Partner | Immunisation Of Children Is The Need Of The Hour

[00:00:00] Hello and welcome to today's podcast, I am your host Prathik Lidhu.

[00:00:05] It's a special session we have today dedicated to India's youngest citizens on children's day.

[00:00:11] We'll be talking about the critical role of immunization or in simpler words, the importance

[00:00:16] of vaccinating your young ones.

[00:00:19] Getting the right vaccine that the right age is pivotal to protect a child's life and

[00:00:24] future.

[00:00:25] It is in fact the most effective and affordable way to ensure a healthy future for our kids.

[00:00:30] It is key to a child's survival and missing it or the lack of awareness around it can be

[00:00:35] life threatening.

[00:00:37] You'd be shocked to learn that the world's most vulnerable children miss out on immunization

[00:00:42] and as a result of it, a healthy life.

[00:00:44] In India at the same time there are multiple efforts that are being taken on this front to ensure

[00:00:50] accessible immunization to create awareness, reduce vaccine hesitancy and more importantly

[00:00:56] to strengthen India's health care system.

[00:00:59] I'm joined by pioneers in this field to tell you more about the immunization efforts in

[00:01:04] India.

[00:01:05] We have experts joining from John Snow India private limited leading public health organization

[00:01:10] and from the ISAP India Foundation which is an organization that works closely with the Indian

[00:01:15] government in managing large and complex projects in routine immunization.

[00:01:20] They have been at the forefront for over 30 years helping create a stronger health care

[00:01:25] system in many parts of the country.

[00:01:28] We have Dr. Sanjay Kapoor managing director at John Snow India private limited.

[00:01:33] Under his leadership, JSI has developed a strong portfolio by raising over $100 million

[00:01:38] in new funding from bilateral multilateral donors and CSR.

[00:01:42] He has successfully established several new partnerships and alliances with public and private

[00:01:47] sector organizations.

[00:01:49] Under his leadership and guidance, JSI has witnessed the five-fold expansion of programs

[00:01:54] and size of the organization.

[00:01:57] He has had several organizational systems developed, garnered membership of key policy

[00:02:01] and technical committees of the government of India in overall leadership role.

[00:02:07] Dr. Kapoor has also been a recipient of several national and international awards for

[00:02:11] his exemplary work in the public health sphere.

[00:02:14] Along with him, we have Dr. Anurada Sunil, the medical director at ISAP India Foundation.

[00:02:19] Anurada's areas of interest include development of technology-driven solutions in healthcare

[00:02:25] and designing an implementation of innovative healthcare models.

[00:02:29] She worked with the National Health Services in the UK in primary care and acute hospital

[00:02:35] trusts for more than 10 years.

[00:02:36] Hello, Dr. Sanjay.

[00:02:37] Hello, Dr. Anurada.

[00:02:38] Thanks for speaking with me.

[00:02:40] My first question is to you, Dr. Sanjay.

[00:02:42] The most recent and the biggest immunization drives we saw was of course the COVID-19 vaccination

[00:02:49] drive.

[00:02:50] So, let's start with that as an example of giving a short introduction to how the immunization

[00:02:56] program actually works in India to give our listeners a little insight.

[00:03:01] So India has the world's largest immunization program.

[00:03:05] We have a system of vaccinators.

[00:03:07] We have about 250,000 vaccinators across the country who gave vaccination to about 27 million

[00:03:13] children who are born every year as well as 30 million pregnant women who get pregnant

[00:03:18] every year.

[00:03:19] So, we have a system of coaching where the vaccine just stood at a particular temperature,

[00:03:25] starting from the manufacturer up to the last mild connectivity.

[00:03:29] There are medical officers who plan the immunization program.

[00:03:33] The COVID-19 vaccination was laid on the existing universal immunization program of India.

[00:03:39] Same vaccinators were used, same cold change space was used.

[00:03:43] But the vaccines were developed in India in a very quick short period of time.

[00:03:47] They were basically COVID shield and the COVID vaccine and there were few others also.

[00:03:51] So, the entire COVID vaccination vaccine approval was done in a very short period of

[00:03:56] time because of the emergency nature.

[00:03:58] The government of India took a lot of steps to quickly get the approval.

[00:04:02] The manufacturers, they increased their capacity over time and the entire sort of 95% of

[00:04:08] India's eligible population was vaccinated in a very short period of time.

[00:04:12] And that is a very commendable work which the government of India has done.

[00:04:15] Of course, it was partnership there were other donors, other partners, private sector also

[00:04:19] played in and use also played a very important role which I can explain to you later on.

[00:04:23] And what is the role of the momentum routine immunization transformation and equity project?

[00:04:29] So, this project is supported by USIT and the project was given to JSI in August 2021

[00:04:38] to actively help government of India to rapidly scale up COVID vaccination across the country.

[00:04:43] So, based on the data, government of India elotted 18 states to JSI to help government

[00:04:50] of India and the 18 state governments to ramp up COVID vaccination in the country.

[00:04:55] We identified 26 NGOs who were part of this whole initiative.

[00:05:00] We worked at the grassroots level to make sure that there is information about COVID vaccination.

[00:05:05] There is clear answer for any missing patients which the local population may have.

[00:05:12] And it was very focused on vulnerable and marginalized populations because usually the government

[00:05:17] of India's programs reach to all populations but some at the margins are sometimes left out

[00:05:22] like truck drivers, like disabled people, like blind people, like transgenders, like migrants

[00:05:27] who were far away or people who would be usually left out of the healthcare delivery systems.

[00:05:32] So, what according to you are the few learnings that this project has gathered from the COVID-19

[00:05:38] vaccination drive that now can be used in routine immunization for kids especially.

[00:05:43] It's a good question and there were several learnings which were sort of generated when the

[00:05:48] COVID vaccination drive was sort of implemented led by government of India.

[00:05:52] So, in a nutshell the first lesson learned is that we should do an evidence generation

[00:05:58] of the communities and target our strategies according to the needs of those particular

[00:06:02] communities which basically means one size will not fit all and was it something that wasn't

[00:06:07] happening earlier? It was being done but not at that level and because there was some hesitancy

[00:06:13] in the COVID vaccination and we were in an emergency situation. It was all the more important

[00:06:18] that we had to convert the nasirs into a serious and there was a lot of time because it was

[00:06:23] an emergency situation. routine immunization has been going for decades but this was an emergency

[00:06:29] situation and we had to somehow get into the communities understand them and devise quickly

[00:06:33] device strategies to address those issues and then get the vaccines to them and it worked very well

[00:06:39] and that's a very good lesson which we have learned. The second important lesson is that

[00:06:43] you know there should be a lot of data collection and strategies should be devised on data

[00:06:48] and because the government of India developed the COVID app through which people were able to

[00:06:55] get their vaccines you know defined where they can get the vaccine when it will be available

[00:06:59] that was a very good denot technology which really acted as a game changer in India.

[00:07:04] Had that not been there it would have been very difficult for us to reach so many millions of

[00:07:09] population in such a period short period of time. Now based on that learning the whole

[00:07:15] program now is for the universal immunization the larger immunization program they are developing

[00:07:20] what is called a human. It is based on the COVID model module but it is much more expanded now

[00:07:28] and it will be useful for all routine immunization for pregnant women as well as for

[00:07:33] and it will include different kinds of it will include all kinds of vaccines which are available

[00:07:37] in the immunization program of the country. The third lesson is that engagement of local

[00:07:42] NGOs, local influencers as well as community leaders whatever are the local influencers

[00:07:48] and they may be different in different communities some places religious leaders are more important

[00:07:52] some places youth clubs are more important some places feed based organizations are there so

[00:07:58] whatever are sometimes the panchaya is a very strong so whichever are the local influencers

[00:08:03] they we should leverage their presence and use them for reaching out to the communities

[00:08:07] and convincing them for the need for vaccination that is another lesson which we have learned

[00:08:13] the fourth lesson is that you know there should be a tab on misconceptions and especially on

[00:08:18] the social media that never used to happen before COVID vaccination there was lot of misconceptions

[00:08:25] lot of wrong ideas were being you know that vaccination we should not take it will do this it will

[00:08:30] do that but keeping a tab on that and doing something to negate those misconceptions was a very

[00:08:36] important lesson learnt which will help now in routine immunization and therefore going forward

[00:08:41] government of India has decided that it will keep a tab on it through various means mechanisms

[00:08:46] partners on its own to make sure that if there are some negative messages going into the community

[00:08:51] vaccination they should be addressed so that you know more and more people children can get

[00:08:56] vaccinated so that's another role of media was also very very important in COVID vaccination

[00:09:02] media can play a very important positive role if it wants to by creating good positive stories

[00:09:07] you know about people who have gotten vaccinated people who have gotten other people more vaccinated

[00:09:13] so that you know they are acting as you know changes into the communities so these are the

[00:09:18] in a nutshell few sort of lessons which we have learnt which can be used for routine immunization now

[00:09:23] and Dr. Anuradha would you have something to add to this yes we are all aware that COVID-19

[00:09:30] vaccination was one is the biggest vaccination drive in the history of humankind

[00:09:36] and there are very valuable lessons that have emerged through this vaccination drive that have

[00:09:41] the potential to be replicated into the Rotany immunization as well I will talk about a couple of

[00:09:47] points or the lessons that we have learnt firstly the role of local NGOs local NGOs have played

[00:09:54] a very very significant role in vaccination drive during the COVID-19 vaccination

[00:10:00] there being engaged in the community they are understanding of the complex on-ground situations

[00:10:06] and the local nuances played a very critical role in the success of the COVID-19 vaccination

[00:10:12] coming to the next point public private partnerships they also played a very big role in

[00:10:17] vaccine distribution we all must have seen that the vaccines are being delivered using boards,

[00:10:25] the camels and you know all sorts of modes of transport so that was one of the biggest

[00:10:32] achievement during this COVID-19 vaccination in vaccine distribution I think the same success can be

[00:10:38] replicated into Rotany immunization as well and as NGOs you know we at ISAP we established

[00:10:46] intersectoral relationships and a great coordination between various government departments as

[00:10:51] well like we worked with the Women and Child Department, Education, Skill Development Department,

[00:10:55] Social welfare and obviously the health department as well so there was a very big coordination

[00:11:01] that was happening during the COVID-19 vaccination I think these lessons or leverage

[00:11:08] these groups can also be utilized in the Rotany immunization as well. Next I'll talk about the

[00:11:15] building public trust we are all aware that during the initial phase of vaccination there was

[00:11:21] lot of myths and rumors going around about the vaccination but eventually all this was overcome

[00:11:27] by using effective communication and community engagement strategies and finally reaching out to

[00:11:33] the unreach you know there was a lot of remote areas in our country which is very difficult to reach

[00:11:39] out to but during this COVID-19 vaccination there was special vaccination drives and community

[00:11:45] engagement activities that were deployed to reach out to these communities and we were able to see

[00:11:50] great success in COVID-19 vaccination I think these are some of the strategies like enriching out

[00:11:57] special people like coal mine workers, PVTG populations, tribal populations, disabled people

[00:12:04] so there was I could list out the entire list of entire spectrum of people who normally would have

[00:12:11] been unreach but COVID-19 vaccination we were able to reach out to all of them so in the same way

[00:12:16] I think the same lessons can be replicated in Rotany immunization as well to reach out to those children

[00:12:22] who normally would be unreachable to the regular programs. One last point I wanted to mention

[00:12:30] which COVID vaccination has given a lesson is that leave no one behind. Everybody's equally

[00:12:36] important, the peripheries have to be taken as important as the center of the population and that's

[00:12:43] actually like something you know which can be used for a general vaccination as well okay so before we

[00:12:50] get into more details I want to get some context on where we currently stand as a country in our

[00:12:57] immunization coverage and how many people have been reached and what should we be doing? What

[00:13:01] are some of those gaps that you can still identify right now. So if we are talking about routine

[00:13:07] immunization coverage India is doing fairly well in this sphere overall we have about 76 or 77

[00:13:15] national immunization coverage. If we talk about individual vaccines like TPD1 our coverage is

[00:13:22] over 95% similarly DPD3 coverage is about 95% our measles coverage for the first doses also 95%.

[00:13:31] So generally speaking India is doing very well yes during the COVID pandemic there was some

[00:13:39] slow down of the routine immunization because the same health workers were providing

[00:13:43] vaccine COVID vaccination and there was lack of movement of there were lockdowns and therefore

[00:13:47] there was some slowing down of routine immunization to the extent of about 6% but after the COVID

[00:13:53] pandemic sort of reduced India has been able to catch up and now we are now we have caught up on

[00:14:00] the last ground which we did. We think the pre-COVID numbers we have already achieved pre-COVID

[00:14:06] demand fact now we are improving upon the pre-COVID numbers also as I mentioned to you India's

[00:14:12] Re-mination program is largest in the world we have about 27 million new bonds every year who are

[00:14:16] vaccinated and 30 million pregnant women who get vaccinated every year. In terms of COVID vaccination

[00:14:24] coverage first dose coverage we were able to achieve 97% coverage of the eligible population which is huge

[00:14:31] considering that you know we have a 1.4 billion total population and even the second

[00:14:35] of second dose coverage was also 90% for India which was unthinkable there were lot of

[00:14:40] skeptics who felt that India will not be able to do it in a very short period of time but you know

[00:14:45] here we are we did an excellent job of sort of ramping up the COVID vaccination in a very short period

[00:14:50] of time. So generally speaking India is doing fairly well and it is making a lot of continued

[00:14:56] and rapid progress we are adding new vaccines every year now we added rotavirus few years back

[00:15:01] we added the PCV company for five years back we are also thinking about adding new more vaccines also

[00:15:07] and the equitable coverage is also improving now so people who were marginalized or vulnerable

[00:15:12] they are being specially taken care of there are specific campaigns which the government

[00:15:18] of India called IMI's or intensified mission in the Tanish. We have done three rounds which are

[00:15:24] basically meant for tracking children who are either dropout or leftouts so those have also given

[00:15:30] us very encouraging numbers and how is JSI a part of this whole initiative and what role does JSI

[00:15:36] play in the larger Indian health care sector. So JSI is a not for profit organization and we

[00:15:44] were we are a key partner of government of India and state governments in helping them to ramp up

[00:15:50] COVID vaccination and routine immunization also the COVID vaccination grant was provided by USA

[00:15:55] and the momentum routine immunization but for other routine immunization activities we have

[00:16:00] several donors which provide us funds and we in turn are a member of all technical committees

[00:16:05] of government of India on immunization. For example, we also anchor the immunization technical support

[00:16:11] unit for government of India which actually acts as the nerve center for helping the government

[00:16:17] of India to plan policies get data and you know defined strategies on what should be done

[00:16:22] for ramping up the routine immunization. We help the government of India in introducing new

[00:16:29] vaccines rollout for example we were the partner for rolling out rotavirus vaccine across the

[00:16:34] country. We were the partner to government of Indian rolling out the new local vaccine for pneumonia.

[00:16:39] So JSI anchors the AFI setup for government of India. AFI is called adverse events following

[00:16:47] immunization it's a very important component of any immunization program in the world and we provide

[00:16:52] them with all the information on what AFI is happening and you know we do case studies.

[00:16:57] If there are any issues with vaccination we sort of do scientific analysis of that and provide

[00:17:02] information to the government to take actual and accordingly the action which they have to take.

[00:17:07] Now Dr Anuradha one of the biggest challenges faced even during the COVID-19 vaccination

[00:17:12] drives was vaccine hesitancy right? How rampant is it when it comes to children's vaccination

[00:17:18] and how do you usually fight it? Vaccine hesitancy among parents still a challenge in several

[00:17:24] pockets of our country. It's a very complex issue you know driven by various factors like misinformation,

[00:17:30] fear of side effects and cultural beliefs. We have seen several incidentals during the COVID

[00:17:36] vaccination itself that parents were fearful that child will become important and men will

[00:17:42] become infertile or they will become disabled or the death of some of the celebrities due to various

[00:17:50] other reasons where all are attributed to COVID vaccination and this is more pronounced in

[00:17:56] undeserved areas due to you know lack of access, lack of information and also disparities between

[00:18:03] urban and rural areas. So how do we overcome these kind of misinformation and misbeliefs?

[00:18:11] We basically I like I talked about earlier a deep dive into the community and engage the communities

[00:18:17] you know we have to work with the communities involving them in conducting workshops one to one

[00:18:23] or group workshops wherein we talk about their various concerns and addressing those particular

[00:18:29] concerns to mitigate this vaccine hesitancy. We also have to build awareness amongst the community

[00:18:35] about the benefits of vaccination. We also have to talk about mitigating the misbeliefs and also

[00:18:41] build the trust and the awareness amongst the community and thirdly we have to also improve

[00:18:47] the public private partnerships to strengthen the vaccination programs amongst the

[00:18:51] unreached areas to improve the coverage and also combatting the hesitancy. Do you think post COVID

[00:18:56] there has been like a decline in vaccine hesitancy generally amongst people? I would think so because

[00:19:02] the government has put in a lot of efforts in reaching to various pockets of population and various

[00:19:09] stakeholders like me talked about earlier NGOs and community organizations we all have worked together

[00:19:15] to reach out to these communities and the trust that has been built through these previous initiatives

[00:19:20] are really helping to achieve this childhood vaccination as well. And you had earlier mentioned that

[00:19:27] immunization among children has increased right and the coverage is also increased. So I want

[00:19:32] to go behind the scenes of this increased coverage. How does it look like? So the main reasons for

[00:19:38] this improved coverage is that we have much more data now, specific data related to the communities

[00:19:45] and there is much more data being used for defining strategies which are relevant to those particular

[00:19:51] communities. Wherever we find that there is less immunization coverage, more resources are being

[00:19:58] directed towards those geographies or those communities where the immunization coverage is less.

[00:20:04] Because the immunization coverage is not homogeneous across the country, some states are doing better

[00:20:08] than the others. So a lot of focus is also going on and the areas which are not doing very well,

[00:20:14] more resources in terms of human resources, financial resources, more vaccines are being sort of

[00:20:18] transported to those areas. So there's a lot of extra efforts which are going, it is a working

[00:20:23] progress. There is still areas of communities, specific geographies where the immunization

[00:20:29] coverage is increasing but not as good as we would like to. So we are continuing to make sure that

[00:20:35] those areas are focused and you know lot more work is happening there. Lot more work is now

[00:20:40] being done on social media. Lot more campaigns are being rolled out more, or step information

[00:20:46] is being rolled out. Efforts are being made to reduce misinformation on an ongoing basis.

[00:20:51] Lot of specific days are celebrated where there are like children's day and other women's day,

[00:20:57] where there are specific push being made on immunization. So doctor Anurada all the points that

[00:21:04] Dr Kapoor just mentioned. What do you think will be the positive impacts of these points

[00:21:10] on the health and well-being of children in our country? The Rotain Humanization helps protect

[00:21:16] the children from various life-threatening diseases like polio, measles, diphtheria,

[00:21:21] petuses, tetanus, et cetera, et cetera. Obviously this will achieving success in

[00:21:28] Rotain Humanization will reduce the child's mortality and mortality rates. And also high

[00:21:33] immunization coverage will lead to herd immunity which means the children who are unvaccinated

[00:21:39] as well can be protected from the vaccine preventable diseases. And also there is a lot of

[00:21:46] economic burden on families and the community and the government if we get vaccine preventable diseases.

[00:21:53] So by achieving higher vaccination rates will also help us save money in terms of preventing

[00:22:03] in terms of cost involved in the treatments. And India has made a very significant progress in achieving

[00:22:09] success in eradicating polio, and I'm sure in the coming years we will also be able to see

[00:22:14] significant success in eliminating diseases like measles and rubella through our concerted immunization

[00:22:21] effect. And what are your plans to further strengthen this immunization program?

[00:22:27] We will continue to work with the government of India as new technologies are emerging.

[00:22:32] We will be helping the government of India to leverage the technologies,

[00:22:36] get that new information, global best practices we like to bring from different parts of the

[00:22:41] world on what others have done. You would also like to showcase India's experiences also.

[00:22:46] That also we are doing very actively, GSI is doing very actively to show India as a world leader in

[00:22:52] ramping up good routine immunization program as well as COVID vaccination lessons. So

[00:22:56] India for the world we are trying to follow and making sure that the lessons which are learnt in

[00:23:01] India are sort of shared across the world. And if there are any good things happening across the

[00:23:04] world they could also come to India. Okay so we are about to close in a bit and the final question

[00:23:11] for the both of you. If you would have one parting message to parents, caregivers and community

[00:23:17] and the community about the importance of increasing the immunization coverage what would it be.

[00:23:22] Basically why is it important for kids to get vaccinated? My message to parents is that

[00:23:30] all parents want to give the best to their children right from the time of pregnancy.

[00:23:35] And timely vaccination is one such gift that you must all give your children without fail.

[00:23:41] This simple but profoundly impactful step will safeguard your children from potentially life-threatening

[00:23:46] illnesses. And my message to the community is timely vaccination is a shared responsibility

[00:23:54] and we as a community must you know collectively participate in this moment and play our respective roles

[00:24:00] to build a resilient and diseased free community. What about yourself? And my message to the

[00:24:07] parents is that the comment of India has a very strong program. It is available right next to

[00:24:12] wherever you are living. Immunization is free of course just you know take your child there whenever

[00:24:17] it is due to the local health worker and you know it will save your children give him or her a

[00:24:22] very healthy future. So you don't have to pay anything you just have to make sure that you

[00:24:26] know children are vaccinated at the right time. Thank you Dr. Anurada and Dr. Sanjif having this chat with me.

[00:24:33] I think through this chat we have established that India and many other countries

[00:24:37] showed with commitment and efforts that progress can actually be restored to the pre-indemic levels.

[00:24:44] Countries and global partners must work in collaboration with local communities,

[00:24:48] health forces and leaders to strengthen services and build trust within communities prior to outbreaks

[00:24:54] beginning. India has come a long way in its immunization coverage but like we spoke earlier there

[00:25:00] are still gaps that need to be filled and efforts are being taken on that front. Meanwhile it

[00:25:05] is conversations like these which help amplify the cause. I hope this discussion help you

[00:25:11] understand the immunization efforts in India and why we need to spread the message for our children.

[00:25:19] Thanks a lot for listening to this podcast and I'll see you in the next one.