There needs to be an adequate stock of vaccines, there needs to be an efficient supply chain to fight back rotavirus in the country. Though, as always, the key factor will remain the financial push, writes NK GANGUlY
First, the good news: India is making a dent in its child mortality figures and Millennium Development Goals. It is being congratulated for eliminating polio — and rightfully so. The Government should also be lauded for its decision to roll out four more vaccines in the Universal Immunisation Programme, confident in the knowledge that this will save lives. These include an injectable polio vaccine (to allow India to take the next step towards eradicating the disease completely), as well as vaccines against rubella, rotavirus and Japanese Encephalitis.
This is progress, but a glance at the scale of the problem shows how far we have still to go. Even as the world marvels at our high demographic dividend, we need to realise, how our policies are putting that very dividend — India’s youth — at risk. Every year, the United Nations Children’s Fund estimates that immunisation saves the lives of four lakh children under the age of five from preventable deaths — but another 75 lakh children miss out on those benefits.
An estimated 14 lakh children under the age of five die every year in the country. That so many of these deaths are preventable is what is unconscionable. In fact, pneumonia and diarrhoea are amongst the biggest killers of our children. Pneumonia kills nearly three lakh children every year, while diarrhoea kills more than 1.4 lakh children every year.
By some estimates, an Indian child dies of rotavirus-induced severe diarrhoea every 10 minutes. The disease also results in up to 10 lakh children being hospitalised. This year, the National Immunisation Technical Advisory Group recommended that an indigenous rotavirus vaccine be rolled out nationally, but it’s not nearly soon enough. Indeed, as we’ve seen with the Pentavalent vaccine, time isn’t on our side. After all, it’s been six years since the NITAG on Immunisation recommended a national roll-out of the pentavalent vaccine, and it’s still rolled out only in nine States. That number should shoot up to 20 by next year, seven years after the final go-ahead.
The solution is glaringly simple, though as always, the key factor will remain the financial push. There needs to be an adequate stock of vaccines, there needs to be an efficient supply chain, and we may want to come back to the issue of lack of cold storage facilities at a later date. Common sense, but it nonetheless needs financial commitment. For the duration of the polio campaign, after all, the Government and public-private partnerships contributed more than Rs12,000 crore.
And yet, healthcare allocation is at a paltry 1.2 to 1.4 per cent of the Union Budget — one of the world’s lowest. The Government’s own data from the Economic Survey shows that it spends just 4.1 per cent of its gross domestic product on health issues. That’s the lowest of the BRICS bloc — does India really deserve a seat at that tableIJ Even Bangladesh does better. It’s not just the stark loss of life, but a loss of labour productivity — Rotavirus, according to some reports, imposes an economic burden of more than 300 crore rupees on India, every year.
A tried and tested route to success is the use of new, improved diagnostics, drugs and vaccines. There is no doubt that vaccines are a cost-effective health solution. Economic benefits after all include labour productivity, as well as treatment cost savings. A recent study put the estimated cost of rotavirus-induced diarrhoea outpatient visits and hospitalisation at more than Rs10 billion — more than double the Rs4.7 billion it would cost to roll-out the rotavirus immunisation programme. Research also suggests that by introducing and scaling up vaccination against the rotavirus as well as Hib and pneumococcal viruses that cause pneumonia, India could save $5.7 billion (more than Rs313 billion) each year. These aren’t just abstract figures, but signify real faces, and real children.
India also needs a comprehensive approach — including in improving sources of drinking water, pushing for sanitation, and ending open defecation. More than 50 per cent of India’s rural population still defecates in the open (which amounts to nearly 60 per cent of the global total) and 97 million Indians do not have access to clean drinking water. Planned water, sanitation and hygiene interventions will need to be scaled up in a big way. In fact, combined with improvements in access to care, clean drinking water and sanitation, vaccines can save our children from life threatening illness as well as repeated infections and help them to reach their full potential.
The Union Health Minister has called for volunteers/ health soldiers, to achieve 100 per cent immunisation — This is the real call to arms. In fact, the Prime Minister’s emphasis on ‘Make In India’ will hopefully spur more indigenous vaccines.The clock is ticking — and now that we have the success of the polio campaign behind us, India must build on that momentum.
(The writer is former Director General, ICMR, and currently visiting professor of Translational Health Science and Technology Institute)