Khadija HetavkarContributing Author, Rightantra Anushka MehtaCo-Founder, Rightantra Vaccination is an important tool to keep children safe from diseases by improving their immune system. Immunity is generally of two kinds - innate, which includes natural protection since birth, such as the skin which prevents entry of germs in our bodies; and adaptive, which develops throughout our lives either when exposed to a disease or through vaccination. Therefore, it is indisputable that children are more susceptible to diseases since they only possess innate immunity which easily gets overwhelmed and is unable to prevent the onset of every disease in a child. It is only through vaccination that children can be protected from diseases, which often have far-reaching consequences of a permanent nature. “Immunisation must start at birth.” To understand the necessity of vaccination it is first essential to know briefly what a vaccine is and how it works. A vaccine is a dead, or weakened version, or part of the germ that causes the disease in question. When children are exposed to a disease in the form of a vaccine, their immune system is able to build up antibodies, which are a fighting mechanism, that protect them from contracting the disease if and when they are exposed to agents of said disease. Keeping this in mind, certain vaccines such as BCG against tuberculosis, Hepatitis B and Oral Polio Vaccine are mandatorily given at birth since the infections prevented by these vaccines can cause permanent damage to a child’s body. To know more about vaccine schedules in India, click here. 1. Situation during the lockdown
If the difficult choice to pause vaccination is made due to the spread of COVID-19, world leaders are urged to intensify efforts to track unvaccinated children, so that the most vulnerable populations can be provided with measles vaccines as soon as it becomes possible to do so, in order to ensure that lives that would otherwise be lost to vaccine-preventable diseases, can be saved. Source: The American Red Cross, US Centres for Disease Control and Prevention (CDC), United Nations Children Fund (UNICEF), UN Foundation, and the World Health Organization (WHO)
One of the reasons for the reduction in vaccination is that ASHA workers who take up immunization campaigns, especially in rural India, are now credited with the task of surveillance, testing and other work during the COVID-19 crisis. This has increased the burden of duties to be performed by ASHA workers, and with the fight against COVID-19 being prioritised, immunization campaigns tend to be neglected. As per figures laid out in a study during the lockdown period, the number of vaccinated children were lower in May (837) as compared to April (1,352) in the year 2020. Further this year in April, a minimum of one lakh children did not get BCG vaccine for tuberculosis and two lakh children were not given the pentavalent and rotavirus vaccines that build immunity against meningitis, pneumonia, diphtheria and tetanus, as per the Centre’s National Health Mission. The data further reveals that there was a 34% drop in the number of measles vaccines across India between February and March. This is alarming information, considering that India has the fourth-highest number of measles cases in the world as per WHO. There has been a significant reduction in attendance to the immunization clinic for routine vaccination during the lockdown period secondary to coronavirus pandemic as compared to the previous year. The maximum reduction has been for MR vaccine and DPT booster followed by other pentavalent vaccines. Birth dose has been relatively less affected. The reduction has been more in May 2020 as compared to April 2020 because of the peaking of cases during that time as India battled with an exponential rise in COVID-19 infections. Logistic difficulties in reaching the hospital and fear of exposure to the coronavirus may have been the main factors for the reduction. Studies are needed in the future to evaluate a rise in cases of Vaccine Preventable Diseases (VPDs) including measles in order to draw conclusions about the adverse outcome of lockdown on child health. Access to immunisation suffered a huge setback across all regions of the country. At least 63% of the households surveyed by CRY, an NGO, in the northern states reported the lack of access to immunisation services, followed by West with 39%; while less than a third of the respondents reported inaccessibility to immunisation from other regions. Routine immunisation could fall further if the focus shifts heavily to the COVID-19 vaccine which would subsequently result in a host of other secondary health crises. 2. Need for Immunization at the right time Infants generally tolerate vaccines, even several different types administered at the same time, very well since as mentioned earlier, they are born with innate immunity from the womb itself. Therefore, it is essential that children receive vaccines at the appropriate age such that disease complications do not arise since vaccines do not act instantaneously and may take a few weeks or require multiple doses to prove effective. In order to further explain this, a simple analogy can be drawn to driving a car with a baby on-board. The baby is first put into a car seat even before the vehicle has been started, no driver waits until the possibility of a car crash to get the baby into some kind of protective gear. Similarly, vaccination should not be deferred as per the parents’ perception of when the child would become exposed to a disease- for example, the common notion is that a child would only be exposed to diseases when they start daycare or only when there is an outbreak and so the vaccine must be given then, however in reality, this is not ideal. The reasons for giving importance to timely vaccination are as follows,
3. How to get children vaccinated during the lockdown
4. Getting back on track: Potential Solutions Immunization in India has been hit mainly by logistical issues including but not limited to the shortage of healthcare workers, lack of availability in the customs and cargos, negative impact of the lockdown on other modes of transport like airlines and most of all the fear and unwillingness of mothers to bring their children on account of the contagious COVID-19 virus. Recognising that immunisation is an essential component of health services and needs to be continued to protect children and pregnant mothers from VPDs, the Ministry of Health and Family Welfare (MoHFW) has identified it as an essential health service. To support this service, Rotary is working closely with the Government of India to educate communities about COVID-19 to help mitigate fears that would prevent parents from ensuring their children receive routine immunisations and to help train high-risk frontline workers as routine immunisation efforts proceed. Additionally, Rotary, along with its Global Polio Eradication Initiative (GPEI) partners, supports the MoHFW in conducting National Immunisation Days (NIDs) and National and Sub-National Immunisation Days (SNIDs) across the country every year to deliver the oral polio vaccine (OPV) to India’s 174 million children. Thus far in 2020, an NID was conducted successfully in January and a subsequent SNID - initially planned for June - was held in September across 10 states including Bihar, Delhi, Gujarat, Haryana, Maharashtra, Punjab, Rajasthan, Jharkhand, West Bengal, Uttarakhand and Chandigarh. Due to the pandemic, for the first time, anganwadis across India have almost completely shut down. In cities like Mumbai and Delhi, they may not re-open for several more months. This could leave lakhs of children from low-income communities more prone to malnutrition and more vulnerable to communicable diseases since one of the key roles of an anganwadi worker is to record every pregnancy and birth in her area, draw up immunisation schedules for each child and ensure that they are vaccinated on time. The COVID-19 lockdown disrupted these schedules for over three months in Mumbai, but immunisation efforts restarted in several small health clinics in mid-June. To prepare for post-lockdown efforts and to ensure both service availability and demand, during and immediately after lockdowns, immunization programs should leverage data for better allocation of scarce resources, arrange for parents to bring their children to EPI centers and use tailored approaches targeted at known high-risk areas and geographies with the highest numbers of missed children. Further, with the gradual phased unlock, a special vaccination drive to cover up for all the vaccination lapses in the community is a must, else we might land up into epidemics of VPDs in near future. There is also a need to intensify outreach services of ASHA workers and government hospitals, especially for immunization. It has to be done now and not left for the future. Please note that this is NOT legal advice but the legal opinion of the author and is for informational purposes only.
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