A need to turn the corner on child health

Though India has become a polio-free country, the fight against polio is still not over and high levels of safe and effective vaccination with both Oral Polio Vaccine (OPV) and Inactivated Polio Vaccine (IPV) are needed. A 2004 file photo shows a pair of twins being given Polio vaccine in Chennai. Photo: S. Thanthoni   | Photo Credit: S_Thanthoni

At 400 million, India is home to the world’s largest child population. More than 50 per cent of the children are malnourished and almost 50 per cent of them do not attend school. That’s the state of our country, soon to have the world’s largest young population.

> Read: The persisting problem of malnourishment

Under-five mortality

In 2012, almost 14 lakh Indian children under the age of five died due to preventable diseases including pneumonia, diarrhoea and measles. Let’s put this into perspective by doing a comparison with the number of children who died just two decades back.

In 1990, 28.5 lakh children in India died before reaching their fifth birthday. Despite the decline in child mortality, a large number of children are still dying, the death of each individual child being more than just a number. India continues to be responsible for the highest number of child deaths in the world, amounting to 21 per cent of the total global burden of child mortality.

The official estimate of the country’s under-five mortality rate is 56 per 1000 live births, as of 2012. This shows that India is far behind from achieving its millennium development goal of 42 per 1000 live births by 2015. India’s Under five Mortality Rate compares poorly with that of countries in its own neighbourhood; Bangladesh (41) and Nepal (42). It is also worth noting that both have already achieved their respective MDG 4s, unlike India.

> Read: Poverty, child, maternal deaths high in India: U.N. report

Though the World Health Organization (WHO) believes that India has been effectively reducing its infant and maternal mortality figures, thanks largely to the many successful programmes that have been initiated by the Government of India such as the National Rural Health Mission (NRHM), the results have not been satisfactory, especially when it comes to infant and maternal deaths.

The current scenario tells us that a lot needs to be achieved in the next one and a half year. Luckily, the subject has been able to attract the attention of the new government. On July 3, 2014, the Bharatiya Janata Party (BJP) government decided to introduce rotavirus vaccine, rubella vaccine and Inactivated Poliovirus Vaccine (IPV) into India’s Universal Immunisation Programme (UIP), making the vaccines available to all children.

In addition, Japanese Encephalitis vaccines will be introduced in 179 endemic districts across nine States. The government aims to reach 27 million Indian children under the Universal Immunisation Programme targeting, and protecting the largest birth cohort in the world against ten potentially devastating diseases. India reported half of the global polio cases until the year 2009. Thanks to the aggressive polio campaign in the country, India has now become a polio-free country. But the fight against polio is still not over, and as the world moves to eradicate polio once and for all, high levels of safe and effective vaccination with both Oral Polio Vaccine (OPV) and IPV are needed. IPV is a critical part of the strategy to protect against any future risk of outbreak and, as recently reported in The Lancet, a study from Christian Medical College (CMC), Vellore showed that IPV also helps boost the effectiveness of OPV vaccine. Adding IPV to the UIP can contribute greatly to the success of this programme and goal of global eradication.

A bird’s eye view into rotavirus may give us a clear perspective of why the government needed to introduce the vaccine immediately. Diarrhoea alone kills more children across the world than AIDS, malaria and measles combined. It is the second leading cause of child mortality worldwide and India alone accounts for a fourth of global child diarrhoeal deaths.

Rotavirus is the leading cause (>40%) of moderate to severe diarrhoea. As per the 2012 demographic and child mortality data, rotavirus kills more than 50,000 children each year in India. Up to a million more are hospitalised. Dr. Vinod Paul of All India Institute of Medical Sciences (AIIMS) points out that even with improved sanitation, rotavirus will continue to cause diarrhoea as it did in all the developed countries prior to vaccination.

Rotavirus causes rapidly progressing diarrhoea which can quickly lead to severe dehydration and death, especially if children do not receive the appropriate care such as Oral Rehydration Solution (ORS) and/or intravenous hydration. Therefore, it is essential to introduce a vaccine to save lives and prevent serious disease. Globally, more than 55 countries already use the rotavirus vaccine as part of their immunisation programme.

Economic implications

The rotavirus vaccine has economic implications as well. With up to one million rotavirus hospitalisations each year, many Indian families are pushed below the poverty line because of this illness. According to estimates, the average cost of hospitalisation for each episode of rotavirus diarrhoea is approximately Rs.3,000, which is equivalent to 7.6 per cent of an average Indian family’s total annual expenditure. Billions of rupees are spent on health care-related costs and the impact on GDP adds up as children do not grow up to contribute to India’s economy.

It is really a historic moment for India to be turning the corner on child health. So much progress has been made on the polio front and we are at the cusp of eradicating the disease. Emphasis is being placed on ensuring that children grow up to lead healthy and productive lives. As a leader vaccine producer, India is poised to move forward as a world leader. Now is the time to make the most out of the government’s decision and do what is needed to make the policy a reality and achieve what has long been missed for India’s children and the nation. As the leading economic power in the region, India has a moral obligation to ensure that every one of its children has access to life saving interventions like vaccines.

( Mathuram Santhosham is a scientist and the recipient of the 2014 Albert B. Sabin Gold Medal Award.)

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Printable version | Sep 24, 2021 6:55:13 AM |

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