By Ranjit Devraj

NEW DELHI

India and other South Asian countries must deal with a dangerous backslide in routine infant vaccinations during 2019—2021 brought on by the COVID-19 pandemic and restrictions imposed to counter its spread, say UNICEF officials.

“Immunization coverage has fallen for nearly all vaccines in the routine schedule between 2019 and 2021,” Rene Ekpini, regional advisor for health at the United Nations Children’s Fund (UNICEF) South Asia told SciDev.Net.

Across the world, some 25 million children missed out on one or more doses of the combined diphtheria-tetanus-pertussis (DTP3) vaccine, according to data released in July by the World Health Organization and UNICEF. “Of the children who missed out, five million were from South Asia,” said Ekpini.

Diphtheria, tetanus and pertussis are serious bacterial infections that can be prevented in children with the combined DPT vaccine that has been part of universal immunization programs since 1948.

“Despite having the largest birth cohort in the world, India was able to prevent a further backslide through special drives such as the Intensified Mission Indradhanush, which enabled the country to bring down zero-dose to 2.7 million in 2021”

Mainak Chatterjee, UNICEF India

According to the UNICEF/WHO data, 3.4 million of the unvaccinated or under-vaccinated children were from India. The country also accounted for 15 per cent of all children who did not receive even a single dose of the DTP3 vaccine — considered a marker for immunization coverage.

Ekpini said that the impact of the drop in coverage would be different and dependent on the contagiousness of a particular disease. “A five percentage point drop in measles coverage may not sound high, but because of its extreme contagiousness it can affect all children who lack protection against it, resulting in large outbreaks,” he said.

Inadequate coverage has already resulted in outbreaks of measles and polio over the past 12 months, underscoring the need to immunize children, adolescents and adults against preventable diseases and keep societies healthy, Ekpini said.

While vaccine coverage dropped in every region, the East Asia and Pacific region recorded the steepest reversal in DTP3 coverage, falling by nine percentage points in two years, with the highest numbers coming from India, Pakistan, the Philippines and Indonesia, according to UNICEF/WHO.

Globally, DTP3 coverage was set back to its lowest level since 2008 which, along with declines in coverage for other basic vaccines, pushed the world off-track to meet global goals, including the immunization indicator for the UN’s Sustainable Development Goals.

The decline was attributed to several factors, including increased misinformation, COVID-19 related issues such as service and supply chain disruptions, resource diversion to pandemic response efforts, and containment measures that limited immunization service access and availability.

“This historic backsliding in rates of immunization is happening against a backdrop of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity and missed vaccinations can mean common childhood illnesses quickly become lethal to them,” a UNICEF/WHO statement said.

While India and Pakistan topped the list of countries that saw the greatest increase in children not receiving a first dose of DTP between 2019 and 2020, they were also quick to bounce back.

Pakistan now figures among countries that successfully fought back declines to return to pre-pandemic levels of coverage “thanks to high-level government commitment and significant catch-up immunization efforts”, UNICEF/WHO said.

In India, progress towards reducing the number of zero-dose children was impacted by the pandemic and the number of children who did not receive the first dose of the DTP vaccine was estimated to have increased to three million in 2020, up from 1.4 million in 2019, according to Mainak Chatterjee, health specialist at UNICEF India.

“Despite having the largest birth cohort in the world, India was able to prevent a further backslide through special drives such as the Intensified Mission Indradhanush, which enabled the country to bring down zero-dose to 2.7 million in 2021,” Chatterjee told SciDev.Net.

In February, the government launched what it described as “the largest vaccination drive globally”, reaching out to missed children and pregnant women. India already vaccinates more than 30 million pregnant women and 26 million children through its Universal Immunization Program.

India not only managed to prevent a decline in routine coverage, it also ensured continued focus on COVID-19 vaccination, said Chatterjee. “A rapid resumption of routine immunization services coupled with evidence-based catch-up campaigns enabled India to limit the backslide,” he said.

“Unvaccinated or ‘zero-dose’ children tend to live in the most vulnerable communities within countries and they suffer the most when hurdles to vaccination increase — the number of zero-dose children was actually found [to be] higher than the number who had received partial vaccination,” Ekpini said.

Families of zero-dose children are more likely to be deprived of other essential health services as well, Ekpini said, adding: “For this reason, efforts for strengthening immunization need to be directed to strengthening overall health and community systems rather than immunization in isolation.”

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Courtesy: Sci Dev Net

The post Child vaccination coverage drops in India, Pakistan first appeared on Sindh Courier.

By: Tahira Ali, Savaila and Zahra Rao

We are writing from one of the only two countries in the world, where the wild polio virus remains endemic. As of October 2021, Pakistan and Afghanistan are the only two countries with one case of Wild Polio Virus (WPV1) each. The one polio case to have been reported in Pakistan is in district Killa Abdullah, Balochistan.

In 2020, Balochistan reported 19 out of overall 71 wild polio cases in Pakistan. Although a majority of polio refusal cases come from the Khyber Pakhtunkhwa, Balochistan cannot afford to slacken its efforts at polio eradication. Having been neglected politically and economically these past seven decades, the province’s development, in many ways has been stunted. It suffers from multidimensional poverty (71% of the population in Balochistan is multi-dimensionally poor; rural population is 85% and urban population is 38% multi-dimensionally poor); lack of infrastructure; an extreme water shortage (62 percent of Balochistan is deprived of safe drinking water and more than 58 percent of its land is uncultivable due to water scarcity); dearth of employment opportunities; illiteracy (45% of Balochistan’s population is illiterate), refugee crisis and a history of gender imbalance.

The Polio Eradication Program in Pakistan has been functional since 1994. Its numbers are a testament to its success; polio-positive cases in Pakistan have declined a 99 per cent from the 20,000 cases reported in the early 1990s. However, polio is a highly viral disease and thorough and rigorous preventative action and coverage is needed for it to be eradicated completely and sustainably. Much of Balochistan’s rural population is scattered and difficult to access. Furthermore, Balochistan has a unique set of cultural norms and history which pose challenges to polio-eradication campaigns.

With such a situation at hand, a group of rural activists has come together to, amongst other things, encourage their local communities to get their children immunized against polio. National Rural Support Program (NRSP) and Balochistan Rural Support Program (BRSP) under the ambit of the European Union funded Balochistan Rural Development and Community Empowerment (BRACE) Program are supporting locals of nine districts of Balochistan to organize themselves into network of local Community Institutions (CIs). These CIs are participatory, self-directed, and democratic bodies and form the Social Pillar to complement the Administrative and Political Pillars of the province. The key features of the Social Pillar are that it has access to each and every household, and is able to mobilize them for common causes. Under the BRACE Program almost 300,000 households are being mobilized into 23,439 Community Organizations (COs), 4,973 Village Organizations (VOs) and 229 Local Support Organizations (LSOs). For polio eradication, it is essential that the network of CIs is engaged.

In October 2019, a Polio Vaccination Officer was facing resistance from multiple households in the village Kamal Zai, a village in district Pishin, Balochistan. The refusing families had two kinds of reasons for refusals; misconceptions of religious nature and issues with the Vaccination Officers. Both of these are rooted in the fear of the unknown.

However, the LSO members challenged this narrative with their agenda of “hakeeki (true) development”, as vocalized by Abdul Hayee, President of LSO Zalan.

“We do not allow outsiders (to the village) into our house”

Within the village, Kamal Zai, there were three households which had refused to get their children immunized. These households comprised eleven families and contributing to the number of children deprived of polio immunization in this cycle was stacking up to be significant. The Union Council Polio Officer, who is also a medical technician informed the LSO president of this concern and requested his support. The UC Polio Officer, LSO President and two members of the LSO Committee met at the local hospital to find solutions to this problem. The group decided that more than anything, it was important to find out the real reason behind the families’ refusal to immunize their children. They visited the relevant households and met with the families. Only the UC Polio Officer and the LSO President were allowed inside the house. A detailed conversation made it clear that the families had issues with the polio vaccinator and not with the vaccine itself. The family members mentioned that they did not appreciate outsiders (to the village) coming to their houses to administer the polio drops. The party took this issue to the District Polio Team who appreciated their efforts and explained their side of the situation: the service could not be decentralized to match each village with a polio worker from their locality, if such a person was even available. However, the LSO leaders could accompany the Polio Officers to the households.

With the issue resolved, the UC Polio Officer, LSO President and other members of the LSO again visited the three refusing households to administer the polio drops. The family head happily agreed to taking a picture as proof of his consent to getting his children immunized and for others to take inspiration from this.

Does Polio Vaccine render a child infertile?

Having successfully overcome this challenge, the LSO members gained confidence in their ability to communicating with local people who were not allowing their children to be immunized against polio. And so when a month later, they came to know of a household refusing to immunize their children against polio in village Hajazai, they decided to tackle the issue head on. The head of this household believed that polio drops make children abusive and aggressive. Furthermore, there were rumors that the vaccine was part of a family planning campaign and would render their child infertile. The LSO President was well-respected in the village because of his previous ties and philanthropic work carried out in the region; he used this linkage to further build rapport with the household. He explained that he was leading by example and had gotten his three children vaccinated as well. Following a detailed discussion, the head of household allowed the Polio Officer to vaccinate his three children and also convinced his neighbor to get his four children vaccinated.

The essence of Abdul Hayee’s hakeeki (true) development is inclusivity. It is context-based and realizes that development is not about tall buildings but about enabling people to live a better quality of life. This perspective aligns with BRACE Program’s Community Awareness intervention, through which beneficiaries are informed of the importance of health and hygiene, education and vaccinations.

While it is difficult for the government to access each and every household, especially in rural Balochistan where population is sparsely spread-out, initiatives taken by the local community itself under projects like the BRACE Program are very effective. The government should take note of this and help build linkages between the local governments and CIs and their leaders like Abdul Hayee to enable an effective and efficient service delivery of polio vaccination for a polio-free Pakistan.

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Tahira Ali, Savaila and Zahra Rao are Islamabad and Quetta based development professionals. They are on Twitter: @savaila1; @rao_zahra and @TaheeraAli.

The post Communities coming together for polio immunization in Balochistan first appeared on Sindh Courier.