Overcoming barriers to immunization in India requires community outreach

Recent surveys have found that nationally, only 61% of children aged 12 months to 23 months have received all 6 vaccines included in India’s Universal Immunization Program (UIP). Some surveys have reported even lower figures, especially in specific regions of the country.

Key Point: Bringing immunization delivery points into the community and providing better monitoring of vaccine-preventable diseases and immunizations could help raise the routine immunization rate in India. The vast majority of unimmunized children are in 6 states, with half of them in Uttar Pradesh alone. Physicians can play a leadership role by educating parents and government officials.

The UIP program was more successful in its first decade, which ended in 1995. At that time, immunization levels were estimated at 70% to 85%. The problem is particularly serious in 6 states that contribute to 80% of the 8.1 million unimmunized children in India. More than half of these children are in Uttar Pradesh and Bihar.

In one study conducted in 225 villages in Uttar Pradesh, one of the major barriers to immunization was[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] education: family members, especially elders, often did not believe in vaccination. Fewer than 20% of women surveyed said that they thought vaccinations could protect against whooping cough, tuberculosis, and diphtheria. Parental opposition also centers on fears of potential side effects, and there is a lack of knowledge about where to get vaccinated.

Other challenges to universal routine immunization are systemic, including shortages of supplies, lack of training, vacant staff positions, lack of supervision and monitoring, and lack of coordination.

Finally, there is a weak surveillance system for vaccine-preventable diseases in India, leading to a misperception by parents and caregivers that these diseases aren’t a public health problem. With no diagnostic tools for some diseases, and a lack of baseline surveillance data, it’s difficult to monitor the effectiveness of vaccination, Vipin M. Vashishtha, MD, FIAP, wrote in his Indian Pediatrics Perspectives article focusing on this topic. Vashishtha is director and consultant pediatrician, Mangla Hospital & Research Center, Shakti Chowk, Bijnor, India.

The solution lies in “bringing immunization closer to the communities,” he wrote, emphasizing the importance of district authorities being involved. In rural and remote areas, Vashishtha recommends more delivery points for immunization, and in urban areas, especially slums, immunization booths could be utilized. Discussions are ongoing about making immunization a prerequisite to be admitted to school—something that would have to be accomplished by legislation.

UNICEF, the World Health Organization, and other partners called for a “Reaching Every District” approach in 2002, which has been successful wherever introduced. India could utilize the same approach, calling it “Reaching Every Community,” wrote Vashishtha. “Developments in vaccines and immunization provide us with tremendous opportunities to impact the health of our populations, particularly the health of poor and marginalized communities who carry a disproportionate burden of disease,” he concluded. “To be successful in the future, we must tackle the technical, logistics, political and social obstacles that are hampering progress in reaching every child with available vaccines.”

Source: Vashishtha VM. Status of immunization and need for intensification of routine immunization in India. Indian Pediatr. 2012;49(5):357-361.

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