“Mission Indradhanush is a unique vaccination program to protect children against life-threatening diseases”
“Mission Indradhanush is a unique vaccination program to protect children against life-threatening diseases”
The Union government’s mega project Mission Indradhanush aims at providing immunization against life-threatening diseases such as diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B, meningitis and pneumonia due to haemophilus influenza type B, at a large scale. But is the Mission successful in achieving its target of universal immunization?
Dr Rakesh Kumar, Joint Secretary, Ministry of Health and Family Welfare, Govt of India spoke at length to Amresh Kumar Tiwary, Editor-in-Chief, Double Helical about this extraordinary programme. Excerpts of the interview…
What exactly is Mission Indradhanush?
The Ministry of Health and Family Welfare, Govt. of India launched Mission Indradhanush on 25 December 2014 as a special drive to vaccinate all partially vaccinated or unvaccinated children under Universal Immunization Programme. The mission focuses on interventions to improve full immunization coverage in India from 65% in 2014 to at least 90% children in the next five years. Mission Indradhanush is providing immunization against life-threatening diseases (diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B, meningitis and pneumonia due to haemophilus influenza type B). In addition, vaccination against Japanese Encephalitis is also being provided in selected endemic districts of the country.
Could you tell us why Mission Indradhanush is needed to be implemented at such a large scale?
Basically, the Universal Immunization Programme has been operational in India since 1978 and is expected to provide vaccines to 2.7 crore children annually. But, despite being operational for the past more than 30 years, only 65% children in India receive all vaccines during their first year of life. The coverage has increased by only 4% in the last 4 years i.e. at the rate of 1% per year. We target to increase this coverage by 4% every year.
But isn’t there a lack of awareness about such mega project, despite all the efforts being made by the government of India?
Oh yes, recent estimates show that, annually, nearly 89 lakh children in the country do not receive all vaccines that are available under the universal immunization programme – this is the highest number of unvaccinated children in any country in the world. Of these 89 lakh children, nearly 17 lakh do not receive any vaccination while 72 lakh receive some but not all vaccinations that are provided under the programme, despite the fact that these vaccinations are available free of cost. These unvaccinated or partially vaccinated children are most susceptible to childhood diseases, disability and run 3-6 times higher risk of death as compared to fully immunized children.
Evaluations have indicated that the major reasons for all children not receiving the vaccines are lack of awareness amongst the parents about the benefits of vaccination, a fear of some side effects of the vaccines and sometimes non-availability of vaccines or vaccinators during vaccination sessions.
What is the present stage of Mission Indradhanush? How is it being implemented?
The focus was on 201 high focus districts with largest number of partially vaccinated and unvaccinated children during the first phase. These districts account for nearly 50% of the total unvaccinated or partially unvaccinated children in the country. During Phase 2 the focus was on selected 352 districts.
Across the country (73 repeated districts of Phase-1). Under this Mission, the following areas were targeted for focused interventions –
Areas with vacant sub-centers: No auxiliary nurse midwife (ANM) posted for more than three months. Villages/areas with three or more consecutive missed routine immunization (RI) sessions: ANMs on long leave or other similar reasons. High risk areas (HRAs) identified by the polio eradication programme. These include populations living in areas such as urban slums with migration, nomadic sites, brick kilns, construction sites, other migrant settlements (fisherman villages, riverine areas with shifting populations), underserved and hard to reach populations (forested and tribal populations, hilly areas etc.). Areas with low RI coverage, identified through measles outbreaks, cases of diphtheria and neonatal tetanus in last two years. Small villages, hamlets, dhanis, purbas, basas (field huts), etc., clubbed with another village for RI sessions and not having independent RI sessions.
How would you rate the success of Mission Indradhanush?
We have done meticulous planning of campaigns/sessions at all levels using polio learning. Effective communication and social mobilization efforts have been carried out. There has been intensive training of the health officials and frontline workers, coupled with establishing accountability framework through task forces at district, state and national level to oversee the program implementation. Under this Mission, the government is ensuring that vaccines are made available for all children, even in the remotest corner of the country.
How is this mission tackling life-threatening diseases?
Four special intensified immunization drives are being conducted on the 7th of every month, starting from April 2015 covering all children less than two years of age and pregnant women for tetanus toxoid vaccine. Four special intensified immunization drives are being conducted, for these groups.
What is the nation-wide progress of this Mission?
As per the data available, during both the phases of Mission Indradhanush, 20 lakh sessions were held, during which 3.56 crore vaccines were administered to the children and pregnant women. During these immunization rounds 1.42 crore children were vaccinated and more than 37 lakh children were fully vaccinated. Also, about 37 lakh pregnant women were vaccinated with tetanus toxoid vaccine during these four rounds. Via Mission Indradhanush, the aim is to reach out to the areas where we have yet not been able to fully vaccinate all the children. These are also the areas where basic health facilities have not yet reached to the children. By vaccinating the children, we may be able to protect them against the vaccine preventable diseases but the same child may die of diarrhea due to lack of health facilities. To combat this problem, zinc tablets and ORS packets were freely distributed to all the children to protect them against diarrhea. About 30 lakh ORS packets and 97 lakh zinc tablets were distributed to the children during these four rounds of Mission Indradhanush. Also, about 40 lakh doses of Vitamin A were administered to children.