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Immunization

Introduction

 

Immunization is one of the most cost-effective interventions to prevent the suffering that comes from avoidable sickness, disability and death. The benefits of immunization are not restricted to improvements in health and life expectancy but also have social and economic impact at both community and national levels.

An effective, evenly targeted immunization programme and its ability to reduce the burden of vaccine-preventable diseases (VPDs) will greatly contribute to achieving the Millennium Development Goal 4 (MDG4) that aims for a two-third reduction in child mortality by 2015.
 
India has the largest number of births in the world – more than 26 million a year – and also accounts for more than 20 per cent of child mortality worldwide. Nine million immunization sessions are organized each year to target these infants and 30 million pregnant women for routine immunization (RI).

Though some improvement has taken place in the past few years, the country still accounts for the largest number of children who are not immunized: 7.4 million. 
 
Some of the challenges to immunization include limited capacities of staff, particularly in poor-performing states and at the field level, and gaps in key areas such as predicting demand, logistics and cold chain management, which result in high wastage rates.

India also still lacks a robust system to track vaccine-preventable diseases. Vaccination coverage varies considerably from state to state, with the lowest rates in India’s large central states. Differences in uptake are geographical, regional, rural-urban, poor-rich and gender-related. On average, girls receive fewer immunizations than boys and higher birth order infants have lower vaccination coverage.

 


Big Picture

  • Nine million routine immunization (RI) sessions are organized in India each year.
  • These target 26 million children and 30 million pregnant women.
  • The sessions are served through a massive 27,000 cold chain stores.
  • The national average for full immunization is 62 per cent(NFHS 3)
  • India has biggest number of children not immunized. 
  • Each National Immunization Day, 172 million children are immunized for polio.
  • India’s polio vaccination campaigns cover 800 million children a year. 
  • A two-year Measles Rubella campaign to ensure children receive the second measles vaccination is targeting 410 million children.
  • Rural children are least likely to have complete vaccination, and this inequity is most pronounced in states like Madhya Pradesh, Rajasthan, Chhattisgarh, Jharkhand, and Uttar Pradesh.
  • The highest inequity between rural and urban areas exists in Kerala, followed by Chhattisgarh and Haryana.

UNICEF In Action

Partnering with government and others on immunization
 
UNICEF works closely with the Indian government on its Universal Immunization Programme (UIP). Introduced in 1985, the UIP has made great progress in expanding Routine Immunization (RI) coverage across the country, and today, it is one of the largest programmes of its kind in the world.

The UIP is an integral component of the government’s flagship Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) approach, and underpinning the approach is an unprecedented commitment to protect every eligible child from vaccine-preventable diseases through immunization. Immunization is also a major key to India achieving its commitment to reach Millennium Development Goals 4 and 5, which focus on maternal and child survival.
 
The Universal Immunization Programme supports national and state governments to boost routine immunization (RI) and supplementary immunization, including for polio, measles, and Japanese encephalitis. It also supports the introduction of new vaccines such as Pentavalent, Hepatitis B and rubella.

UNICEF’s role in UIP is to take the lead in fine-grained planning, cold chain logistics and Advocacy and Communication. It works with programme partners to build capacity and monitor and evaluate programmes through the country office in New Delhi and its 15 field offices. 
 
UNICEF also has responsibility for coordinating the various India-based partners and leading meetings between the Ministry of Health and Family Welfare (MoHFW) and partners like the World Health Organization (WHO), Bill and Melinda Gates Foundation, PATH, MCHIP, and UNOPS. As an alliance partner, UNICEF supports GAVI through proposal development, the Annual Progress Report, and implementation. UNICEF is an active member of the National Technical Advisory Group, the Immunization Action Group, and the Polio Expert Advisory Group to support policy development. 
 
In 2012, a national communication strategic and operational guideline was developed by MoHFW with UNICEF support to guide the government in developing state-relevant communication plan social research on the reasons for missed and partially immunized children indicate that better communication and social mobilization interventions to address demand-side barriers to immunization are required. 
 
UNICEF, along with the World Health Organization (WHO), was a major partner in drafting the government’s comprehensive Multiyear Plan for immunization 2013-17 (CMYP), which provides a framework to achieve the UIP. Among other things, the plan seeks out technological innovations in areas like vaccine management as spelled out in the National Vaccine Policy 2011, and addresses ways to reduce gaps in immunization coverage.

The Government of India and UNICEF are committed to reducing inequities in coverage and ensuring immunization reaches every child in the country. 
 
UNICEF’s roles and areas of focus in the India’s immunization supply chain
 
In order to push through roadblocks and ensure immunization centres are equipped and capable, UNICEF:
 
Provided technical support to establish national centres  for cold chain logistics  like the (National Cold Chain and Training Centre) NCCTC and National Cold Chain and Vaccine Management Resource Center (NCCVMRC) is continuing its work by helping build the centres’ capacity to act as effectively resource centres for the country. Read More 
 
Supports the Ministry of Health and Family Welfare (MOHFW) to formulate strategies and policies to strengthen immunization supply chains, including the cold chain through studies.
 
Takes responsibility the development of the National Cold Chain and Vaccine Logistics Action Plan.

Acts as the key agency for National Cold Chain Assessment and Effective Vaccine Management Assessment followed by improvement plan development facilitated by MOHFW.

In GAVI-HSS (Global Alliance for Vaccine and Immunization) focus on cold chain management. Developed and provides technical support to the National Cold Chain Management Information System (NCCMIS) for the MOHFW.

Served as the key agency for developing and running the Effective Cold Chain and Vaccine Management Course for programme managers and a training module for cold chain handlers.