Poor public delivery systems hindrance to vaccine benefits

Kolkata: Unless Indian public vaccine delivery systems are upgraded, most of the children living in the states with poorly performing public sectors will not benefit from introduction of the pentavalent vaccine, said a study released on Tuesday.

As India moves towards upgrading its Universal Immunisation Programme (UIP) by introducing newer and more expensive vaccines, "public sector vaccination service delivery systems will need to become much more sophisticated", said a February 23 British Medical Journal (BMJ) retrospective analysis.

The pentavalent vaccine is a combination of five vaccines in one and acts against five diseases -- diphtheria, pertussis, tetanus (DPT), Hepatitis B and Hib (meningitis).

The analysis said Hib vaccine has been available in India's private sector market since 1997. It was not until December 2011 that the Indian government actually initiated the phased public sector introduction of a Hib-containing pentavalent vaccine in just two states -- Kerala and Tamil Nadu.

The Hib-containing pentavalent vaccine is intended to replace two other pre-existing UIP vaccines-DPT (diphtheria, pertussis, tetanus) and Hep B (hepatitis B).

Haemophilus influenzae type b (Hib) is a bacteria responsible for severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than five years.

The study 'Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data' is the first nationwide analysis of the Hib vaccine uptake in India's private sector market.

It investigated the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector.

Private sector Hib vaccine uptake in 16 of a total 29 Indian states was analysed from 2009 to 2012.

These 16 states include all geographic regions of India and are home to around 90 percent of India's annual birth cohort of over 26 million.

It estimated that "Hib vaccine coverage among the 2009-2012 birth cohort (when the vaccine was available only in the private market) in India was low (four percent) and varied widely among the Indian states (minimum 0.3 percent; maximum 4.6 percent)".

The ongoing public sector introduction of the pentavalent vaccine is required if India has to achieve high and equitable Hib vaccine coverage levels, the research said.

However, all Indian states may not be prepared for pentavalent vaccine introduction in the public sector, notwithstanding the leading states of Kerala and Tamil Nadu.

Apart from upgraded public delivery systems, India needs state-specific microplanning, efficient implementation, disease surveillance and coverage data collection, and timely monitoring and evaluation, to ensure higher vaccination coverage rates, the study highlighted.

The role of the private sector in contributing to universal Hib vaccination coverage is as yet undefined, but the private sector should not be neglected as it might be a useful complement to public sector services as they are scaled-up, it noted.

India has the highest Hib disease burden in the world with around 2.4 million cases and 72,000 Hib-related deaths annually, which accounts for over four percent of total child deaths in the country.