India's infant immunisation drive comes to a halt over Covid-19 fear

Health activists seek door-to-door drive; protocol to start 'catch-up' immunisation

Anshita Khanna (name changed) has a three-month-old daughter. Despite living in Navi Mumbai, close to large corporate hospitals, Khanna has not been able to take her baby to the paediatrician for regular check-ups and important vaccinations, fearing that she will expose the infant to the risk of coronavirus disease (Covid-19).
 

The paediatrician's clinic too is closed, but he has assured that 'catch-up' immunisation drives will be held soon.
 

Immunisation against deadly diseases is beyond the scope of telemedicine. And healthcare experts caution that countries like India must not let down their guards, lest there be an outbreak of preventable diseases like measles.
 

A dipstick survey covering 30 villages in Rajasthan threw up some worrisome numbers. About 250 children missed their regular vaccination schedule in March alone, said Chhaya Pachauli, member of the Jan Swasthya Abhiyan (JSA), a national platform that co-ordinates activities on health and health care.

These numbers are alarming. India has around 600,000 villages according to the 2011 census. Back-of-the-envelope calculations show that an estimated 5 million children might have missed out on vaccination in March, and those numbers are swelling in April.
 

Chhaya explains that the accredited social health activist (ASHA) workers or community health workers under the Ministry of Health and Family Welfare (MoHFW) basically drive the immunisation campaigns in the hinterland.

"These are outreach programmes and villagers seldom turn up with their kids at the public health centres (PHCs) to get vaccinated. Now, with the ASHA workers busy with surveillance and other work during the Covid-19 outbreak, this infrastructure has collapsed," she said.

In fact, in a note on April 20, Vandana Gurnani, the additional secretary and mission director of the National Health Mission (NHM), MoHFW, acknowledged that ASHA workers were undertaking additional Covid-19 work — community awareness, access to testing, guidance for essential services — and requested states to pay monthly incentives to these workers.
 

Leading vaccine makers say all vaccines, except those given immediately after birth (such as BCG), have been impacted. Speaking to Business Standard, S Sridhar, managing director of Pfizer, said, "All vaccines except those that are given immediately after birth are expected to have been impacted.

The Indian Academy of Pediatricians (IAP) has recently issued guidelines to its members on immunisation practices during pandemic. IAP is organising webinars to educate its members on this subject.”
 

Sridhar added that the website of GAVI, the Vaccine Alliance, a global public-private health partnership, says delays in vaccination campaigns and routine introductions will mean at least 13.5 million people in 13 of the world’s least-developed countries will be at risk of not being protected against diseases like measles, polio and human papillomavirus (HPV), with millions more likely to follow.

Others like Adar Poonawalla of Serum Institute said because of logistical issues, vaccine demand had been hit as most countries were unable to procure these items.

“In some countries, it is due to the shortage of healthcare workers and in some, the customs and cargos are not available. Other modes of transports like airlines have been impacted as well and most of all the mothers are not willing to bring their children because they fear getting Covid-19.”

It is estimated that about 65 per cent of the world's children get at least one Serum Institute vaccine in their lifetime.
 

Poonawallah warned that this was a huge risk as there are far worse diseases than Covid19.
 

“All other vaccines should be taken, especially for children aged between 0 and 2. All these vaccines are given, so that children are protected against deadlier diseases like pneumonia, measles, rotavirus, etc. We are now going to be at risk unless we start all the immunisation programmes, and encourage mothers to bring their children to clinics.”
 

Public health experts feel a protocol needs to be put in place for restarting such drives. K Srinath Reddy, president of the Public Health Foundation of India (PHFI), said the protocol should cover all parameters on how clinics in urban areas and PHCs in rural areas can restart vaccination drives.

Some states are asking PHCs to hold weekly vaccination camps. Desai said around 1,400 rural PHCs were holding camps every week, while around 10,000 sub-centres across Gujarat were conducting camps and refresher training programmes every day. He added that this was in accordance with guidelines issued by the Central government.
 

Pachauli said JSA has written to the Rajasthan government and will also write to the chief minister to start a door-to-door vaccination drive in the state. “If work on the MGNREGA can begin, why not immunisation drives?” Pachauli asks.

However, the Centre has mostly kept mum on the topic. Government sources, however, indicated that soon there would be an advisory on launching 'catch-up' immunisation drives.
 

Meanwhile, adult vaccinations, a much neglected area, has now come under the limelight. Sridhar explained, “The prevalence of immunisation amongst adults in India is very low. Most adults, including the elderly, are unaware that there are vaccines for a number of respiratory diseases such as pneumococcal disease — one of the most significant causes of illness among the elderly — and the flu. A number of hospitals are now starting up their adult immunisation programs and centres, and this should help improve awareness and immunisation levels.”
 

The UNICEF recently said as Covid-19 continues to spread globally, over 117 million children in 37 countries could miss out on receiving life-saving measles vaccination. Measles immunisation campaigns have already been delayed in 24 countries, and might be postponed in many more countries as well.