India needs to sign up for life-long vaccination

before covid-19 pandemic, mostly associated with vaccination and associated only with children. The fact that vaccines – since first vaccine against smallpox Became available in 1798 – always meant for a wider age group, including adults. However, smallpox eradicated and soon after the launch of Expanded Program on Immunization (EPI) around the world in the 1970s—and in India in 1978 Concerted efforts were made to increase the use and coverage of vaccines in children. Scientifically, the benefit of most vaccines is greater if administered earlier in life – infancy and childhood – one reason children are usually preferred and vaccines are recommended for each child. For the remaining age groups, including adults, vaccines are recommended for specific sub-groups such as older people or people with specific health conditions.

Vaccines for COVID-19 are an exception in some sense. These are the first vaccines recommended for all adults, with priority over children. In fact, the jury is still out on what age sub-group and when children should get the COVID-19 vaccine.

The importance of vaccines, which are considered to be the most cost-effective public health intervention, has been recognized globally. Still, the full benefits of vaccines do not reach all children and other age groups. There are wide disparities in vaccine coverage among children based on geography, gender, parental education and socio-economic status of the family, and other levels. The coverage of most vaccines available to adults in India is sub-optimal. The COVID-19 vaccination campaign is an opportunity to take stock of the state of adult vaccination and the future ahead.

Adult vaccination required

After the outbreak of Japanese encephalitis (JE) in 2005–06 – in the years that followed – India had carried out large-scale JE vaccination in endemic districts, including in the adult age group. Then, during the H1N1 (2009) pandemic in 2009–10, there was limited use of swine flu vaccines for healthcare workers. Furthermore, systematic efforts for adult immunization in India have received limited attention. There was no mention of adult immunization in India’s first and only national vaccine policy released in 2011. The National Technical Advisory Group on Immunization in India (NTAGI) discussed adult immunization on a few occasions, but did not make any recommendations for the general population except for vaccination of health workers as high-risk groups for hepatitis B vaccine, etc. stay away from ,

Outside the government, professional groups such as the Association of Physicians of India and the Indian Society of Nephrology have issued guidelines on adult vaccination; However, since these are voluntary and the private sector’s share in vaccination in India is very low, obviously, the impact is unknown and is likely to be low.

There is very limited data on the burden of vaccine-preventable diseases (VPDs) in adult age groups in most settings, including India. More recently, a review of available data has indicated that increased childhood vaccination coverage has resulted in a higher proportion of VPD cases in older age groups. It is known that the burden of VPD is relatively low in adults (compared to children); Large adult populations provide greater social impact in terms of absenteeism from work (due to illness) and the associated costs of health care and hospitalization.

Scientific evidence is emerging on decreased immunity in the adult age group and the need for booster doses for childhood vaccines. Vaccines that have become available in the past two decades (which adults did not get as children) have the potential to be beneficial. For example, pneumonia causes more deaths in adults than in children. The proportion of those diseases, hospitalizations and deaths in all age groups can be prevented by increasing the coverage of currently licensed vaccines that prevent pneumonia and related complications. Fortunately, these vaccines have become part of childhood vaccination programs; However, coverage and benefits need to be extended to the identified high-risk adult population. Available evidence has resulted in global stakeholders agreeing to the ‘Immunization Agenda 2030’ (https://bit.ly/3qlKnH1), which emphasizes that countries should consider expanding the benefits of vaccines to all age groups needed.

an opportunity in hand

The COVID-19 vaccination campaign has drawn our attention to the possibilities of adult vaccination, which should be used effectively.

Initiatives should be taken to educate the public, health care providers and members of professional associations about currently available vaccines for adult age groups. It can help people make an informed choice and help healthcare providers share information with citizens. Various training programs and undergraduate and postgraduate teaching curricula should be modified to contain material on adult immunization.

The current discourse should be used to plan and develop a national adult immunization strategy and road map for India. This can be done through some coordinated efforts.

steps to take

First, the mandate of NTAGI needs to be expanded to adult immunization. NTAGI can begin with reviewing available scientific evidence and providing recommendations on adult vaccination in India. These recommendations may be regularly reviewed and revised once additional data become available. An NTAGI sub-group on adult immunization may also be formed to facilitate the process.

Second, there is a need to strengthen VPD surveillance systems and the ability to record, report and analyze data on disease burden and vaccination coverage. The focus should be on analyzing vaccination coverage and VPD surveillance data by age and other related stratifiers.

Third, there is a need to boost the capacity of research and academic institutions to conduct operational research, including cost-benefit analysis, and to guide evidence-informed decisions. Such analysis and evidence may be used by NTAGI in decision-making processes.

Fourth, perhaps the process of developing and preparing a road map for India’s national adult immunization policy and strategy should be initiated. Any such policy should also incorporate the lessons and lessons learned from the ongoing COVID-19 vaccination campaign. In fact, policy questions in need of answers must be recognized now, and the process of generating evidence has begun. Otherwise, we may be at risk of asking policy questions in 10 years that may be answered a few years from now.

Fifth, at a more operational level, the shortage of life-saving rabies vaccines in India in 2019 is a reminder of the risks and vulnerability in vaccine supply. To ensure vaccine safety and be future ready for adult immunization, existing public sector vaccine manufacturing units in India need to be revived and more need to be set up.

Vaccination Policy for Adults

The Childhood Immunization Program is one of the best performing government health programs in India. In COVID-19 vaccination, it was government facilities that have given 93% – 95% of the total vaccine shots. The COVID-19 vaccination is a reminder that the benefits of vaccines already licensed have not reached the adult population. It also seeks to institutionalize mechanisms for health policy makers in India to examine the need, make policy decisions on adult immunization, and enable adult citizens to make informed choices about whether they wish to receive the vaccines currently available. have the opportunity. It is time to plan and expand the benefits of vaccines to all age groups as part of Universal Immunization Program Plus in India. Drafting and developing a National Adult Immunization Policy and Strategy for India could be one such concrete step in this direction.

Chandrakant Laharia, a physician-epidemiologist, is a vaccines and health systems specialist. his upcoming book is The Lighthouse of Peeragarhi: What we need to prevent diseases and protect health