Here’s Why India Needs a Pneumonia Vaccine Across States

On World Pneumonia Day, take a look at life-saving intervention from vaccine preventable illness.

In India, pneumococcal disease is the leading cause of vaccine preventable death and illness among children under 5.

(Photo: iStockphoto)

A major cause for infant deaths is the fact that India is home to 1/3rd of the world’s unimmunized children. The 9.6 million unimmunized children in India today account for more than one-third of the 27 million unimmunized children around the world.

Pneumonia is the single largest cause of death among children under five worldwide. Pneumococcal pneumonia (Streptococcus pneumoniae) is the most common cause of severe pneumonia among children in the developing world.

In India, pneumococcal disease is the leading cause of vaccine preventable death and illness among children under 5. It is a major cause of hospitalizations or even death in children under 5 years in the country.

Unfortunately, even when treatment for pneumococcal pneumonia is possible, in the form of a Pneumococcal Conjugate Vaccine or PCV, the costs associated with treatment can have substantial impact on the financial stability of low-income states.

In the Indian setting, the burden of pneumococcal disease is the greatest among under privileged children and vulnerable populations who do not have access to affordable quality health care.

The incidence of the ailment is particularly higher in places marked by poverty, illiteracy, lack of hygiene, poor diet and nutrition. Common issues such as malnutrition, poor access to care, overcrowding, immune-compromising infections, low levels of parental education contribute to the fact that a child born in the poorest fraction of society has many times the risk of pneumonia and death compared to a child born in the wealthiest fraction.

The vicious cycle of poverty-associated risks are sick children get sick more often, negatively impacting their growth and development. Their weakened immune system puts them in a greater risk of pneumonia.

Also, poor children, and those with less educated parents, are less likely to be immunized.

India Accounts for Nearly 20 Percent of Global Pneumonia Deaths

The states with the highest pneumococcal pneumonia burden are Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh.

To honour commitments to the United Nations Sustainable Development Goals, India now has a means to address this disease burden, thus enabling children to see their fifth birthday and pave the way for their healthier life.

A Pneumococcal Conjugate Vaccine (PCV) was introduced under the Universal Immunization Programme from 2017 in a phased manner in identified districts of Uttar Pradesh, Bihar and the entire state of Himachal Pradesh.

It is currently being scaled up to include Madhya Pradesh, Haryana, remaining districts of Bihar, six new districts of Uttar Pradesh and nine districts in Rajasthan.

PCV - Safe & Effective Method for Protection

PCV also provides protection against meningitis and other diseases caused by the pneumococcus bacteria and can be administered to children at 6 weeks, 14 weeks and 9 months (booster dose) of age. This expensive vaccine has been available in the private market in India, but has not been accessible to vulnerable children who need it most. These children include low birth babies, born in remote locations and whose families who do not have access to information and many times those who are unable to afford such a vital yet expensive vaccine.

With the introduction of PCV, India is strengthening its fight against pneumonia and meningitis to help save the lives of children and contribute to the cause of a healthy nation.

PCV is also helping erase the complex inequity into which children living in poverty are born. Hardships associated with everyday life for children in poor households are the risk factors for childhood pneumonia and pneumonia mortality.

Given the significantly increased risk of pneumonia – and recurrent infections – borne by children in poverty, it stands to reason that these children will benefit the most from the protective boost afforded through vaccines such as Hib, pneumococcal and measles vaccines. The disadvantaged sections of society will greatly benefit from the introduction of PCV in the UIP, in terms of out-of-pocket treatment expenditure borne by them.

The additional benefits of PCV are protection against life-threatening meningitis and sepsis, tempering the threat of antibiotic resistance and overuse and preventing life-long disabilities.

Both the Government of India and the States that are rolling out these vaccines have put in place robust monitoring mechanisms to ensure that any untoward incident is efficiently handled and that the initiative to save lives that are vaccine preventable is realised. Over the years the government has launched and implemented several programs and schemes dedicated to infant health. One such scheme being Intensified Mission Indradhanush (IMI) to achieve universal immunization of children in the country.

The biggest impact made through the successful implementation of this movement has been that the number of deaths of children under the age of five in India declined to 802,000 in 2017 from around 1 million two years ago. That means close to 200,000 lives have been saved.

India’s ‘Mission Indradhanush’ Programme

(Photo Courtesy: Facebook/UNICEF India)With the introduction of PCV, India is strengthening its fight against pneumonia.

A recent UNIGME (UN Inter agency Group for Child Mortality Estimation) report validated that India recorded lowest infant deaths first time in last five years, i.e., from 867,000 in 2016 to 802,000 in 2017. Acknowledging India’s significant achievements and commitment in addressing common challenges to improve the health and wellbeing of women, children and adolescents worldwide, the global community has entrusted Govt of India to host this year’s prestigious global Partners’ Forum and lead the dialogue on enhancing country-level action on Sustainable Development Goals 2030.

The 2018 Pneumonia and Diarrhoea Progress Report released by the Johns Hopkins Bloomberg School of Public Health ahead of the 10th annual World Pneumonia Day — observed on November 12 — describes efforts to fight pneumonia and diarrhoea in 15 countries with the greatest number of deaths from these illnesses.

Besides India, the other countries are Nigeria, Pakistan, the Democratic Republic of Congo (DRC), Ethiopia, Chad, Angola, Somalia, Indonesia, Tanzania, China, Niger, Bangladesh, Uganda, and Côte d’Ivoire.

The report also calls for further scale up of vaccine to all states, as the vaccine is currently available in only six states till date.

Last year, the report had lauded India for its Mission Indradhanush programme saying that “the initiative actualises its vision towards equitable immunisation and demonstrates its commitment to the nation’s health.

This year, India would be presenting Intensified Mission Indradhanush (IMI) as a success story at the fourth edition of Partners’ Forum 2018 on 12th and 13th December 2018 in New Delhi.

The forum will be co-hosted by the Ministry of Health and Family Welfare, Government of India and PMNCH. A big focus of the forum will be to share stories of how states and countries are successfully collaborating across sectors and stakeholders to fast-track improvements in health and well-being of women, children and adolescents.

(Dr V K Bansal is the Director of MCH, NHM, Haryana. He started working for NHM Haryana in 2017. Earlier, in 2010 he was the Chief Medical Officer, Panchkula. He has also served as Senior Medical Officer in 2009 and Medical superintendent, Panchkula in 2007.)