Vaccination in India

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

• BCG vaccine for Tuberculosis
• DPT vaccine for Diphtheria, Pertussis and Tetanus
• OPV vaccine for Poliomyelitis
• Measles vaccine/ Measles and Rubella vaccine
• Hepatitis B vaccine
• TT vaccine
• Pentavalent vaccine for Hib, DPT, Hep B
• JE vaccine (localised)
• Rotavirus vaccine
• PCV for Streptococcus pneumoniae

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]

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]

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]

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]