Background of immunization program in India
The success of smallpox eradication in the 70s brought attention to the immunization program globally as well as in India. The Expanded Program on Immunization (EPI), a program for immunizing all children during the first year of life with DPT, OPV, BCG and typhoid–paratyphoid fever vaccines was launched in 1978. In 1985, the name of EPI was changed to the Universal Immunization Program (UIP) .The stated objectives of UIP are to:
- Rapidly increase immunization coverage
- Improve the quality of services
- Establish a reliable cold chain system to the health facility level
- Introduce a district-wise system for monitoring of performance
- Achieve self-sufficiency in vaccine production
India’s Universal Immunization Programme is one of the largest of its kind in the world, in terms of quantity of vaccine used, number of beneficiaries reached out to, number of immunization sessions organized and the geographical spread and diversity of areas covered. It caters to nearly 27 million infants and 30 million pregnant women annually free of cost. There is a strong political commitment in the country for achieving universal immunization coverage and for the eradication and elimination of the targeted diseases.
As a key element of the national child survival strategy, UIP has contributed significantly to reducing mortality and morbidity due to vaccine-preventable diseases and the infant mortality rate over the last decade. While surveillance information for specific VPDs is limited, the steady fall of IMR from 123 to 50 deaths per 1000 live-births does in part reflect the impact of the UIP.
The goal of the current comprehensive multiyear plan for 2013-2017 is to reduce mortality and morbidity due to vaccine preventable diseases through high quality immunization programs. Its key objectives are to:
- Improve program service delivery for equitable and efficient immunization services in all districts;
- Increase demand and reduce barriers for people to access immunization services through improved advocacy at all levels and social mobilization;
- Strengthen and maintain robust surveillance system for Vaccine Preventable Diseases (VPDs) and Adverse Events Following Immunization (AEFI);
- Introduce and expand the use of new and underutilized vaccines and technology in UIP;
- Strengthen health system for the immunization program; and
- Contribute to global polio eradication and the elimination of measles, maternal and neonatal tetanus.
How the AEFI unit contributes to the larger UIP goal
Immunization is among the most successful and cost-effective public health interventions. It has led to the global eradication of smallpox as well as the elimination of poliomyelitis in many regions of the world. As per WHO, immunization currently averts an estimated 2 to 3 million deaths from diphtheria, tetanus, pertussis (whooping cough), and measles every year in all age groups.
The goal of immunization is to protect the individual and the public from VPDs. Although modern vaccines are safe, no vaccine is entirely without risk, and adverse reactions will occasionally occur following immunization. Adverse Events Following Immunization are usually mild and rarely life threatening. The majority of serious events reported after immunization are mere coincidences, and there is no causal relationship between the vaccine and the reported event. But sometimes these are caused by the vaccine or by an error in the administration or handling of the vaccine. Irrespective of the cause, when AEFIs cause anxiety, people may refuse further immunization of their children, making the children susceptible to disabling and life-threatening VPDs.
An effective and responsive AEFI surveillance system will ultimately lead to enhancing the confidence of the community in vaccines and motivate parents for full immunization. Such a system will provide accurate, trustworthy and timely information to them on the safety of vaccines. The AEFI unit contributes to system preparedness for handling new vaccine introduction by ensuring timely reporting, investigation and assessment of reported AEFIs. The unit aims to conduct pilot and operations research on vaccine safety so as to further advance the knowledge base on vaccine safety in the country.
How the E to P unit contributes to the larger UIP goal
The Evidence to Policy unit at ITSU works as a vital link for translating scientific evidence into immunization policy. The unit collates and synthesizes evidence to inform the introduction of new or underutilized vaccines and changes to the Universal Immunization Programme. As part of this work, the unit supports evidence generation on epidemiology of Vaccine Preventable Diseases and programmatic aspects of UIP such as program performance and impact evaluation. In its capacity as the secretariat to the National Technical Advisory Group on Immunization (NTAGI), the unit has worked to strengthen the immunization policy formulation process at the NTAGI and its Standing Technical Sub-Committee (STSC). Recommendations from the NTAGI help inform decision making for immunization policy within the UIP. An active and functional secretariat has provided a vital boost to immunization policy making and accelerated several immunization program decisions such as the nationwide roll-out of the Pentavalent vaccine and the introduction of vaccines against Rotavirus, IPV and Rubella in the UIP.
How the PO&ME unit contributes to the larger UIP goal
The Program Operation, Monitoring and Evaluation team at ITSU provides strategic support to the Immunization division for monitoring program performance in delivery of immunization services. This includes a review of routine program data, performance indicators, as well as development of a strategic M&E framework for the Universal Immunization Programme. The unit works under the guidance of MoHFW and collaborates with state officials and immunization partners. To achieve the goal of >90% full immunization coverage (FIC) the unit focuses on developing Immunization Coverage Improvement Plans for the four high priority states (UP, MP, Rajasthan and Bihar).
The PO&ME pillar at ITSU consists of a Senior Advisor, Manager (PO&ME), Manager (Data Operations), State Managers each for the four high priority states (Uttar Pradesh, Madhya Pradesh, Rajasthan and Bihar), and a data analysis team including a GIS expert. In addition, Technical Officers are deputed in the Immunization Division of the Ministry of Health and Family Welfare for continuous support to the immunization program. The unit has also been supporting MoHFW by conducting regular monitoring through field visits and analysis of data collected from the field.
How the STRATEGIC COMMUNCIATION unit contributes to the larger UIP goal
At the national level, the ITSU is providing technical support to UIP for strengthening, revitalization and successful implementation of RI. The mandate of the Strategic Communication Unit is to act as a catalyst in improving the demand for RI services and achieve full immunization coverage by supporting states to develop and implement a multi-pronged BCC strategy and operational plan. Implementation of this plan, with an emphasis on high-focus states, will increase awareness of parents and caregivers (irrespective of their level of literacy), who are the primary target audiences for social and behavior change communication, to clearly comprehend the benefits of immunization, reflecting in an enhanced demand for immunization services.
How the STRATEGIC PLANNING AND SYSTEM DESIGN unit contributes to the larger UIP goal
The Strategic Planning and System Design (SP&SD) unit of ITSU works with the Ministry of Health and other stakeholders to address the design challenges in different aspects of the immunization program such as financing, infrastructure, service delivery, supplies and capacity building. The unit provides research, analysis and advice for comprehensive multi-year planning to ensure efficient delivery and equitable access to vaccines to all children across the country, irrespective of geographical location, gender and socio-economic status.
This cross functional unit also assists MoHFW in developing operational guidelines, accountability framework, planning the roll-out of new vaccines in the program and conceptualizing and piloting innovative operational strategies.
How the VACCINE LOGISTIC AND COLD CHAIN MANAGEMENT unit contributes to the larger UIP goal
In line with ITSU’s commitment to strengthen India’s UIP, the VLCCM team aims to improve the performance of India’s immunization supply chain. Delivering vaccines in adequate quantities and in quality conditions to the most peripheral health facilities is an important requirement for any national immunization program. The VLCCM team is dedicated to ensuring that India is able to deliver vaccines effectively to each and every child by targeting efforts towards improving storage facilities, vaccine distribution, and human resources capacity building.