At a time when the slow pace of Covid-19 vaccination drive at about 1.3 million doses a day compared to the at least 10 million a day that some specialists have been in search of, Prime Minister Narendra Modi’s a great deal awaited address to the nation on Monday, June 7th evening threw up some essential points to ponder on India’s immunization plans.
The prime minister, referring to the pre-covid days, gave his government credit for taking up kid immunisation in a mission mode and creating a large effect. He mentioned the nation had just about 60 per cent kid immunization coverage in 2014, when his government was voted to energy. But then, by way of varied initiatives like Mission Indradhanush (MI) and Intensified Mission Indradhanush (IMI) the coverage was expanded and extended to attain more than 90 per cent and was all set to go beyond when Covid-19 walloped India.
But look closely at India’s kid immunization journey and it appears replete with numbers and a definition conundrum. But then, it is tough to ignore, not just mainly because of the valuable group of population one is dealing with but also mainly because of the absolute numbers. Afterall, practically 27 million new-borns require immunization every single year in India.
First the definition of complete immunization: The World Health Organisation (WHO) defines it as the percentage of one-year-olds who have received one dose of Bacille Calmette-Guérin (BCG) vaccine, 3 doses of polio vaccine, 3 doses of the combined diphtheria, tetanus toxoid and pertussis (DTP3) vaccine, and one dose of measles vaccine. Numerator: Number of children aged 12–23 months getting one dose of BCG vaccine, 3 doses of polio vaccine, 3 doses of DTP3 vaccine, and one dose of measles vaccine. Denominator: Total quantity of children aged 12–23 months surveyed.
The National Family Health Survey (NFHS) brought out by the ministry of wellness and family welfare is what most specialists turn to. The NFHS-5 (2019-20), the most up-to-date in the series, released in December 2020, follows the WHO definition of children who are in the age bracket of 12 to 23 months. But the Niti Aayog SDG (Sustainable Development Goals) India Index 2020-21 released on June 3, 2021, offers information based on percentage of children totally immunised but in the age group of 9-11 months.
Here are some examples of what the two definitions do to numbers for exact same states:
– For Maharashtra, the Niti Aayog index definition puts the coverage at one hundred per cent though the NFHS-5 information puts it at 81.7 per cent.
– Similarly, for Bihar, the numbers are 94 per cent and 82.7 per cent respectively.
– For Assam, 85 per cent and 71.8 per cent.
– For Himachal Pradesh, 86 per cent and 96.4 per cent.
– For Kerala, it is 92 per cent and 85.2 per cent respectively.
By Niti Aayog SDG India index, the national figure is 91 per cent but then the NFHS-5 is not however comprehensive with the information out only for just about half the Indian states.
To get a more clearer image on the progress made as a result far, there is the Roadmap document for reaching 90 per cent complete immunization brought out once more by the ministry of wellness and family welfare in January 2019. It talks of immunization coverage amongst children aged 12-23 months in the nation escalating at a really slow pace of about 1 per cent every single year and increasing from 35 per cent in 1992-93 to 62 per cent in 2015-16. On the status as on January 2019, this document points to the following:
– 91 districts in India have had significantly less then 50 per cent FIC (complete immunization coverage). – 555 districts have had in between 50 and 90 per cent FIC. – 54 districts have had more than 90 per cent FIC.
Taken collectively, it does convey the deep inter-state variations that we nevertheless have as also the extended distance that is however to be covered. What has
complex the approach is the pandemic hitting the nation in 2020 which several specialists think would have impacted the immunization drive even though the numbers once more require to looked at closely across states and unique regions. If this is not all, then there is one more information point that adds to the immunization conundrum: A report from Gavi – Meeting of the Strategic Advisory Group of Experts on Immunization place out in October 2015 lists India along with 15 other nations that had reached 80 to 89 per cent coverage in 2014. This is for “Routine immunisation coverage in Gavi countries.” But then, we are leaving that aside for the moment and the definitions applied therein.