The Union health ministry's ambitious Mission Indradhanush to immunise children against various diseases faces a major challenge as the Hib vaccine to safeguard the little ones from deadly infections like meningitis, pneumonia and severe throat conditions remains out of the reach in vast areas of the country.
The Haemophilus Influenzae Tybe b (Hib) was added in the bouquet of vaccines to be administered under Mission Indradhanush. But experts argue that even outside the programme, very few children in the country have been covered by this vaccine whose penetration in rural areas is as low as four per cent.
The vaccine has been available in the country since 1997.
A recent data released by Boston University School of Public Health of the US and the Indian Institute of Public Health, published in the British Medical Journal (BMJ), showed that the vaccine has hardly been used in the country. "The overall statewide Hib vaccine coverage was found to be four per cent, ranging from a minimum of 0.3 per cent in Assam to a maximum of 4.6 per cent in Punjab and Haryana," said Dr. Sanjay P. Zodpey of the Indian Institute of Public Health.
The study covered the entire country - Punjab, Haryana, Delhi, Rajasthan, Uttar Pradesh, Madhya Pradesh, West Bengal, Odisha, Bihar, Assam, Andhra Pradesh, Karnataka, Kerala and Tamil Nadu.
Eight out of 29 Indian states have public sector delivery of Hib-containing pentavalent vaccine. The Centre initiated a phased public sector introduction of a Hib (and diphtheria, pertussis, tetanus)-containing pentavalent vaccine in December 2011 only in two states of Kerala and Tamil Nadu.
Subsequently, the Hib-containing pentavalent vaccine was introduced in Haryana in December 2012, followed by five more states - Jammu and Kashmir, Goa, Gujarat, Karnataka and Puducherry - in 2013.
"Kerala and Tamil Nadu, the states with the best performing public sectors, are not truly representative of many other Indian states that have suboptimal public sector vaccination machinery," said Dr. Zodpey.
"The public sector rollout of the Hib-containing pentavalent vaccine will be difficult in those Indian states that are primarily rural, with poor access to private and public sectors. With the public sector introduction of pentavalent vaccine, more parents with low purchasing capacity would likely opt for the vaccine. However, this alone does not necessarily ensure high coverage of Hibcontaining pentavalent vaccine, as the coverage of other free-of-cost public sector traditional vaccines remains low in India," he said.
"Unfortunately, the existing public and private DPT coverage levels are low, at less than 60 per cent in states such as Bihar, Madhya Pradesh, Assam, Rajasthan and Uttar Pradesh (BIMARU) where more than 50 per cent of children live.
This suggests that coverage levels of the new Hib (and DPT)-containing pentavalent vaccine may be similar to the present weak coverage of DPT alone in these states," said Abhishek Sharma from the Boston University.
India has the highest Hib disease burden in the world, with around 2.4 million cases and 72,000 Hib-related deaths annually, accounting for over four per cent of total child deaths in India.
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