Context: Recently, the National Statistical Organisation (NSO) published the ‘Health in India report’. 

• According to the report, although almost all children in India are vaccinated against tuberculosis, and receive their birth dose of the polio vaccine, two out of five children do not complete their immunisation programme. 

Key highlights of the report

• The report is based on the 75th round of the National Sample Survey (July 2017-June 2018) on household social consumption related to health.
• Most of the children remain unprotected against measles, and partially protected against a range of other diseases. In the national capital, less than half of all children have been given all eight required vaccines.
• Across the country, only 59.2% of children under five years are fully immunised, according to the NSO report. This contradicts the Centre’s Health Management Information System portal data, which claimed that full immunisation coverage for 2017-18 stood at 86.7%.
• About 97% of children across the country received at least one vaccination — mostly BCG and/or the first dose of OPV at birth — a statistic that remains steady across income groups and geographies. 
• Only 67% of children are protected against measles. Only 58% got their polio booster dose, while 54% got their DPT booster dose.

State-wise performance

• Manipur with 75%, Andhra Pradesh with 73.6% and Mizoram with 73.4% recorded the highest rates of full immunisation.
• At the other end of the spectrum lies Nagaland, where only 12% of children received all vaccinations, followed by Puducherry with 34% and Tripura with 39.6%.
• The vast majority of these vaccinations 95% in rural India and 86% in cities were carried out in government health facilities and primary health centres. 

Immunization Programme in India

• Immunization Programme in India was introduced in 1978 as ‘Expanded Programme of Immunization (EPI) by the Ministry of Health and Family Welfare.
• In 1985, the Programme was modified as ‘Universal Immunization Programme (UIP)’.
• UIP aimed to prevent mortality and morbidity in children and pregnant women against 12 vaccine-preventable diseases. 
• Between 2009-2013 immunization coverage has increased from 61% to 65%, indicating only a 1% increase in coverage every year. To accelerate the process of immunization by covering 5% and more children every year. 

Mission Indradhanush

• It was launched by the Ministry of Health and Family Welfare, Government of India on December 25, 2014.
• It aims to accelerate the process of immunization by covering 5% and more children every year and achieve the target of full coverage by 2020.

Objectives

• To cover all those children by 2020 who are either unvaccinated or are partially vaccinated against vaccine-preventable diseases. 
• It provides life-saving vaccines to all children across the country free of cost to protect them against 12 Vaccine-Preventable Diseases (VPD)  namely Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea. 
• Vaccines for Rubella, JE and Rotavirus vaccine are provided in select states and districts

Implementation

• Focused and systematic immunization drive will be through a “catch-up” campaign mode where the aim is to cover all the children who have been left out or missed out for immunization. 
• The pregnant women are administered the tetanus vaccine, ORS packets and zinc tablets are distributed for use in the event of severe diarrhoea or dehydration and vitamin A doses are administered to boost child immunity.
• The Mission Indradhanush in its four phases has reached to more than 2.53 crore children and 68 lakh pregnant women with life-saving vaccines.
• The Ministry of Health is being technically supported by WHO, UNICEF, Rotary International and other donor partners. Mass media, interpersonal communication, and sturdy mechanisms of monitoring and evaluating the scheme are crucial components of Mission Indradhanush.

Area of Focus
The following areas are targeted through special immunization campaigns:
High-risk areas identified by the polio eradication programme. These include populations living in areas such as:

• Urban slums with migration
• Nomads
• Brick kilns
• Construction sites
• Other migrants (fisherman villages, riverine areas with shifting populations etc.) and
• Underserved and hard to reach populations (forested and tribal populations etc.) 
• Areas with low routine immunization (RI) coverage (pockets with Measles/vaccine-preventable disease (VPD) outbreaks).
• Areas with vacant sub-centres: No ANM posted for more than three months.
• Areas with missed Routine Immunisation (RI) sessions: ANMs on long leave and similar reasons
• Small villages, hamlets, dhanis or purbas clubbed with another village for RI sessions and not having independent RI sessions.

Intensified Mission Indradhanush (IMI)

• It has been launched by the Government to reach each and every child under two years of age and all those pregnant women who have been left uncovered under the routine immunisation programme. 
• The special drive will focus on improving immunization coverage in select districts and cities to ensure full immunization to more than 90% by December 2018 but only 16 districts in the country have achieved 90% coverage so far.
• It will cover low performing areas in the selected districts and urban areas. These areas have been selected through triangulation of data available under national surveys, Health Management Information System data and World Health Organization concurrent monitoring data. Special attention will be given to unserved/low coverage pockets in sub-centre and urban slums with the migratory population. 
• The focus is also on the urban settlements and cities identified under the National Urban Health Mission (NUHM).
• It will have inter-ministerial and inter-departmental coordination, action-based review mechanism and intensified monitoring and accountability framework for effective implementation of targeted rapid interventions to improve the routine immunization coverage. 
• The Intensified Mission Indradhanush 2.0 will target the districts which have immunisation coverage of 70% or below. 

Road Ahead

• The Covid-19 pandemic has already impacted the childhood vaccination programme. According to advocacy group Child Rights and You reports, only half of Indian families with children under five years were able to access immunisation services during the lockdown.
• Immunisation is a simple and effective way of protecting children from serious diseases. It not only helps protect individuals, it also protects the broader community by minimising the spread of disease. Therefore the government needs to remove any gap in immunisation.