India sees sharpest drop in polio vaccination since 1990s, shows data

Most immunisation programmes witnessed a decline in 2020; India was worst among South Asia and, in some cases, one of the worst significant economies in the world

As the Modi government finally offers Covaxin jabs to young adults in the age group of 15 to 18 years, India’s non-Covid immunisation programme since the onset of the pandemic seems to have taken a backseat. 

Data released by Unicef shows that the immunisation programme in the country suffered its worst hit in 2020, as coverage declined across all major vaccination programmes. Under India’s Universal Immunisation Programme (UIP) operationalised in the late 1980s, vaccines are administered to infants and children to prevent seven diseases: diphtheria, pertussis, tetanus, polio, measles, severe form of childhood tuberculosis and Hepatitis B, Haemophilus influenza type B (Hib) and diarrhoea.

Data now shows that the administration of the third dose of polio vaccine for children aged 12-23 months declined five percentage points in 2020, compared to 2019 — the worst drop since 1991. In terms of overall coverage, at 85 per cent, India’s polio vaccination levels went back to those witnessed in 2014.

Similarly, in the case of DPT (diphtheria, pertussis and tetanus), the first dose for children aged 12-23 months fell by seven percentage points — the worst fall since 1991. The last time DPT shots had registered a decline (of one percentage point) was in 2006.

Administration of the tuberculosis (TB) vaccine was also down seven percentage points compared to last year.

The last time the country witnessed a decline was in 2007.

Only the rotavirus vaccine and the newly introduced pneumococcal vaccine witnessed an increase in coverage among children compared to last year. The rotavirus vaccine coverage for children aged 12-23 months went up 29 percentage points from 53 per cent to 82 per cent, whereas pneumococcal uptake increased from 15 per cent to 21 per cent between 2019 and 2020.

India’s immunisation programme was envisaged to cover all districts by 1989-90. And while the country was making progress on all vaccination parameters, the pandemic seems to have reversed some gains.

A global comparison shows India’s performance in some cases was one of the worst among the world’s major economies.  

In terms of the drop in TB vaccine, among the major economies, India was behind Mexico, Brazil and the United Arab Emirates. It also fared worse than all South Asia nations with even Pakistan and Afghanistan increasing coverage during the pandemic year. Bangladesh and Sri Lanka were among the best performers in continuing to administer TB jabs despite lockdowns and outreach challenges posed by the pandemic in 2020.

With respect to hepatitis B, India was behind Brazil and Indonesia. In the DPT vaccination, only Pakistan and Nepal fared worse than India in the South Asian region. Brazil and Indonesia fared worse in the case of measles and rubella vaccination

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One of the primary reasons for this seems to be setbacks to rural health manpower and its debilitating impact on rural health programmes, including the government’s vaccination drives. According to the National Health Mission, the total number of health and nutrition days (HNDs) held in thousands of villages declined drastically in 2020 as compared to the previous year.

At the same time, there was a fall in the number of ASHA (accredited social health activist) workers recruited by the government in Indian villages. It is at these village health and nutrition days that ASHA workers compile a list of infants who require immunisation or have been left out.