Immunization programmes have been one of the world’s most cost-effective public health strategies to save children from preventable life threatening diseases. The World Health Organisation (WHO) estimates that vaccines prevented at least 10 million deaths between2010-2015. Considerable progress has been made in improving vaccination coverage amongst children. In 2015, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services, an increase from 73% in 2000. In Meghalaya we still have a long way ahead to reach desirable immunization rates amongst our children. We continue to lose children to diseases like measles despite the existence of effective vaccines that offer excellent protection.
The Government of India launched the Universal Immunization Programme (UIP) in 1985. India’s UIP is one of the largest immunization programmes in the world in terms of number of beneficiaries, quantities of vaccines used, number of sessions and the areas covered. Initially, UIP started with four vaccines against six preventable diseases and this was progressively expanded.The current programme offers free immunization againsttuberculosis, polio, diphtheria, whooping cough (pertussis), tetanus, measles andHepatitis B, across the country. In addition mumps, rubella, rotavirus, pneumococcal vaccines and Japanese Encephalitis have been launched in some states. In order to achieve full immunity, a child should be vaccinated as per schedule and dose, this involves multiple doses of certain vaccines. The National Family Health Survey (NFHS-4) reports Meghalaya’s full immunization coverage in12-23month old children to be 61.5%, which is slightly lower than the national average. As per District Level Household and Facility Survey (DLHS-4), only 48.9% 12-23month old childrenof the state are fully immunized while 13.7% have not received any vaccination. Partial or no immunization leaves the child and others around it at risk of diseases, disability and death.
The UIP,despite being operational for over 30 years, has not been able to achieve full immunization coverage of all children. It is unfortunate that even after so many years of the launch of UIP, myths regarding immunization still persist contributing to partial or no immunization of many children. Despite the mobilization activities carried out by our frontline health workers like ANMs, ASHAs and others, myths about immunization continue to persist in several villages – often referred to as ‘refusal villages’. Thus even after the laudable work done by the health department and associated partners, a significant chunk of the population remain unconvinced of the benefits of immunization.
Full immunization against preventable diseases is the right of every child.The Government of India launched the Mission Indradhanushinitiative in December 2014 to enhance coverage and immunize all children under the age of two years who are either unvaccinated or partially vaccinated, against various vaccine preventable diseases. In Meghalaya, the fourth phase of Mission Indradhanush was held in March 2017. But the desired outcomes have not been achieved even following these efforts. Earlier this year wewere part of the External Monitoring teamof the WHOs National Polio Surveillance Project.We visited 18 villages acrossEast Khasi Hills, East and West Jaintia Hillsdistricts over 3 days where Mission Indradhanush immunization sessions were scheduled.
In several villages, frontline health workers informed us about strong refusal for immunization present in that community. In one site no children were brought for immunization at the immunization session that was scheduled and planned for by health workers. Discussions with health workers on the uninspiring turn out brought forward many reasons primarily on the perceptions of the community towards immunization. These included fear of side effects such as fever in children following immunization,poor awareness on the efficacy and usefulness of vaccines, concerns over the quality of vaccines given for free by the government, distrust of vaccine potential and fears arising from rumours of death following immunization. A couple of myths need special attention: one is a misunderstanding that vaccines offer protection from minor illnesses like common colds and the second one about side-effects post immunization can be addressed if the key messages are conveyed appropriately at immunization sessions. A mild fever after certain immunizations is an expected side-effect about which the health worker is expected to raise awareness and inform mothers but during our observation visits we noticed that this aspect was being missed often.There are gaps in training of health workers that needs addressing if we are to improve our children’s immunization indices. Perhaps we also need to relook if we are getting the right persons for the job, for we came across at least one village where the ASHA worker herself had not immunised her children!
An all-out communication blitzkrieg targeting specific resistant areas will go a long way in convincing the care-givers and the larger community about the life saving benefits of immunization. Service providers need to be trained appropriately so that they give correct information in a culturally sensitive manner. It is often seen that the four key messages that frontline workers are expected to convey to caregivers following vaccination is often missed – (i) what vaccine was given and what disease it prevents (ii) when and where to come for the next visit, (iii) what minor adverse events/side effects could occur and how to deal with them, and (iv) to keep the immunization card safe and bring it along for the next visit. Diligent delivery of the four key messages carries the potential to improve the immunization coverage to a great extent.
A mix of media and locally appropriate community-based intervention is the need of the hour to address the refusal cases. Interpersonal communication is one of the best ways to address the concerns of the community regarding various myths, doubts, concerns and taboos related to immunization. Health officials can make more efforts to engage with local stakeholders including religious and community leaders to build the community’s trust in immunization.
Every year World Immunization Week falls between 24th to 30th April but even beyond that, it is time to renew our efforts to dispel prevailing myths regarding immunization and to expand access and acceptance for immunization across communities.