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. 

    History of Vaccination

    • The first vaccine against smallpox became available in 1798 
    • It was always for a far wider age group, including for adults. 
    • However, after smallpox eradication and the launch of the Expanded Programme on Immunisation (EPI) across the world in the 1970s and in India in 1978 
      • there were concerted efforts to increase vaccine use and coverage in children.

    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. 

    National Technical Advisory Group on Immunisation (NTAGI)

    • It was established by an order of the Ministry of Health and Family Welfare (MoHFW) in 2001.
    • Chaired by 
      • Secretary of Health and Family Welfare, Ministry of Health and Family Welfare
    • Co-chaired by:
      • Secretary of the Department of Biotechnology, Ministry of Science and Technology and 
      • Secretary of the Department of Health Research, Ministry of Health and Family Welfare.
    • As India’s apex advisory body on immunization, the NTAGI provides guidance and advice to the MoHFW on provision of 
      • vaccination and immunization services for the effective control of vaccine-preventable diseases in the country.
    • The NTAGI is not a policy-making body in its own right and has no regulatory function.

    Source: TH