Vaccination in India

Vaccine Hesitancy

India launched the world’s largest Covid-19 vaccination program in 2021. Despite logistical hiccups, India surpassed the USA in administering the maximum number of doses in the world. However, only 4 per cent of India’s population is fully vaccinated compared to 45 per cent in the US and 48 per cent in the UK. The abysmal low percentage of vaccinated is much attributed to the demand-side barriers like vaccine hesitancy which is less debated. Even before the emergence of Covid-19, WHO recognised vaccine hesitancy as one of the 10 leading threats to global health. WHO defines ‘Vaccine Hesitancy’ as a “delay in acceptance or refusal of vaccination despite the availability of vaccination services.”

Challenges leading to vaccine hesitancy

• Lack of trust in the safety and efficacy of the newly developed vaccines
• Fear of side-effects
• Rumours about infertility and death after taking the vaccine
• The inconvenience of registration/booking slots,
• Low-risk perception from Covid-19
• Absence of incentives for rural and urban poor
• High Price of vaccination
• Religious beliefs
• Reluctant to take vaccination highest being in Tamil Nadu (40 %)

Steps to be taken

• A target-based approach focusing on the needs and concerns of individuals, groups, and communities.
• Pro -Vaccine campaigns to curb misinformation through social media, newspapers, TV etc.
• Improving accessibility
• Active involvement of local influencers, religious leaders, traditional healers, local NGOs, local doctors, panchayat heads, etc., may encourage vaccine uptake.
• Indelible ink, generally used in elections, can be applied on the fingers of vaccinated people. Such a campaign will create a sense of nation-building and can encourage participation.
• Given that a large proportion of the rural population works as daily wagers and fears losing a day’s income due to vaccination, workers may be given one-day MGNREGA wage for taking the shot.
• Small incentives, (1kg rice and pulses, 1 litre of cooking oil, etc.) can be given to compensate people for the time and money they spend to get the vaccine.
• Behaviour innovations like announcing prize money (lucky draw) amongst the people vaccinated in selected centres with low uptake can boost the vaccination rate.

Achieving the ambitious target to vaccinate 300 million individuals by September 2021, requires a collaborative effort from relevant stakeholders to prevent the potential third wave. Going forward, India’s ability to achieve its objectives of vaccination campaigns will depend on healthcare capacity, overcoming vaccine hesitancy and misinformation, and ensuring an equitable distribution of vaccines.

Universal Immunization Program

• Immunization Program in India was introduced in 1978 as the ‘Expanded Program for Immunization’. (EPI)
• In 1985, this was modified as the ‘Universal Immunization Program’ to cover all districts in the country by 1989-90

Vaccines Covered

• BCG to infants to protect them from tubercular meningitis and TB.
• Oral Polio Vaccine is given at birth called zero dose and three doses are given at 6, 10 and 14 weeks.
• Hepatitis B vaccine
• Pentavalent Vaccine to protect children from Diphtheria, Tetanus, Pertussis, Haemophilus influenza type b infection and Hepatitis B.
• Rotavirus Vaccine against rotavirus diarrhoea. It is given in select states.
• Pneumococcal Conjugate Vaccine against disease caused by the bacterium Streptococcus pneumonia.
• Measles/ MR vaccine
• In 2014 Rubella was introduced
• Japanese encephalitis vaccine.

EVIN (Electronic Vaccine Intelligence Network)

It is an indigenously developed technology system that digitizes vaccine stocks and monitors the temperature of the cold chain through a smartphone app.

Objective

• It aims to support the GoI’s Universal Immunisation Program by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in these states.
• The technological innovation is implemented by the United Nations Development Program (UNDP).

Intensified Mission Indradhanush 3.0 (IMI 3.0)

• India conducts one of the world’s largest vaccination programs (Universal Immunisation Program (UIP)) catering to the vaccination needs of children and pregnant women against 12 Vaccine-Preventable Diseases. However, some children and pregnant women get missed out on the network each year.
• IMI 3.0 aims to reach out to these unreached populations with all the available vaccines under UIP.
• It will have 2 rounds starting in February and March 2021 and will be conducted in pre-identified 250 districts/urban areas across 29 States/UT in the country.
• The focus of IMI 3.0 will be on children and pregnant women who have missed their vaccine doses during the COVID-19 pandemic. Beneficiaries from migration and hard-to-reach areas will be targeted as they missed their vaccine doses during the COVID-19 pandemic.
• Districts across the country have been classified: 313 as low risk, 152 as medium risk and 250 as high-risk districts.

Objectives

• Achieve 90% full immunisation coverage in all districts and sustain the coverage through immunisation system strengthening.
• Strengthen the existing Universal Immunisation Program for improving quality and sustaining gains achieved through Mission Indradhanush
• Implement intensified campaigns to boost coverage in low-performing areas and among vulnerable populations. Increase demand and build vaccine confidence for vaccination.