A strike against pneumonia

*J.P. Nadda

In 2014, this government made a promise to the people of India, to safeguard their health, to provide the men, women, and children of this country the best chance to survive and thrive. One of the key initiatives was to protect as many of our children against as many diseases as possible, with the introduction of new vaccines into the Universal Immunization Programme (UIP), as well as by ensuring these reach the unreached. This was one of the most significant policy decisions in public health arena taken because of the visionary leadership of Shri Narendra Modi Ji.  Today, I can say that promise is well on its way to being fulfilled.

For decades, our children have died from diseases that could be prevented. Introduction of new vaccines is key to reducing childhood and infant mortality and morbidity in the country.  In the last two years, through the UIP, we saw the introduction of the Inactivated Polio Vaccine (IPV), Rotavirus vaccine (RVV) against diarrhoea, and the measles-rubella (MR) vaccine, to protect against both measles and rubella. The latest weapon in the arsenal being introduced is pneumococcal conjugate vaccine (PCV). More than 130 countries worldwide have introduced PCV as part of their childhood immunization programmes, in line with World Health Organization (WHO) global recommendations. This vaccine provides protection against one of the most common causes of pneumonia—a bacterium called pneumococcus. This bacterium also causes other diseases such as ear infections, meningitis and blood infections, with some of these resulting in death or serious disabilities.

This vaccine has long been available in the private sector in India, so children of wealthy families who could afford it could be protected. But today, by introducing it in the UIP, we are ensuring that this vaccine reaches all children, especially those who need it the most, the underprivileged and underserved. The availability of life-saving vaccines should not be limited to only those who can afford it. It is through vaccines like PCV that we can give the citizens of this country a shot at an equitable future and achieve the vision of an India in which every citizen lives a healthy and productive life.

Many people ask, “Why immunize?” Previous generations, the argument goes, suffered from diseases like diarrhoea, measles, and pneumonia; why is it essential for us to immunize our children against it? By the time you finish reading this article, one child in India would have died from pneumonia. One child every three minutes – that is the tragic toll pneumonia claims in this country. We need to protect and save those children.

The decision to introduce a vaccine in the UIP is a well-regulated and carefully thought-out process that takes into account the need, the safety and the efficacy of the vaccine.  For a new vaccine to be introduced in the country, the National Technical Advisory Group on Immunisation (NTAGI) reviews disease burden and epidemiology of a particular vaccine preventable disease and vaccine availability along with its cost effectiveness before making recommendations for any new vaccine introduction. NTAGI is an independent body of experts with repute and experience in the field. The Ministry introduces new vaccines only when NTAGI recommendations are subsequently approved by the empowered programme committee and Mission Steering Group (MSG). 

All new vaccines, including the PCV, have been included in the UIP at the recommendation of NTAGI and following this procedure. PCV helps protect against the bacterium that causes the maximum number of child pneumonia deaths worldwide and in India. We are starting by introducing it in parts of Bihar, parts of Uttar Pradesh and Himachal Pradesh, but the plan is to soon cover all of India. It is an expensive vaccine, but it will now be available to our citizens for free. The cost to the government exchequer is offset by the additional economic benefits of having a healthier society.

With close to 1.8 lakh deaths and over 20 lakh cases annually, child pneumonia poses a significant financial burden on India. The costs of treating a case of pneumonia perpetuates the cycle of poverty. Parents of children who contract pneumonia have to pay expensive hospital bills, which can cost them several months in wages. To add to this, they have to take time off and stay home to care for sick children, negatively impacting India's economy. Healthier children enjoy better cognitive development, are better in school, missing fewer days, and in the long run, when they join the workforce, they tend to be more productive and earn more. Health thus creates wealth. There are several global examples where healthier populations grow their incomes and escape from poverty quicker, making PCV an investment into India’s progress towards becoming an economically developed nation. India leads the world in pneumonia deaths but, with the launch of PCV, we have definite chance at changing that statistic and making a serious dent in our contribution to the global burden of the disease.

In the past, vaccines have greatly contributed in reducing death and disease. Ailments like smallpox no longer plague us and India is now free of polio and maternal and neonatal tetanus. The government’s investment and commitment to India’s UIP has contributed to this progress. Today, the UIP provides Indian children with vaccines for 11 deadly and debilitating diseases; the introduction of PCV will increase that number to 12. Recently released National Family Health Survey (NFHS-4) data shows that India’s full immunization coverage stands at 62%, up from 43.5% just a   decade ago. More vaccines and higher coverage have helped to drastically reduce our infant and child deaths. To accelerate that momentum, Mission Indradhanush was launched in 2014 to reach the most vulnerable and ensure 90% of India’s children have access to life-saving vaccines by 2020. This project now has attained top speed with our Honourable Prime Minister rescheduling the target to 2018, emphasizing that no child should be left behind.

It is our duty to deliver on the promise and save the lives of tens of thousands of children in this country who don’t live to see their fifth birthday due to preventable diseases. To achieve these ambitious targets, we cannot afford to slow down. Let us immunize and give our children the protection they need to fight off deadly diseases and reach their full potential.

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*Author is the Union Minister for the Ministry of Health and Family Welfare.