary. There are concerns that because of the emphasis on MI and …