Striking a balance: Resuming routine immunization in India

June 9, 2020 by Dr. Satyabrata Routray

As the COVID-19 pandemic continues, we must adapt immunization services to protect Indian children from deadly, vaccine-preventable illnesses.

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Women cover their faces and follow physical distancing measures as they wait outside a community and outreach immunization session site in the state of Bihar in India. Photo: PATH.

Some 26 million children are born in India every year—more than any other country in the world. Without vaccination, each infant is susceptible to a host of life-threatening diseases: polio, rubella, measles, pertussis, and diphtheria, among others. In 2005, fewer than 45 percent of Indian babies received all their basic vaccinations. A decade later, thanks to improved immunization services across the country, that number had jumped to 62 percent.

But that progress is threatened by the novel coronavirus. The pandemic response has temporarily taken over India’s health system, leaving state governments overwhelmed. Many frontline health workers who once delivered routine immunization services are now focused on COVID-19 containment efforts.

This diversion of resources deprives communities of essential services and, over time, will lead to a buildup of unimmunized or partially immunized children. This is a critical situation that may trigger outbreaks of vaccine-preventable diseases—some of which can be more deadly and cause greater harm than COVID-19 itself.

Since the COVID-19 outbreak in India, different states have adopted different approaches toward immunization. While some maintain fixed sites and institutions to deliver vaccinations, others have temporarily put these services on hold.

As the nationwide lockdown gradually lifts, state governments are planning to resume immunization service delivery. With the danger of vaccine-preventable disease outbreaks looming large, health systems need to quickly adopt a middle path to resume basic immunization services and protect more Indian children.

Catching up at Village Health and Nutrition Days

India’s Ministry of Health has provided guidelines to reestablish and restart outreach sessions -with special precautions. However, this is not sufficient. With the cohort of left-outs and dropouts increasing by the day, special catch-up immunization should be undertaken at Village Health and Nutrition Days. These are traditional and regularly occurring community-level meetings, often used for organizing immunization and other community health activities.

Catch-up immunization will require tracking of mother-child pairs, listing of children due for immunization, administration of all primary and secondary vaccine doses using the updated due lists, and targeted social mobilization. This effort will demand meticulous planning and well-coordinated outreach sessions that feature supportive supervision and monitoring to ensure safe, high-quality vaccination.

Confidence-building measures through effective communication will be critical for communities to feel safe and secure when they come forward to accept vaccination. Vaccine chain management, including alternate vaccine delivery, immunization safety, and waste management, must also be ramped up to face the mounting backlog of unimmunized children.

PATH advances routine immunization

PATH has two decades of experience in advancing Japanese encephalitis (JE) immunization services in India. The country’s strategy of conducting catch-up campaigns in high-burden, high-priority districts, followed by routine immunizations, was recommended by the World Health Organization. We are supporting the state government of Bihar to resume a wide-ranging JE vaccination campaign that was delayed by the COVID-19 outbreak.

In the midst of the pandemic, our field teams are monitoring the Village Health and Nutrition Days for routine immunization activity. We are ensuring that new guidelines are followed and that health workers and beneficiaries take all precautions and protective measures. These include maintaining physical distance and using triple-layered surgical masks, gloves, and hand sanitizers at session sites.

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The PATH field team monitors a routine immunization session at a Village Health and Nutrition Day in the state of Bihar in India. Photo: PATH.

A special communication plan to address community apprehension and safety issues will go a long way in tackling some of the demand-side challenges for routine immunization. This will help instill confidence and thus improve immunization coverage.

With COVID-19 becoming a way of life, all health care delivery, including immunization services, must resume to ensure that the precious gains made in reducing India’s childhood disease burden over the last few decades are not lost.