It is not common for India to be mentioned when health indices are questioned. Mission Indradhanush (MI), a central government initiative launched three years ago in December 2014 with the goal of achieving full immunization, has managed to garner its share of international attention and adulation. This includes a reference in a 2017 report from the Johns Hopkins Bloomberg School of Public Health.

Mission Indradhanush was designed as a booster vaccination program in over 200 underserved districts with low immunization coverage, to ensure that all children under two years of age and pregnant women are fully immunized against seven life-threatening diseases: tuberculosis, polio, hepatitis. B, diphtheria, pertussis, tetanus, and measles.

The word ‘Indradhanush’ was chosen to represent the seven vaccines that are currently included in the Universal Immunization Program against these seven diseases; since then, the number has increased to 12 with the inclusion of the measles, mumps, and rubella (MMR), rotavirus, Haemophilus influenzae type B, pneumococcal, and polio vaccines. In a few select states and districts, Japanese encephalitis vaccines are also provided.

The importance the government attaches to the program was made clear when last year, in October 2017, during the run-up to the Gujarat Assembly elections, Prime Minister Narendra Modi launched the enhanced version of the MI project – Mission Enhanced. Indradhanush who aims to reach the last ‘unreached’ child. For intensified IM, 1,743 districts and 17 cities were identified, with the goal of reaching ‘full immunization’ by December 2018. According to the National Family Health Survey 4, vaccination coverage in the country is just 65 percent. hundred.

In the three phases of Intensified MI so far (usually taking place between the 7th and 14th of every month), health workers have covered approximately 4.5 million ‘unreached’ children, those who they have never been vaccinated, and have fully vaccinated approximately 1.2 million children. . They have also reached approximately 1 million pregnant women. The four phases of Mission Indradhanush, as of July 2017, had reached approximately 26 million children and around 6.8 million pregnant women in 528 districts across the country.

According to the government’s Integrated Immunization and Childhood Survey, the first two phases of the Indradhanush Mission led to a 6.7% annual increase in immunization coverage compared to the 1% increase in the past. At this rate, it would take the country a quarter of a century to reach the goal of 90% coverage.

MI occurred without additional resources from the Center. When first raised, states raised the demand for additional vaccines, but Dr. Pradeep Halder, often hailed as the brainchild of the immunization schedule, argued that since vaccines are procured with the entire cohort of birth, those intended for children who are not covered “should be somewhere in the system.” One might assume that about 10 percent was wasted, but the rest would be fished out by the states. They did that and out of this experience ‘eVIN’ was born.

eVIN (Electronic Vaccine Intelligence Network) is a locally developed technology system in India that digitizes vaccine stocks and monitors cold chain temperature through a smartphone app. The innovative eVIN is currently being rolled out in twelve states in India. eVIN aims to support the Government of India’s Universal Immunization Program by providing real-time information on vaccine stocks and flows, and temperatures at all points of the cold chain in these states. The technological innovation is already being implemented by the United Nations Development Program (UNDP) and has been categorized as a global best practice. Teams in the Philippines, Indonesia, Bangladesh and Thailand are now preparing to roll it out in their own countries.

Future challenges and opportunities –

The outlook is not so rosy. Health officials have reason to worry. There are fears that MI is de-emphasizing the routine immunization (RI) project. While MI is only intended to supplement RI, some states have begun reporting consolidated numbers for RI and MI that not only remove a realistic assessment of MI, but also raise fears that the booster will replace the primary. There is concern that because of the emphasis on MI and now Enhanced MI, states will dedicate resources to this and the routine immunization schedule will suffer.

The first 2 phases of MI had led to an increase in immunization coverage of approximately 7 percent. Micro-planning needs to be strengthened so that all children and pregnant women, especially those in remote areas and high-risk housing, are covered. The biggest challenge is the target date that India has set for itself, i.e. lowering the target date (for 90% immunization coverage) from 2020 to December 2018. This means that Enhanced IM would have to reach populations in the most remote locations in a limited period of time. However, it is easier said than done. A major barrier to achieving this goal is deeply held cultural issues and religious beliefs and the general lack of formal health communication at ground level (village households).

MI is a strategy to strengthen RI. MI should lead to capacity building of the frontline health workforce to deliver quality immunization services. There have been massive campaigns for MI that have led to increased immunization awareness and fostered inclusion. Most importantly, MI in areas that were previously outside of RI has led to these areas being integrated into RI microplans and bringing immunization services closer to people than ever before. An integrated IR Plus MI (and now MI Intensified) has provided a much-needed boost to the national immunization program.

Is it possible to reach the 100% target for India?

Achieving 100 percent immunization coverage requires persistent and sustained efforts because new cohorts of children are continually being added to be immunized. There is always a high probability that a small proportion of children will not be covered despite the best possible efforts due to reasons such as migration (for work), among other factors. Therefore, there can never be a deadline to achieve 100 percent coverage. The goal should probably be to reach and maintain immunization coverage throughout the country at levels of 90-95 percent.

conclusion

Vaccination is one of the surest methods to ensure healthy children and ultimately a healthy nation. Under the direction of the Prime Minister of India, the goal of the Indradhanush Intensified Mission is to increase immunization coverage to 90 percent by the end of this year. This can only be achieved when we reach out to those ‘unreached’ children who are left out of routine immunization sessions.

A public health program, let alone a childhood immunization program, even globally, has never addressed such a large population in such diverse geographies. The only way forward is to focus on the most backward districts. What is significant is that India does not need money to push these things forward, but rather unwavering focus and meticulous planning and implementation.