India needs to sign up for life-course immunisation

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• The COVID-19 vaccination drive is a reminder that the benefits of many vaccines have yet to reach the adult population.

Challenges of Adult Immunisation

• Perception of Child Oriented Thing
  • Before the COVID-19 pandemic, most people linked and associated vaccination with children only.
• Maximum benefits when administered early 
  • Scientifically, the benefit of most vaccines are greater if administered earlier in life ( during infancy and childhood) 
    • A reason children are usually prioritised and vaccines recommended for every child.
  • For the remaining age groups, vaccines are recommended for specific sub-groups such as 
    • For older people or those with specific health conditions.
• Inequities in Vaccine Coverage
  • The importance of vaccines, which are considered to be among the most cost-effective public health interventions, has been recognised globally. 
    • Yet, the full benefits of vaccines do not reach all children and other age groups.
  • There are wide inequities in children by geography, gender, parent’s education and family’s socioeconomic status, and other stratifies. 
  • The coverage of most available vaccines in adults in India is sub-optimal. 

Why is there a need for adult vaccination?

• Outbreaks: 
  • Japanese Encephalitis (JE) in 2005-06
    • India had to conduct mass scale JE vaccination in the endemic districts, which included the adult age group. 
  • Swine Flu vaccines 
    • For health workers during the H1N1 (2009) pandemic in 2009-­10. 
  • Other than that, there has been limited focus on the systematic efforts for adult vaccination in India. 
• Low vaccine-preventable diseases (VPDs) burden:

• Review of available data has pointed out that increased childhood vaccination coverage has resulted in
  • Proportionately higher cases of VPDs in the older age groups. 
• The larger adult population renders a greater social impact in terms of absenteeism from work (due to illnesses) and the associated costs of health care seeking and hospitalisation. 

• Decreasing Immunity:
  • There is emerging scientific evidence on waning immunity 
  • Thus there is a need for booster doses in the adult age group for the vaccines administered in childhood. 
• An opportunity in hand:
  • The COVID­ 19 vaccination drive has drawn our attention to the possibilities of adult vaccination, which should be used effectively. 
• The Immunization Agenda 2030:
  • The vaccines which have become available in the last two decades (which adults had not received as children) have the potential to be beneficial. 
  • There are more deaths due to pneumonia in adults than in children. 
  • A proportion of illnesses, hospitalisations and deaths in all age groups can be prevented by 
    • increasing coverage of currently licensed vaccines which prevents pneumonia and related complications. 
  • These vaccines are already a part of childhood vaccination programmes
    • However, the coverage and benefits need to be expanded to the identified high-risk adult population. 
  • The available evidence has resulted in the global stakeholders agreeing to ‘the Immunization Agenda 2030’ 
    • which has emphasised that countries should consider extending the benefit of vaccines to all age groups. 

Reasons for lack of Adult Vaccination

• National vaccine policy of India, 2011
  • The first and only policy of India, released in 2011. had no mention of adult vaccination. 
  • The National Technical Advisory Group on Immunisation (NTAGI) in India
    • on a few occasions, discussed adult immunisation but stayed away from any recommendation for the general population except for 
    • the vaccination of health workers as high-risk groups, for hepatitis B vaccine, etc.
• Low Private Sector participation
  • Outside the Government, professional groups such as 
    • The Association of Physicians of India and the Indian Society of Nephrology have released guidelines on adult vaccination.
  • However, as these are voluntary and thus the private sector share in vaccination in India is very small
• Limited Data
  • Therefore the impact remains unknown and is likely to be low. 
  • There is very limited data on the burden of vaccine-preventable diseases (VPDs) in adult age groups in most countries including India. 

Steps to be taken 

• Expand the mandate of NTAGI:
  • It may review available scientific evidence and provide recommendations on adult vaccination in India. 
  • These recommendations can be regularly revisited and revised once additional data become available. 
  • An NTAGI subgroup on adult vaccination can also be constituted to facilitate the process.
• Strengthen Vaccine-Preventable Diseases (VPD) Surveillance System:
  • The capacity to record, report and analyse data on the disease burden and immunisation coverage need to be enhanced. 
  • The focus has to be on analysing immunisation coverage and VPD surveillance data by age and other related stratifiers. 
• Capacity Building:
  • The capacity of research and academic institutions to conduct operational research including 
    • the cost-benefit analysis and to guide evidence-informed decisions needs to be boosted. 
  • Such analysis and evidence can be used by NTAGI in decision-making processes. 
• Drafting India’s national adult vaccination policy:
  • The process for developing and drafting a road map or the policy and strategy should be initiated. 
    • Any such policy should factor in the learnings and lessons from the ongoing COVID­19 vaccination drive as well. 
  • Policy questions in need of the answers should be identified now, and the process to generate evidence started. 
    • Otherwise, there is a  risk of asking policy questions 10 years down the line which can be answered in a few years from now. 
• Operational level 
  • The shortage of life-saving rabies vaccine in India in 2019 is a reminder of the risk and vulnerability in vaccine supply. 
  • To ensure vaccine security and be future-ready for adult vaccination.
    • The existing public sector vaccine manufacturing units in India should be revived and more need to be set up.
• Awareness drive:
  • Initiatives should be taken to educate public health care providers and members of professional associations 
    • about currently available vaccines for adult age groups. 
  • This can help people to make an informed choice and healthcare providers to share information with citizens. 

Way Forward / Conclusion

• Benefits of Licensed Vaccines
  • In COVID­ 19 vaccination, it was the government facilities which have delivered 93%­- 95% of total vaccine shots. 
  • The vaccination is a reminder that the benefits of already licensed vaccines are yet to reach the adult population.
• Institutionalise Mechanism 
  • It is an opportunity for health policymakers in India to institutionalise mechanisms to examine the need for adult vaccination.
  • Also to make policy decisions and empower adult citizens to make informed choices on whether they wish to get currently available vaccines. 
• Expanding Immunisation
  • It is time to plan for and expand the benefits of vaccines, for all age groups as part of the Universal Immunization Programme Plus in India. 
• Drafting and developing a national adult vaccination policy
  • The strategy could be one such concrete step in the right direction. 
  • The success of strategizing can be seen in the childhood vaccination programme.
    • It is amongst the best performing government health programmes in India. 

Source: TH