The World Health Organisation’s (WHO) slogan for immunisation week (April 24-30) this year is “Close the immunization gap” which essentially means “reaching the unreached”. To meet this challenge, the ministry of health and family welfare has recently launched Mission Indradhanush, focusing mainly on 201 districts where immunisation coverage is low. It is an effort to raise coverage to above 95 per cent, considered near-ideal.
This opportunity could also be utilised to introduce several other vaccines that are safe, have proven effective elsewhere in the world and are also easy to deliver, mainly oral vaccines like rotavirus and the oral cholera vaccines. This could have a great impact on the productivity of the nation as a whole in the long run but significant support is needed from parents with children less than five years of age for the endeavour to succeed.
India has been one of the five countries with the highest burden of infectious diseases, particularly pneumonia and diarrhoea, in children below five. The Million Death Study conducted by the scientists at Centre for Global Health Research and office of the Registrar General of India reported that of the 2.3 million deaths reported in children aged below five, pneumonia accounted for 0•37 million and diarrhoeal diseases for 0•30 million deaths. In addition, there were 1.01 million deaths in the neonatal age group which included deaths due to sepsis, tetanus and meningitis.
Contrary to the belief of parents that repeated infections in childhood will render a child immune to diseases later in life, diarrhoeal diseases—mainly the persistent manifestations often coupled with malnutrition—lead to stunting. Although diarrhoeal deaths have been significantly reduced due to oral rehydration therapy, with the coverage reaching nearly 48 per cent in India, enteric infections continue to persist, especially in developing countries like ours. Diarrhoea due to repeated bouts of common infections like giardia and cholera lead to malabsorption of Vitamin B12, Vitamin D and fats, render the children cognitively impaired and unable to reach full potential as adults, ultimately leading to significant loss of productivity in the country.
In a study published in Nature Reviews Gastroenterology & Hepatology in April 2013, the authors have shown that the burden of diarrhoea and stunting also predisposes the child to increased risk of obesity and associated co-morbidities at adolescence, therefore resulting in the triple burden of repeated gut infections.
In a country that houses 17 per cent of world population of which 91.9 million people remain without access to safe water and 790 million live with no access to adequate sanitation, deaths and disability due to diarrhoeal diseases continue to grow unabated. While India is trying to achieve zero open defecation by 2019 and spending thousands of crores to achieve this under the Swacch Bharat Mission launched by prime minister Modi, one should not forget that we also have safe and effective vaccines to prevent deaths due to diarrhoea. A rotavirus vaccine manufactured in India about to be launched in the Universal Immunization Programme (UIP) will help reduce significant number of deaths in children under five due to rotaviral diarrhea. It will also help bring down the direct costs of hospitalisation for rotavirus diarrhoea.
Apart from this, India also produces the WHO-prequalified vaccine ShancholTM for cholera, which has been shown to be effective both in endemic and outbreak situations in several countries. This could help reduce both morbidity and mortality in endemic areas and during outbreaks in India. Both the rotavirus as well as the cholera vaccine are oral vaccines and could be delivered easily with other UIP vaccines.
On the whole, it will be an enormous contribution from parents towards long-term national productivity if they get their children vaccinated, hand-in-hand with the government initiatives towards increasing coverage of vaccination.
The author is visiting professor of eminence, Translational Health Science and Technology Institute, Faridabad, and former DG, Indian Council of Medical Research.
Email: nkganguly@nii.ac.in