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The Power of Vaccines Protecting India’S Future

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The Power of Vaccines Protecting India’S Future THE POWER OF VACCINES Protecting India’s Future PROPERTY OF BILL & MELINDA GATES FOUNDATION 2 THE POWER OF VACCINES Protecting India’s Future AcKNOWLEDGEMENTS CONTENTS Content support provided by Global Health Strategies (GHS) India and the International Vaccine Access Center (IVAC) at 1 4 the Johns Hopkins Bloomberg School of Public Health, in collaboration with Dr. Jacqueline E. Tate, Centers for Disease EXECUTIVE SUMMARY 02 DIARRHOEA AND Control and Prevention, Dr. Chandrakant Lahariya, World PNEUMONIA IN INDIA 11 Health Organization (WHO), and Dr. Satish Gupta, UNICEF. 2 Rotavirus: Leading cause of severe diarrhoea Developed and published by CHILDHOOD DEATHS AND Hib and pneumococcus: Leading causes of Immunization Technical Support Unit (ITSU) DISEASE IN INDIA 05 severe pneumonia India’s share of global child mortality About ITSU Need for a comprehensive approach Leading causes of under-five child deaths ITSU was established by the Public Health Foundation of India (PHFI) in March 2012, under the auspices of the 5 Ministry of Health and Family Welfare (MoHFW) to support 3 VAccINES FOR DIARRHOEA the Universal Immunisation Programme (UIP). The overall AND PNEUMONIA 15 vision of ITSU is to catalyse national improvements in routine VALUE OF PREVENTION 07 immunisation by providing the technical and management Vaccines: A public health “best buy” Global impact expertise required to design, create, implement, and More than just saving lives Status of introduction institutionalise a stronger immunisation programme fully “Herd immunity” and other indirect effects Potential impact led by the Immunisation division of MoHFW, Government of India, and supported by Bill & Melinda Gates Foundation. Role of vaccines in reducing death and 20 ITSU works through six different pillars to accomplish this, disease in India REFERENCES including monitoring and evaluation (M&E); vaccine logistics Routine immunisation in India: A system and cold chain management; strategic communication; built to deliver AEFI management and vaccine quality and safety; strategic planning and system design; and evidence to policy. Case study: Success in eliminating smallpox ITSU serves to harmonise various initiatives being piloted Case study: Success in eliminating polio or implemented in different states by all immunisation partners and provide a single platform for discussions, development of strategies, and coordination with partners for scaling up successful models. Design by Design Route © 2015 by ITSU VACCINES AND IMMUNIZATION 2 3 EXECUTIVE 1 SUMMARY PROPERTY OF BILL & MELINDA GATES FOUNDATION The unique role of vaccines nationwide coverage of the third dose of Vaccines – necessary part of an Recommended by national and Vaccines have played a pivotal role in the diphtheria-tetanus-pertussis (DTP) integrated strategy to address diarrhoea international experts improving child health and survival in vaccine increasing to an estimated 72% in and pneumonia The aforementioned diarrhoea and India and around the world. They are 2012 from 60% in 2000.[3] World Health Organization (WHO) and pneumonia vaccines are: considered one of the most cost-effective Several states have shown marked United Nations Children's Fund (UNICEF) • Recommended by the WHO for use in national solutions in the history of health and improvement in recent years. Bihar, for recommend an integrated approach immunisation programmes worldwide. development. Vaccines are unique in that example, has increased DTP3 coverage to protect against, prevent and treat • Recommended by the Indian Academy of they help people stay healthy by preventing from 54% in 2007-2008 (per District Level childhood diarrhoea and pneumonia in Pediatrics (IAP) for all Indian children. infection at the very outset, in turn avoiding Health Survey-3) to over 80% in 2012-2013 the “Integrated Global Action Plan for the • Listed as a necessary component of WHO and recurring sickness, death and unnecessary (per Annual Health Survey). Prevention and Control of Pneumonia and UNICEF’s GAPPD. social and economic costs to society. Diarrhoea” (GAPPD). They recommend • Key elements of the WHO Global Vaccine Childhood diseases in India Immunisation not only helps protect health the adoption of a comprehensive approach Action Plan, which is endorsed by 194 and provide medical savings, but also Despite making important progress in that includes vaccines as one of the most member states, including India. yields indirect economic benefits, including reducing the burden of vaccine preventable critical tools to prevent child deaths and improvements in cognitive development, diseases and achieving overall reductions suffering. Equal access for all educational attainment and labour in child mortality, serious challenges Delivering vaccines to children safely and Vaccines protect against the leading productivity. Many vaccines also provide remain. An estimated 1.3 million Indian effectively requires a strong immunisation causes of diarrhoea and pneumonia “herd immunity,” offering protection even children under five continue to die each system. In India, the Pulse Polio Program, to unimmunised individuals. year, with more child deaths in India than The leading cause of moderate-to- as well as the Japanese encephalitis and in any other country in the world. India severe diarrhoea – rotavirus – and measles catch-up campaigns, have amply Vaccines work in India alone accounts for roughly one-fifth of the the two leading causes of bacterial demonstrated the capacity of a well- India has made significant progress world’s total under-five deaths.[1, 4] pneumonia – Haemophilus influenzae developed immunisation system to deliver towards reducing child deaths as it aims type b (Hib) and Streptococcus oral and injectable vaccines to millions Diarrhoea and pneumonia – the leading to achieve multiple child health targets. pneumoniae (pneumococcus) – are all of children safely and effectively. Several causes of death and suffering in children The country’s child mortality rates have vaccine preventable in children. Vaccines children across India rely solely on the under five declined by over 58% since 1990.[1] This that protect against these causes are national public health system to access has been possible due to the many steps Diarrhoea and pneumonia together widely used around the world and have childhood vaccines. Given that pneumonia taken by the Government of India (GoI) to account for the largest share (23%) of proven to be very effective in preventing and diarrhoea are the leading causes of accelerate child survival in the country, total under-five deaths in India. In 2013, and reducing cases of diarrhoea and death for children under-five, vaccines that including strengthening the country’s diarrhoea claimed the lives of more than pneumonia. As of January 2015 the Hib protect against these diseases must be routine immunisation (RI) programme. 130,000 Indian children under five. In the vaccine has been introduced into India’s included in India’s routine immunisation same year, pneumonia caused nearly Universal Immunisation Programme Vaccines have successfully eliminated program. 175,000 deaths of Indian children under (UIP) in 15 states and union territories in smallpox and polio from India; brought five.[1, 4] Even in cases of survival, the the form of the pentavalent (DTP-HepB- Equitable access to these life-saving measles to an all-time low; and reduced severe burden of illness that diarrhoea and Hib) vaccine, with plans for a nation wide vaccines is an essential step in India’s tetanus by an estimated 95% over the pneumonia cause could adversely impact scale-up. India has also developed and effort to successfully accelerate past three decades, with at least 18 child growth and development. These licensed its first indigenous rotavirus progress towards achieving national and states since 2003 validated as having diseases also place a significant economic vaccine, manufactured by Bharat Biotech international child health and development eliminated maternal and neonatal burden on families, communities and the in collaboration with the Department of targets. tetanus as of December 2013.[2, 3] Over healthcare system. Biotechnology (DBT) and All India Institute the years, India has also seen progress of Medical Sciences (AIIMS). expanding immunisation coverage, with EXECUTIVE SUMMARY EXECUTIVE SUMMARY 5 More children die each year in India than in any CHILDHOOD DEATHS other country 2 AND DISEASE IN INDIA In 2013, there were an estimated 1.3 million deaths among Indian children under-five. Many of these deaths were from largely preventable causes.[4, 1] While the country has made significant progress in reducing child deaths, current efforts, especially for pneumonia and diarrhoea, must be enhanced and accelerated to achieve national and global goals. In the years to come, India will also need to continue its efforts towards reducing child deaths in line with the Post-2015 Development Agenda.[5] INDIA’S SHARE OF GLOBAL However, more than 17,000 children CHILD MORTALITY continue to die globally each day. India witnesses more child deaths each year The incidence of global deaths among than any other country, accounting for 21% children under-five has reduced by more of global deaths among children under than half, from an estimated 12.6 million five.[1] deaths in 1990 to 6.3 million deaths in 2013.[1] FIGURE 1 India’s Share of Global Child Mortality 2013 (figures in thousands) KENYA DEMOCRATIC REPUBLIC 106 (2%) OF CONGO 320 (5%) BANGLADESH 129 (2%) PAKISTAN
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