50 years of immunization in India: progress and future

Area of Science:

• Public Health
• Immunology
• Epidemiology

Background:

• Immunization is a cost-effective intervention crucial for reducing under-five mortality.
• Despite India's role as a vaccine producer, a significant number of children remain unvaccinated, contributing to over 5 lakh annual deaths from vaccine-preventable diseases (VPDs).

Observation:

• Challenges include India's large, growing population, geographical diversity, hard-to-reach areas, low awareness, inadequate health services, weak supervision, poor micro-planning, lack of inter-sectoral coordination, and insufficient VPD surveillance.
• A substantial portion of the world's unimmunized children reside in India.

Findings:

• Remedial measures proposed include strengthening political will, enhancing Information, Education, and Communication (IEC) for increased demand, expanding routine immunization delivery points, and improving program monitoring.
• Shifting program objectives towards meaningful VPD reduction and demand creation, rather than just coverage, is recommended.
• Upgrading Adverse Event Following Immunization (AEFI) and post-marketing surveillance systems, strengthening regulatory capacity, and restructuring the Expanded Program on Immunization (EPI) with new vaccines are vital.

Implications:

• Implementing these strategies can significantly improve India's immunization status and reduce VPD burden.
• An efficient integrated disease surveillance system can be built upon a successful Acute Flaccid Paralysis (AFP) surveillance network.
• Establishing clear guidelines for new vaccine introduction and a dedicated public health department are critical for future success.