Kanchana TK, Director General, Organisation of Pharmaceutical Producers of India
“Vaccines are the tugboats of preventive health”, said William Herbert Foege, American epidemiologist credited with devising the strategy that helped eliminate small pox. Immunisation is a proven tool for controlling and even eradicating disease, and undoubtedly, childhood vaccines are one of the great triumphs of modern medicine. It has substantially reduced morbidity and mortality from infectious diseases in much of the developed world.
A successful immunisation programme is of relevance to India as it contributes to one fifth of global under five mortality with a significant number of deaths attributable to vaccine preventable diseases. There is no doubt that substantial progress has been achieved in India with wider use of vaccines, resulting in prevention of several diseases. However, a lot remains to be done.
Now, India has resolved to eliminate measles and control congenital rubella syndrome (CRS) by 2020. The Ministry of Health and Family Welfare has initiated measles-rubella (MR) vaccination in the age group of nine months to less than 15 years in a phased manner across the nation. The campaign aims to cover approximately 41 crore children. The aim is to rapidly build up immunity for both measles and rubella diseases in the community to knock out the disease. Fortunately, we have effective and affordable vaccines to take on all the three diseases-measles, mumps and rubella.
According to IAP Guidebook on Immunisations 2013-14, while single dose of rubella/ rubella containing vaccines is enough to provide almost 100 per cent protection against the disease, two or more doses of measles and mumps vaccines are needed to accord adequate protection. For purposes of universal immunisation, the vaccine should be introduced in areas where immunisation coverage is at least 80 per cent and can be sustained on a long-term basis.
The Guidebook also states that the MMR vaccine should be given early to have much higher coverage than introducing it late at the time of second booster of DTP. According to available evidence, both these vaccines (MR/MMR) can be given safely at different ages including at 9 months of age. It is critical to achieve minimum 80 per cent coverage of childhood vaccination which will not allow virus to circulate freely and infect women of child bearing age, thus avoiding any inadvertent epidemiological shift.
However, scepticism towards immunisation still prevails. Globally too, the opposition to vaccines has remained a concern. Public opinions about vaccination include varied and deep-seated beliefs, a result of the tension between divergent cultural viewpoints and value systems. While some of these have been triggered by philosophical and personal beliefs, most of them are due to unfounded understanding of science and modern medicine. World over there are a few voices that question the safety of the vaccines. Especially for vaccines for children, is it ethical to let these voices determine the choice one makes as parents for their children? Are these voices emerging from science and rationality? Or are they misinterpretations, myths or lack of awareness?
While, the future of immunisation depends on the success of medical research for vaccines that are simpler to administer and will provide a more substantial and long-lasting immune response, the need for continued communication and collaboration between medical and public health officials and the public regarding acceptable and effective immunisation continue to remain critical. Candidly, all vaccines do have inherent risk of adverse events following immunisation (AEFI), but the benefits are undoubtedly immense, and clearly outweigh the risks. As the world progresses, science-based evidence will deliver the proof points as vaccines continue to play an important role in improving public health.