The necessity of taking the immunisation programme back to the community in Tamil Nadu while providing safeguards is at the centre of the set of recommendations of a study conducted in 11 States.

Conducted by Makkal Nalvazhvu Iyakkam, the Tamil Nadu chapter of Jan Swasthya Abhiya, and CHAD, CMC Vellore, the study spoke to about 4,000 mothers in 11 districts in the State. It found that the coverage of measles vaccine among children in the 12-17 months age group is 87.1 per cent. This is a significant 10 percentage point drop from the government's District Level Household Survey 3 (2007-2008).

The study has two important dimensions — coverage of vaccines and sociological implications of change, Ameer Khan of MNI says. It was conducted between November 2009 and March 2010, following the availability of anecdotal evidence that immunisation coverage was dropping.

In May 2008, after the deaths of four infants during a routine measles immunisation programme in Tiruvallur, the government decided to stop village-level vaccination.

Following this, parents were forced to go to the primary health centres to get their children vaccinated.

Making an assessment of the indirect costs of such visits, MNI and CHAD found that while the vaccine itself was free, it cost Rs.168 per head per dose of vaccine. Much of it was spent on travelling, and included the wage loss due to being away from work for the day.

Rakhal Gaitonde, of MNI, says this would amount to about Rs.800 if a parent conforms to the full immunisation schedule – DPT 1, 2, and 3 and Measles. This is reflected in the reactions of mothers to the new strategy. About 67.2 per cent of the mothers interviewed want their children to be immunised at the village itself.

“We did not want this study to be just a number-crunching game. It is also important to find out what people want,” he adds.

“Free and quality treatment is a fundamental right of the people which is in threat due to this policy change,” the report concluded.

A UNICEF study also expressed concern over the fall in immunisation coverage (about 6-7 points).

The Common Review Mission for the National Rural Health Mission in Tamil Nadu also recently raised the issue of inadequate coverage, Thelma Narayanan, who was part of the mission, says.

The team made a strong case for reversal of the current immunisation strategy to the State.

“While it would not be possible to directly co-relate an increase in infectious diseases (which happens over a period) to falling immunisation coverage, if the herd immunity goes down it is a cause for concern,” Dr. Thelma points out.

“Epidemiologically, one has to be above a certain basic level of immunisation in the community.”

The government has also decided to introduce outreach programme, a sort of reversal of policy, but only for areas that are remote and unreachable. The MNI has expressed its appreciation for this move, but stresses that there needs to be uniformity of policy.

“We urge the Tamil Nadu government to re-start village level vaccination at all villages immediately and also put in systems to ensure complete safety during vaccination,” Dr. Rakhal says.