India at 75: How vaccination programme evolved in the country over the years?

At present, a total of 13 vaccine-preventable diseases are covered against which free immunisation is provided which include: Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, Hepatitis B, Meningitis, Pneumonia, Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis.

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After declaring itself smallpox free in 1977, India started focusing on better health and reducing mortality.

In the recent decades, India has made tremendous progress with respect to vaccinating its citizens. Amid the ongoing coronavirus pandemic, the country’s cumulative COVID-19 vaccination drive surpassed the 200-crore milestone last month. According to reports, since 2000, the country has introduced a number of new vaccines into its Universal Immunisation Programme (UIP). Vaccination is one of the most cost-effective ways of intervention to contribute to a child’s health and survival. According to studies, the history of vaccines and vaccinations starts with the first effort to prevent and eradicate Smallpox. A study published in the Indian Journal of Medical Research reveals that historians and physicians have sometimes referred to smallpox as the ‘Indian Plague’, which suggests that the disease might be widely prevalent in India in earlier times.

According to public health experts, inoculation, ‘the process of injecting an infective agent in a healthy person, which leads to often mild disease and preventing that individual from future serious disease’ was common in India in ancient times. After the first small vaccine was discovered, it reached India in 1802. Anna Dusthall, a three-year-old child from Bombay (now Mumbai) became the first person in India to receive the smallpox vaccine on June 14, 18026. Meanwhile, through human chain of vaccinees, the smallpox vaccine as lymph was sent to Madras, Poona (Pune), Hyderabad and Surat from Bombay. With several hurdles and challenges over the next few years, the system of ‘Paid vaccinators’ was started in the second half of the 19th century in the country.

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In 1892, the Compulsory Vaccination Act was passed in India to ensure higher coverage of smallpox. According to reports, the law was in force in approximately 80 per cent of the districts of British India in 19386. Between 1900 to 1947, various “socio-scientific-geopolitical events” affected vaccination efforts in the country. Some of these changes include the outbreak of cholera and plague, the first world war, and a new scientific understanding of the smallpox vaccine among others. Studies show that the vaccination coverage went down and from 1944-1945 India reported the highest numbers of smallpox cases in the last two decades.

Interestingly, at the beginning of this period, India achieved another important milestone. Between 1904-1908, typhoid vaccine trials were carried out in the country. The British Army Medical Department’s Anti-typhoid Committee carried out extensive trials of vaccines in 24 units of the British Army, joining their operations in India and Egypt. Over the next few years, several other crucial steps were taken in the country. Between 1910-1930 a number of vaccine institutes were set up in various provinces of British-ruled India. After India attained independence in 1947, BCG laboratories were set up in Chennai’s Guindy and the vaccination was initiated at pilot level. From 1951 onwards, mass campaigns of BCG was started across the country.

It is noteworthy that after the World Health Assembly passed a resolution to eradicate smallpox, India also started to focus on launching mass vaccination programmes. In 1962, India launched its National Smallpox Eradication Programme along with National Tuberculosis Control Programme which included BCG vaccination for the people. With tremendous effort towards the battle against Smallpox, India declared itself Smallpox free in 1977 after reporting the last case of the deadly disease in 1975. In early twentieth century, at least four vaccines (smallpox, cholera, plague, and typhoid) were available in the country.

One of the game-changing development was the setting up of vaccine manufacturing units in the private sector too and these units started developing vaccines other than smallpox. In 1957, the Pasteur Institute of India developed an influenza vaccine and in 1970 a BPL inactivated rabies vaccine. In the same year, this institute developed and produced, for the first time in India, an indigenous trivalent oral polio vaccine (OPV). As India rapidly started focusing on research and development, soon the majority of vaccines available in the global market had become available in the Indian market also. Now, the vaccine manufacturing units in India were producing not only smallpox vaccines but a few of these were also producing Diptheria, pertussis and tetanus (DPT), Diptheria and tetanus (DT), tetanus toxoid (TT), oral polio vaccine (OPV) and other vaccines except measles vaccine.

After declaring itself smallpox free in 1977, India started focusing on better health and reducing mortality. With this goal in mind, in 1978, India launched a National Immunization programme called the Expanded Programme of Immunisation and introduced BCG, OPV, DPT and typhoid-paratyphoid vaccines. Over the years, more and more vaccines were added to the programme. In 1985, EPI went through major changes and it was relaunched as Universal Immunisation Programme (UIP). The major goals of this renovation were to rapidly increase immunization coverage, reduction of mortality and morbidity, establishment of a reliable cold chain system, and achieve self-sufficiency in vaccine production and manufacturing of cold chain equipment.

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In 1988, the World Health Assembly passed a resolution for polio eradication by 2000. Soon, the Indian government joined hands with global leaders to eradicate polio the first two National Immunization Days (NIDs) for poliomyelitis eradication in India were conducted on December 9, 1995, and January 20, 1996. In 1997, the Central government collaborated with WHO and established the National Polio Surveillance Project (NPSP). On February 25, 2012, WHO removed India from polio-endemic countries.

In 2010, India became the last country in the world to introduce a second dose of the measles vaccine in the national immunization programme. Along with UIP, the government has launched several other diseases specific programmes in the last 75 years. In recent decades, vaccine manufacturing and procedures for clinical trials have become systematic in the country. Moreover, the Department of Biotechnology (DBT) has also launched key initiatives to support basic and translational research for strengthening vaccine science that are currently under implementation which include: Indo – US Vaccine Action Programme (VAP), National Biopharma Mission (NBM) Ind-CEPI Mission and now Mission COVID Suraksha.

At present, a total of 13 vaccine-preventable diseases are covered against which free immunization is provided which include: Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, Hepatitis B, Meningitis, Pneumonia, Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis. In 2014, the central government launched another major health mission called Mission Indradhanush which seeks to drive toward 90 percent full immunization coverage for all children and pregnant women at a rapid pace.

Deemed as one of the largest public health programmes, UIP is targeting close to 2.67 crore newborns and 2.9 crore pregnant women annually. According to UNICEF, in the last two decades, India has made significant progress in improving health indicators, particularly those related to child health.

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