HEALTH MATTERS: The Gaps in the Provision of Vaccines and the Way forward

healthVaccines play a significant role in building immunity against several diseases especially in children. Apart from Polio, many infectious diseases like measles, diphtheria, rubella, tuberculosis, stomach ailments and influenza can be prevented through vaccination. The other infectious disease that is the cause of death in children is Pneumonia, which can be prevented through vaccination.

However, there are several gaps in providing vaccines across India.

For instance every year, 27 million children are born, however, less than 44 percent get immunized. A majority of those who are not vaccinated are in rural areas where the coverage is extremely poor. In several villages in Jharkhand, it was found that none of the children had been vaccinated for polio. Apart from poor outreach, it was found that these children were ignored due to discrimination, since they belong to tribal communities.

Due to inadequate health coverage in many areas, the uptake of vaccines in India continues to be low in a number of pockets. However there are other multiple reasons why children don’t get vaccinated. Apart from poor accessibility and non-availability of vaccines, families are hesitant to immunize their children. One prime cause is the risk of losing their children since there have been cases of infants dying after being vaccinated. Parents often refuse to vaccinate their children because they are afraid that child might die.

The other cause why many families, living in rural areas and villages do not want their children vaccinated is related to their social and cultural point of view which influence families and communities.

For instance, after being vaccinated, many newborns often develop fever or have pimples, abscess or a small scar after being given the BCG vaccine meant to prevent tuberculosis. In many places, especially villages, these symptoms are seen to be putting the child at risk. Those who have a traditional belief believe the pus and abscess is a sign that the child is untouchable.

Therefore many do not vaccinate their child after delivery, which exposes the child to a number of ailments. This mind set is defined as vaccine hesitancy, which prevents hundreds of newborns and children below five from getting vaccinated.

Such delay in acceptance or refusal of vaccines despite availability has a serious impact on their health and longevity.

In order to ensure that every child is to be vaccinated on time to protect them all infectious diseases, these barriers must be broken and appropriate steps need to be taken to create awareness so that children and their health are not compromised.

Therefore, it is also imperative that awareness about the benefits of vaccines is created in the public domain especially in areas where children have not been vaccinated or provided proper care. In rural areas, ASHAs, (Accredited Social health Activists), who are given the responsibility of providing health care for pregnant mothers and also vaccinate newborns, also need to be trained how to vaccinate appropriately, especially in areas where discrimination is rampant, ASHAs need to be hired by engaging with the communities itself and trained to be health educators and also how to vaccinate so that every child or mother is not denied immunization due to bias and discrimination.

Currently, the Union Health Ministry has launched Mission Indradanush, which aims to vaccinate all children who have been partially vaccinated or those who are not vaccinated at all. The focus districts are 82 located in four states, Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan.

In these districts, steps are being taken to improve routine immunization.

However, so far no steps have been taken in rural areas in eastern states where vaccination coverage is low and routine immunization has not been done.

In states like Jharkhand where a large number of populations reside in hamlets located in hilly terrains, as well as southern part of Chhattisgarh, where a number of tribes reside in far-flung areas away from the mainstream, as well as those who live in villages, vaccination or other medical care is not provided to the community.

If every child like newborns, infants and children below five in these communities is to be vaccinated routinely, primary health care services and sub centres need to be activated across all neglected regions, especially in rural and far to reach areas. Adults and the elderly also need vaccines but are often undiagnosed and unvaccinated. The health workers must also be trained to identify the disease and assist in providing medical care and vaccination and not ignore the community.

However, for better services there is also an urgent need for proper manpower. While initially only one health workers was assigned by the government, and ANMs kept only for three months, the mandate needs to change to ensure overall comprehensive care across all categories, especially the underprivileged, primary health care centres, sub centres and community health centres must be provided with increased work force like more than one ASHAs, ANMs and male health workers as well so that they can not only provide on time appropriate vaccination but also overall healthcare so that each disease burden can be identified at the early onset.

Other than vaccines, health workers also need not only training to understand how to vaccinate and provide proper health care but also support in terms of provision of medical kits, tools, medicine as well as vaccines and the ability to create awareness in the public space. They also need to be given appropriate guidelines in order to take the right steps.

Apart from health workers, doctors at the district level must also be involved in the providing health care. Currently in many rural areas, district health officials often ignore communities denying them health care.

The most critical step needed to be able to reach the unreached, both for children, adolescents, adults and the elderly if is important to understand the disease burden especially in high risk areas afflicted by infectious diseases. Measures like analysis of the incidence and prevalence of diseases like polio, measles, Japanese encephalitis, kalaazar, tetanus, tuberculosis, diphtheria and Hepatitis B, epidemiological studies need to be done. Based on the data, vaccines and medical care for these life threatening infectious diseases can be treated and prevented on time.

India produces adequate vaccines which are most often exported to other countries. If diseases like Pneumococcal Rotavirus which causes diarrhea, Polio, Cervical Cancer, rabies, Diphtheria – Tetanus-Pertussis, Chicken pox, Hepatitis and Influenza (flu) are to be controlled and prevented across all states in the country, the government must ensure that all vaccines for these infectious diseases as well as the medicines required are not only produced in the country but also made available across all states.

Currently, these vaccines are available in only a few districts, denying thousands of people from accessing proper treatment and care.

If vaccines are to reach the unreached and the most marginalised groups to protect them from multiple infectious diseases it is imperative that apart from campaigns, the government must invest in vaccines and other medical care on time and also provide free treatment and care so that the public is able to access vaccination and health care without having to face in financial problems, which often prevents them from accessing health care.

(Mohuya Chaudhuri is a senior journalist and researcher)