By Ritika Sakhuja
New Delhi: Vaccines play a crucial role in preventing life-threatening diseases, especially in children as their immune system isn’t fully developed. Timely immunisation is essential for children to protect them from life-threatening diseases that vaccines can easily prevent. Thus, it is crucial for parents, guardians and childcare workers to understand the consequences and methods to rectify the declining rates of childhood vaccinations. Children’s vaccinations are as important as breast milk and a nutritious diet for their growth and development.
The COVID-19 pandemic caused a severe decline in child immunisation rates. According to the WHO and UNICEF’s 2022 report on worldwide childhood immunisation coverage, 25 million children missed out on essential vaccination in 2021, which is two million more than in 2020, 5.9 million more than in 2019 and the highest number since 2009.
Decline in immunisation rates due to COVID-19
As per India’s National Health Mission, more than 2,00,000 children missed out on essential vaccines in March 2020 during the lockdown imposed due to the COVID-19 pandemic. Most of these children reside in societies with poor access to healthcare where vaccination rates are already low.
Speaking to ETHealthworld on World Immunisation Day about the immunisation gap during the pandemic, Dr Daya Krishan Mangal, Senior Associate, Department of International Health, John Hopkins Bloomberg School of Public Health, John Hopkins University said, “During the COVID-19 pandemic, hospitals could only provide emergency and COVID related services. So, regular services like immunisation and child healthcare were at a standstill. Grassroots-level staff like aanganwadi workers, Accredited Social Health Activist (ASHA) workers, and Auxillary Nurse Midwife (ANM), had to allocate more time in COVID related services. Hence, routine healthcare services were adversely affected.”
Further adding to it Dr Rajath Athreya, Senior Consultant and HOD Paediatrics and Neonatology, Sakra World Hospital, said, “Universal immunisation against vaccine-preventable diseases is one of the most powerful tools in reducing infant and childhood mortality and takes us towards achieving our Sustainable Development Goals (SDG). The gains that have been made over several decades can come undone if there is a slack in vaccination coverage.”
The lapse in immunisation can lead to dire consequences that can result in disease outbreaks. “We have seen cases of measles and diphtheria resurface. There was certainly an increase in cases of bacterial pneumonia too. Post-pandemic as children returned to schools, we saw a huge spike in repeated febrile illnesses and respiratory infections. This led to further delays and a catch-up of routine immunisations,” shared Dr Athreya.
Amends initiated to fast-track essential vaccinations
To bridge the gap in childhood vaccinations, the Indian Academy of Paediatrics (IAP) published detailed guidelines in 2020, covering necessary aspects in line with COVID-19 norms. These guidelines included mandatory COVID precautions, vaccinations in ‘red zones’ and buffer zones, prioritising primary vaccines, ‘catch-up’ schedules, measures to address logistics and supply chain issues, and measures to create public awareness. The Government of India also launched Mission Indradhanush 3.0 in February 2021 which had a provision to focus on catch-up vaccinations. Additionally, outreach vaccine services were arranged by several state governments.
After the lockdown was lifted, regular healthcare services started going back to normal, immunisation rates have slowly picked up, and are predicted to reach pre-covid levels soon enough.
Applauding India’s immunisation practices, Dr Mangal, said, “Childhood immunisation programme is ongoing in the country since 1970. Initiatives like the Extended Programme of Immunisation (EPI), and the Universal Immunisation Programme (UIP) evolved over the years and have matured now. In rural and urban areas, immunisation services are very well organised as per COVID norms. Adverse reactions are also regularly monitored.”
To take action at an individual level, Dr S Indu Nair, Senior Consultant, Neonatology & Paediatrics, Kinder Women’s and Fertility Centre, Bengaluru, recommends, “For parents who have missed out on the scheduled dose of vaccinations, catch-up vaccinations can be administered. Multiple vaccines can be administered in the same session without any adverse effects. One can use the shortest acceptable interval between two doses of the same vaccine. Booster doses can also be given at the earliest possible date.”
Preparing for future adversities
To prepare India for future events that could lead to an elongated gap in immunisation, Dr Mangal encourages the Indian healthcare system to be proactive and advises, “In our healthcare system, there is not adequate focus on public health function. In case of a natural disaster or another pandemic, we need to have a contingency plan designed in advance, to ensure that our normal services are not adversely affected, and the pandemic is also managed. We need to thoroughly train people for public health practice, and we need to have a contingency plan stating which workers will be allocated or delegated for which task. This is the need of the hour.”
India has a good track record with immunisation programmes, but extra efforts may be needed to bridge the gap of missed vaccinations, especially for children belonging to poorer sections of society, regions with poor healthcare coverage and children of migrant workers. To ensure routine healthcare services, especially immunisation programmes operate smoothly in case of future pandemics and disease outbreaks, the Indian healthcare system must diligently prepare for adversities ahead of time.