India has just introduced three new paediatric vaccines to its Universal Immunization Program (UIP), extending protection to its children against deadly and crippling diseases (rotavirus, rubella, and polio through an injectable polio vaccine). With an estimated 27 million children born in India each year, this is an unprecedented policy leap by the new government, which is flexing its muscles. Rotavirus diarrhoea alone costs the country 300 crore rupees (£29m; €37m; $50m) each year in terms of healthcare costs. It also causes 80 000 deaths, and up to a million hospitalizations, in children each year. One episode of rotavirus treatment costs 7-8% of annual income for low income Indian families. The situation couldn’t have been more urgent.
While there are many groups in India that brand introducing new vaccines as “too much spending” for children born in a country the size of India, the UIP is the only system through which every child can hope to be reached. India has an immunization coverage rate of up to only 75%, and immediate measures are required to strengthen that. Yet given the lack of awareness and, most importantly, the lack of healthcare access, UIP is still the only way that vaccines can reach those who need it the most. And yes, for free too.
Indian policymakers recently announced that anyone spending less than 47 rupees a day in cities and 32 rupees a day in rural areas (less than a pound, euro, or US dollar) is living below the poverty line. That makes nearly 30% of India poor. Needless to say, at 47 rupees a day or 32 rupees a day (or even more), no family can be expected to vaccinate their children, and it is these low income families who lose the most children to disease. Equity has a much larger meaning in India—something that the vaccine naysayers keep forgetting.
Many groups in the country have been pushing for improved sanitation levels, which is admirable, because at the moment the levels are nowhere near what they should be. Sanitation is crucial to health, especially public health, but to say vaccines are not would be more than misguided.
First of all, the simple fact is that issues of health and sanitation are dealt with by two different arms of the government in India. The money for each is funded separately. So spending on one does not mean that the other is losing out in anyway. In its latest budget, which was announced last week, the Indian government allotted Rs 14 389 crore (£1.4bn; €1.7bn; $2.4bn) for building roads in villages, and Rs 3600 crore (£350m; €440m; $599m) for nationwide drinking water programmes—measures that are sure to have dividends in improving public health, improving healthcare access, and, yes, improving sanitation.
Secondly, deadly diseases, like rotavirus diarrhoea, cannot only be controlled with high levels of sanitation. There is a reason why the US and the UK, countries with high sanitation levels, are vaccinating their children against rotavirus infection. Indeed, 62 governments globally have the vaccine in their UIP, including countries like Rwanda and Ethiopia. And, as a recent study found, the US has saved $900m in healthcare costs after introducing two vaccines against rotavirus in the last eight years.
Thirdly, highly contagious infections like rubella—which is known to cause congenital defects in newborns, including blindness and deafness—clearly calls for more than just one mode of protection against it. In fact, we need to give all possible protection against it to mothers and children.
Like polio, vaccinating against rubella means vaccinating against disability, which often has a larger burden and places deeper social difficulties on communities. This is especially true where access to education, healthcare, and rehabilitation is sparse, like in rural areas. Likewise, rotavirus is also behind severe malnourishment in children, which leads to reduced physical and mental development during childhood. With an effective vaccine available to prevent these, there is simply no reason not to use it.
When the polio program was initiated in India back in the early 1990s, similar questions on the “need for the vaccine” were raised. Today, India has not only eliminated polio, it is joining global efforts to eradicate the disease by introducing the injectable polio vaccine, which gives lasting protection against the virus. We are essentially investing in solving the problem once and for all, as opposed to continuing to spend on it forever. It is simple and cost effective.
Apart from the introduction of the pentavalent vaccine, this is the biggest leap in India’s immunization policy in three decades. The introduction of the three paediatric vaccines has the potential to dent the child mortality rate and the less talked about, but equally important, disease and disability rates in the country.
Shalini has worked as a television health journalist for nine years, with CNN-IBN (Indian affiliate of CNN International) in India. She has covered disease outbreaks, medical breakthroughs, and has extensively reported on public health epidemics like tobacco control. At present, she is working with the Public Health Foundation of India.
Competing interests: I declare that I have read and understood the BMJ policy on declaration of interests and I have no relevant interests to declare.