Successful child immunisation programs key to meet India's Sustainable Development Goals

Several milestones have been achieved over the years. Polio was eradicated in 2014; new life-saving vaccines (Inactivated Polio, Rotavirus, Measles-Rubella, Pneumococcal Conjugate Tetanus, and adult diphtheria) have been added to the routine schedule; indigenous vaccine production capacity has been added; cold chains established, and monitoring and evaluation system have been implemented across the country.

These investments in child and maternal health over the years have yielded substantial results—but more so, in the last two decades. U5MR dropped by 49 percent and NMR by 38 percent from 2000 to 2017.  In 2018, U5MR stood at 38 per 1000 live births; this was down from 111 per 1000 live births in 1990. These statistics are promising, but we still have a way to go to achieve the proposed SDG target for

 child mortality aims of 25 deaths per 1000 as set by Sustainable Development Goals (SDG) 2030.

Most recently, evidence from phase 1 of NFHS-5 shows that full immunisation among children age 12-23 months—a key Sustainable Development Goal (SDG) indicator—has recorded substantial improvement across Indian States/UTs/districts. There has also been significant improvement in reporting of immunisation coverage from vaccination cards. Across states, 70 percent to 96 percent of children age 12-23 months are reported to be fully vaccinated based on information from vaccination cards only.

Data has shown that the possession of vaccination cards by mothers of young children (below three years) has substantially increased after implementing 'Mission Indradhanush'—a renewed push to drive coverage rates rolled out in 2017. In almost three-fourths of the districts, 70 percent or more children aged 12-23 are fully vaccinated against childhood diseases. One of the areas we have to address is the inequity in the delivery of vaccines because it has also consistently shown that outcomes vary considerably with the lowest rates in the large central states. The highest numbers of partially immunised and non-immunised children are found in large states such as Bihar, Madhya Pradesh, Uttar Pradesh, and Rajasthan. There are also differences across geography, region, socio-economic levels, rural-urban, and gender.

On average, girls receive fewer vaccinations than boys, and higher birth order infants have lower vaccination coverage. Studies have also shown that inequality between districts within states has actually increased for the majority of the states. These district-level trends and gaps must inform the next phase of vaccine delivery and make targeted efforts to reduce child mortality to meet our national child survival targets. Indian authorities will also have to address vaccine-hesitancy, which is now described by the WHO as a global health problem.

Indeed, owning to misinformation on vaccine side—effects, community-specific social norms, and general lack of awareness of the benefits of vaccines rooted in scientific evidence, individuals and communities have refused to take the vaccines in the past. As recently as 2018, a Ministry of Health and Family Welfare study found that up to 11 percent of parents were reluctant to vaccinate their children against infectious diseases.

Today, there are several programs in place that can continue to drive better outcomes. These include programs that entitle all pregnant women delivering in public health institutions to absolutely free and no expense delivery; targeted interventions to reduce neonatal mortality and stillbirths; a plan to tackle Pneumonia and Diarrhoea has been launched in states with the highest child mortality; the roll-out of Village Health and Nutrition Days for imparting nutritional counselling to mothers and to improve child care practices; and a National Iron Plus Initiative for preventing anaemia among the vulnerable age groups, women of reproductive age, pregnant and lactating women is in place.  Once data on district-level mortality trends and state-level trends for causes of under-5 and neonatal death are available to policymakers, these interventions can build more targeted to address gaps.

But going forward, India will also have to make additional investments in certain underserved program areas. These include early detection of paediatric cancer, which remains the 9th common cause for deaths among children between 5 to 14 years of age, but which are 70 percent treatable if detected in time; early detection of primary immunodeficiency disorders (PIDs) in children; identification of behavioural disorders; and a comprehensive strategy to prevent child abuse. Furthermore, managing children's health also requires rationalising antibiotic use to limit antibiotic resistance. For this to happen, the country will have to leverage technology, upgrade point of care facilities, deploy additional resources to drive awareness, and educate parents and community to keep every child safe, wherever he or she is born.