It is encouraging that the Government has gone a step further towards achieving universal immunisation by launching rotavirus vaccine under its Universal Immunisation Programme. This programme needs people’s support
Two-year old Meena stared listlessly at me, hardly flinching when the needle was slipped into her vein to give her life-sustaining fluids. For three days she had recurrent loose motions, vomiting and fever which steadily worsened until she became too weak to eat or drink. The 120-km journey her mother had to make to the city hospital, where I worked, was not a moment too late. Meena had severe viral diarrhea, one that made her so dehydrated that she almost lost her life. She tested positive for rotavirus — the primary cause of moderate and severe diarrhea — but she was one of the luckier ones who recovered after a week of hospitalisation and left for home, smiling brightly.
Thousands of Indian children face this fate daily and have less of an opportunity to smile. Most cases of diarrhea in children result from infection caused by viruses, bacteria or parasites, which disrupt the normal functions of the intestines, making them inflamedand vulnerable to other illnesses.
While these illnesses may seem mild in older children or adults, they take a tremendous toll on the lives of young children. In a year, more than 1,30,000 children in India, under the age of five, are estimated to succumb to diarrhea. Among these, around 40 per cent may be attributed to rotavirus alone.
Treatment in the form of oral rehydration solution can be life-saving, however, it may be inaccessible due to non-availability or lack of awareness. Thus, in many cases, rotavirus can be a death sentence for young children.
Children who are survivors of recurrent diarrhea often become victims of malnutrition and impaired growth, and become susceptible to other infections, that increases the risk of death from other causes. Furthermore, early, childhood diarrhea has been linked to long-term cognitive deficits that can potentially lead to low productivity in later life.
Although Meena’s parents got their beautiful daughter back, they suffered a serious financial setback, both in terms of hospitalisation costs and their lost wages. An oft unreported aspect of deep adversity imposed by Rotavirus is the significant financial burden on families and the country as a whole. A single hospitalisation for Rotavirus diarrhea is estimated to cost between Rs 2,000 to Rs 8,400, an amount that can easily force a low-income family into catastrophic poverty. In aggregate, these hospitalisations cost the country approximately Rs 4.9 billion each year.
It is plain to see that a preventive approach is a smart and effective strategy against one of the commonest forms of diarrhea in young children. Prevention stops the onset of the disease in the first place, making it important for children without reliable access to healthcare. Prevention also mitigates the harmful impact of diarrhea on physical growth and mental development in children and reduces their susceptibility to other diseases.
While treatment is an essential component of healthcare, prevention in the form of a national Rotavirus immunisation programme in India, estimated at Rs 4.5 billion, may be more economical from a national stand point, than the cost of covering treatment for an unvaccinated population with a high burden of disease. Recognising this case, the Government of India prioritised the addition of Rotavirus vaccine in India’s Universal Immunisation Programme (UIP), and introduced it in four States this year — Andhra Pradesh, Haryana, Himachal Pradesh and Odisha.
What is equally exciting is that the vaccine is completely developed in India, with the original strain taken from an Indian child. Also manufactured indigenously, the vaccine has demonstrated favorable efficacy against severe Rotavirus disease among Indian children in the first year, and continued protection in the second year.
Clinical trials also examined vaccine safety in detail, and there was no evidence of significant vaccine associated adverse events, particularly intussusception (a condition where one part of the bowel slides into another part, resulting in bowel obstruction). However, post-licensing monitoring of vaccine-related events is essential for increasing our evidence-base on safety issues, and the trials underscored the need to strengthen a robust surveillance and healthcare delivery system to ensure a rapid response to tackle any adverse event related to the vaccine.
It is heartening that India is making significant progress in immunisation. Vaccination is a simple intervention that affords great savings, both to families and the exchequer. Most importantly, it is an intervention that, when accessible to all regardless of social, economic or religious status through universal programs such as the UIP, helps increase healthcare equity and boost collective immunity to disease outbreaks.
The infrastructure and capabilities afforded by the ongoing Mission Indradhanush campaign will help make vaccines accessible to those who need it. These programmes need our support. It is our moral responsibility to give today’s children, such as Meena, a better future. Universal immunisation, universal in its coverage of diseases and of people can ensure just that.