Vaccination in India

COVID-19 vaccination roll out in AIIMS, New Delhi, India on 16 January 2021

Vaccination in India includes the use of vaccines in Indian public health and the place of vaccines in Indian society, policy, and research.

Vaccination policy

India's Universal Immunization Programme (UIP) began in 1985. The UIP covers:[1][2][3]

Available vaccines

Coronavirus

A 5ml vial of Covaxin BBV152

India has been vaccinating against coronavirus since 16 January 2021.

Rotavirus

India's implementation of the rotavirus vaccine in its Universal Immunisation Programme has saved many children's lives.[4]

Nearly every child in every country globally experiences at least one rotavirus infection in early childhood.[5] However, in India, children are more likely to get this infection multiple times, and children in India are more likely to die from it.[5]

A rotavirus vaccine is available.[5] This vaccine is highly effective and has been preventing half of the severe rotovirus diarrhea cases which would occur in India otherwise.[5] Scientists in India produce vaccines for this disease which are special for India only.[5]

HPV

As of 2019 the Indian government is scaling up efforts to promote the HPV vaccine for girls to prevent cervical cancer.[6] This effort began in 2008 with the introduction of one sort of vaccine and in 2018 the government began providing a newer version of the vaccine.[6]

Respiratory syncytial virus

Cases of respiratory syncytial virus (RSV) in India mainly occur in North India in the winter.[7] This virus causes lower respiratory tract infection.[7]

Safety

India, like many other countries, uses the World Health Organization system for reporting and classifying "Adverse Events following Immunization".[8] The government agency which manages this program is responsible for both increasing safety and giving an explanation if a problem occurs.[9] Between 2012 and 2016, the system identified about 1000 cases.[10] Researchers responded by examining these cases to improve safety.[10]

History

In 1802 a 3-year old girl in Mumbai received a smallpox vaccine, making her the first person to take a vaccine in India.[11] The British government claimed success and began to block use of the previous technology variolation to only recommend vaccination instead.[11] In hindsight, the situation was complicated because vaccines were the long term solution but way that the British Raj introduced them was disruptive to how people accessed traditional health services, and to government operations, and in religion.[12]

Society and culture

The pharmaceutical industry in India is strong and has a reputation for producing good vaccines for sale and export.[13] Typically when a country makes vaccines, that means that local people have good access to them.[13] For various reasons, India has both a strong vaccine manufacturing sector and also people in India, especially children, have higher rates of missing vaccines than in comparable countries.[13]

Various commentators have given different reasons for why India has less vaccination.[13] One historic reason is that India has contributed intensely to encouraging vaccines for smallpox and polio at the expense of being able to promote other vaccines.[13] Another explanation could be that the Indian government underspends on vaccines in general.[13] Somehow India's population does not demand vaccines, which could be a result of lack of public health education.[13] India also has pseudoscience activists promoting vaccine hesitancy.[13]

Some research has suggested that community engagement (CE) may be especially important to consider in supporting vaccination in India. This may include "[efforts that are] focused on upstream relationships (bidirectional), fostering trust, transparent communication, capacity building, and political will to ensure such approaches."[14] There appears to be overarching support for vaccination CE among decisionmakers in India, but there remain many structural and social barriers to moving forward on this front.[15]

Vaccines in research

Dengue

There has been a dengue vaccine available since 2015.[16] However, this vaccine is not effective in many cases.[16] The Indian government participates in the global research to develop an effective general use dengue vaccine.[16]

Kala azar

There is research for a kala azar (Leishmaniasis) vaccine in India, but none exists.

Special populations

Foreign tourists visiting India contribute significantly to India's economy.[17] People who visit India from countries with different diseases may not have vaccines to protect against infections in India.[17] When tourists do get an infection in India, often that infection could have been prevented with a vaccine.[17][18]

The World Health Organization recommends different vaccines for tourists in different circumstances.[17] Those vaccines include diphtheria vaccine, tetanus vaccine, hepatitis A vaccine, hepatitis B vaccine, oral polio vaccine, typhoid vaccine, varicella vaccine, Japanese encephalitis, meningococcal vaccine, rabies vaccine, and yellow fever vaccine.[17]

References

  1. ↑ Lahariya, Chandrakant (April 2014). "A brief history of vaccines & vaccination in India". The Indian Journal of Medical Research. 139 (4): 491–511. ISSN 0971-5916. PMC 4078488. PMID 24927336.
  2. ↑ Madhavi, Yennapu (May 2005). "Vaccine Policy in India". PLOS Medicine. 2 (5): e127. doi:10.1371/journal.pmed.0020127. ISSN 1549-1277. PMC 1140944. PMID 15916465.
  3. ↑ "National Immunization Schedule under Universal Immunization Programme (UIP), India". The Pharmapedia. 2021-02-27. Retrieved 2021-05-28.
  4. ↑ Malik, A; Haldar, P; Ray, A; Shet, A; Kapuria, B; Bhadana, S; Santosham, M; Ghosh, RS; Steinglass, R; Kumar, R (16 September 2019). "Introducing rotavirus vaccine in the Universal Immunization Programme in India: From evidence to policy to implementation". Vaccine. 37 (39): 5817–5824. doi:10.1016/j.vaccine.2019.07.104. PMC 6996154. PMID 31474519.
  5. 1 2 3 4 5 Soares-Weiser, Karla; Bergman, Hanna; Henschke, Nicholas; Pitan, Femi; Cunliffe, Nigel (28 October 2019). "Vaccines for preventing rotavirus diarrhoea: vaccines in use". Cochrane Database of Systematic Reviews. 2019 (10). doi:10.1002/14651858.CD008521.pub5. PMC 6816010. PMID 31684685.
  6. 1 2 Sankaranarayanan, Rengaswamy; Basu, Partha; Kaur, Prabhdeep; Bhaskar, Rajesh; Singh, Gurinder Bir; Denzongpa, Phumzay; Grover, Rajesh K; Sebastian, Paul; Saikia, Tapan; Oswal, Kunal; Kanodia, Rishav; Dsouza, Amantia; Mehrotra, Ravi; Rath, Goura Kishor; Jaggi, Viniita; Kashyap, Sundram; Kataria, Ishu; Hariprasad, Roopa; Sasieni, Peter; Bhatla, Neerja; Rajaraman, Preetha; Trimble, Edward L; Swaminathan, Soumya; Purushotham, Arnie (November 2019). "Current status of human papillomavirus vaccination in India's cervical cancer prevention efforts". The Lancet Oncology. 20 (11): e637–e644. doi:10.1016/S1470-2045(19)30531-5. PMID 31674322.
  7. 1 2 Broor, S; Parveen, S; Maheshwari, M (2018). "Respiratory syncytial virus infections in India: Epidemiology and need for vaccine". Indian Journal of Medical Microbiology. 36 (4): 458–464. doi:10.4103/ijmm.IJMM_19_5. PMID 30880691.
  8. ↑ Singh, AK; Wagner, AL; Joshi, J; Carlson, BF; Aneja, S; Boulton, ML (24 July 2017). "Application of the revised WHO causality assessment protocol for adverse events following immunization in India". Vaccine. 35 (33): 4197–4202. doi:10.1016/j.vaccine.2017.06.027. PMID 28648545.
  9. ↑ Joshi, J; Das, MK; Polpakara, D; Aneja, S; Agarwal, M; Arora, NK (February 2018). "Vaccine Safety and Surveillance for Adverse Events Following Immunization (AEFI) in India". Indian Journal of Pediatrics. 85 (2): 139–148. doi:10.1007/s12098-017-2532-9. PMID 29170922. S2CID 4252838.
  10. 1 2 Singh, AK; Wagner, AL; Joshi, J; Carlson, BF; Aneja, S; Boulton, ML (June 2018). "Causality assessment of serious and severe adverse events following immunization in India: a 4-year practical experience". Expert Review of Vaccines. 17 (6): 555–562. doi:10.1080/14760584.2018.1484285. PMID 29865876. S2CID 46929595.
  11. 1 2 Lahariya, Chandrakant (1 April 2014). "A brief history of vaccines & vaccination in India". Indian Journal of Medical Research. 139 (4): 491–511. ISSN 0971-5916. PMC 4078488. PMID 24927336.
  12. ↑ Bhattacharya, Sanjoy; Harrison, Mark; Worboys, Michael (2005). Fractured states : smallpox, public health and vaccination policy in British India 1800-1947. Orient Longman. ISBN 978-8125028666.
  13. 1 2 3 4 5 6 7 8 Laxminarayan, Ramanan; Ganguly, Nirmal Kumar (June 2011). "India's Vaccine Deficit: Why More Than Half Of Indian Children Are Not Fully Immunized, And What Can—And Should—Be Done". Health Affairs. 30 (6): 1096–1103. doi:10.1377/hlthaff.2011.0405. PMID 21653963.
  14. ↑ Dutta, Tapati; Meyerson, Beth E.; Agley, Jon; Barnes, Priscilla A.; Sherwood-Laughlin, Catherine; Nicholson-Crotty, Jill (December 2020). "A qualitative analysis of vaccine decision makers' conceptualization and fostering of 'community engagement' in India". International Journal for Equity in Health. 19 (1): 185. doi:10.1186/s12939-020-01290-5. ISSN 1475-9276. PMC 7574459. PMID 33081792.
  15. ↑ Dutta, Tapati; Agley, Jon; Meyerson, Beth E.; Barnes, Priscilla A.; Sherwood-Laughlin, Catherine; Nicholson-Crotty, Jill (2021-06-25). Borrow, Ray (ed.). "Perceived enablers and barriers of community engagement for vaccination in India: Using socioecological analysis". PLOS ONE. 16 (6): e0253318. doi:10.1371/journal.pone.0253318. ISSN 1932-6203. PMC 8232440. PMID 34170920.
  16. 1 2 3 Swaminathan, S; Khanna, N (July 2019). "Dengue vaccine development: Global and Indian scenarios". International Journal of Infectious Diseases. 84S: S80–S86. doi:10.1016/j.ijid.2019.01.029. PMID 30684747.
  17. 1 2 3 4 5 Verma, R; Khanna, P; Chawla, S (2015). "Recommended vaccines for international travelers to India". Human Vaccines & Immunotherapeutics. 11 (10): 2455–7. doi:10.4161/hv.29443. PMC 4635693. PMID 25483659.
  18. ↑ Mehta, B; Jindal, H; Bhatt, B; Kumar, V; Singh Choudhary, S (2014). "Vaccination for safe travel to India". Human Vaccines & Immunotherapeutics. 10 (4): 1111–3. doi:10.4161/hv.27234. PMC 4896562. PMID 24284411.
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