The Universal Immunization Program (U.I.P.) in India is one of the largest in the world in terms of the number of beneficiaries, quantities of vaccine used, the geographical spread, the number of Immunization session organized, and diversity of areas covered.
The Universal Immunization Program in India seeks to provide the complete series of primary vaccination with OPV, DPT, BCG before reaching the age of one year.
Earlier this program was adopted in 1978 with the lunching of EPI to increase the Immunization coverage in infancy to 80%. After it, Universal Immunization program was launched in 1985 in a phased manner. The measles vaccine was added in 1985 and in 1990 Vitamin A supplementation was added to the program. Due to similar programs Small pox was eliminated in 1975 from Indian soil. And with the help of UIP polio was eliminated in 2014 and maternal and neonatal tetanus (MNT) was eliminated in August 2015.
Under UIP, the government launched ‘Mission Indra Dhanush’ to make immunization a public health priority, in December 2014. The target of Indra Dhanush was to fully immunize 90% of India’s 26 million children born each year, till the age of five.
After it, four new vaccines have been added, including a vaccine against polio, PCV vaccine, rotavirus vaccine against diarrhoea, the pneumococcal vaccine against pneumonia, and rubella against measles.
What are the Vaccines?
In 2014, the Indian government announced the decision to introduce four new vaccines as part of India’s Universal Immunization Programme (UIP). These vaccines are introduced against polio (injectable), rotavirus, rubella and an adult vaccine against Japanese encephalitis.
Before this, in 2011, a vaccine against Haemophilus influenza type B (Hib) was introduced as part of the pentavalent vaccine to contain tetanus, diphtheria, hepatitis B, pertussis, and Hib.
The India Newborn Action Plan (INAP) was launched in September 2014. The purpose of this program is to reduce preventable stillbirths, newborn deaths. Apart from it, this plan aims to attain single digit neonatal mortality and stillbirth rate by 2030. In India, the current rate is 38/1,000 live births. To achieve this feat, the government has shown commitment to introduce more vaccines than it has in the last 30 years of the UIP.
Here is the description of 4 vaccines which are introduced by the government to achieve universal immunity in India.
1. The Pneumococcal conjugate vaccine
In India, singularly, bacterial pneumonias kill more children under the age of five than any other disease. The world’s highest numbers of deaths which are caused by Streptococcus pneumoniae, happen in India. This bacteria is most commonly associated with pneumonias. There are around 5-6 lakh cases of severe episodes of pneumococcal pneumonia and 95,000-1,05,000 deaths which happen in India annually. A safe and effective vaccine for pneumococcus pneumonia is available.
2. The Human Papillomavirus (HPV) vaccine
One of the top three cancers affecting women in the world is cervical cancer. Worldwide, every fourth new case is an Indian. In India, it is estimated that there are around 1.32 lakh new cases every year and about 75,000 deaths reported. Two strains of HPV-16 and -18 are responsible for almost 80 to 85 per cent of cervical cancers. And the preventive vaccines are available and are given to adolescents between 9-13 years.
3. Influenza Vaccine
Now, it is well known that the immunization of the mothers during pregnancy against vaccine-preventable diseases has the potential to improve health outcomes in mothers and their children. This is very effective way to eliminate MNT. Clinical trials have shown that influenza vaccination during pregnancy can prevent influenza disease in pregnant women and their newborn children for the first six months of life without any indication of harm to the recipients or their children.
The World Health Organisation Strategic Advisory Group of Experts on Immunization (SAGE) has recommended that pregnant women should be made priority of having influenza vaccine receipt.
In India, a large number of deaths were reported during the H1N1 outbreak from 2009 onwards. Infection in pregnant women led to deaths in their third trimester. The Maharashtra government has introduced seasonal flu vaccine for high-risk groups including pregnant women. Season flu vaccine, which includes the pandemic H1N1 strain, is a priority vaccine for use in high-risk groups in India including pregnant women.
4. The cholera vaccine
Cholera remains an important cause of morbidity and mortality in India. In India, for the prevention and control of cholera an oral vaccine which is produced and licensed in India is available. It is estimated that there are about 7-8 lakh cases of Cholera occur every year resulting in about 20,000-24,000 deaths. There are about 400-500 million people are at risk.
India still constitutes of the highest number of unvaccinated children in the world. Here
89 lakh children do not receive all vaccines and 17 lakh do not get vaccinated at all.
In India, till 2014, only 65% children were fully immunized, which is measured on the basis of three doses of the DPT or pantavalent vaccine against diphtheria, whooping cough, tetanus, haemophilus influenza type b and hepatitis B, till the age of 2.
Congenital Rubella Syndrome which is more commonly known as German Measles or CRS, is believed to affect about 25,000 children born in India every year. The symptoms of this disease can include cataracts and deafness, and the disease can also affect the heart and the brain.
Apart from above diseases, diarrhoea caused by Rotavirus is one of the leading causes of death among children less than five years of age. In India, between 80,000 to one lakh children die due to Rotavirus diarrhoea annually while nearly 9 lakh children are admitted to hospital with severe diarrhoea. Another 32.7 lakh children visit the hospital as patients due to this disease.
Impacts of UIP
The vaccines which are included in the Universal Immunization program could collectively prevent at least one lakh deaths of adults in the working age group, one lakh infant deaths, and up to 10 lakh cases of hospitalization each year.
As India’s UIP will now be able to provide free vaccines against 13 life-threatening diseases to 27 million children annually. Due to it, India’s UIP becomes the largest birth cohort in the world.
Data show that India’s infant mortality rate is 39, which means that around 9.9 lakh babies die within one year of birth, mostly from preventable causes.
Studies have shown that unvaccinated children are three to six times at risk of dying before their fifth birthday, which makes vaccines the most cost-effective public health intervention to prevent disease and death.
1.India has the highest number of unvaccinated children in the world
Till now, Immunization has immensely helped bring down the annual mortality of children under five, from 3.3 million a generation ago, to 1.3 million deaths in present which is 17,000 deaths each day.
The improvements in immunization coverage and the introduction of a rotavirus vaccine will significantly alleviate disease and financial burden in Indian households. Population and regions with low existing immunization coverage benefit the most from the universal immunization program.
From this stage, increasing coverage by targeting those regions and population will alleviates the burden more than simply increasing coverage in the population at large.