Return of grand scale

Immunisation has to address ground realities

Published: Tuesday 31 January 2006

-- the union ministry of health and family welfare has just come up with what seems to be a commendable plan to reach vaccination for six common diseases -- diphtheria, measles, polio, tetanus, tuberculosis and whooping cough -- to children throughout the country, especially those in remote rural areas. The best part of the plan is that it envisages that this immunisation programme will go from door to door. But weary and cynical as we are of such grand programmes, there are a number of questions that spring to mind. First, but hardly foremost, are the symbolic trappings. This year is immunisation year -- and the programme kicks off barely before 2006 gets underway: permit us a grimace. But what really puts us on our guards is the track record.

What's most worrying is that the statistics for immunisation coverage is going down. At present just about half the children in the country are being vaccinated. The government says it has enough both by way of funds and vaccines. But clearly expanding the scope of immunisation -- as the government has done by including hepatitis B in the basic basket -- without first ensuring delivery of what it already has on its plate is not the way to go about increasing immunisation cover. The problem is that the government is tied to the coat tails of international donor agencies and that its regulatory and surveillance mechanism is in a sorry state. International agencies -- especially Global Alliance for Vaccines and Immunisation -- which have strong links to the pharmaceuticals industry, tend to push vaccination regimes that cater to the its interests rather than what developing countries need. These countries, including India, which so often cast themselves in a supplicatory light, accept the prescriptions laid down by global fund-raisers -- which is often why their immunisation programmes go off the rails.

But that's just part of the problem. The other is that regulation is not happening, partly because there is a serious lack of surveillance on the part of the central agencies that are mandated to keep a leash on the vaccination regime.

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