Against all odds, India set to make history yet again

Measles-rubella campaign to vaccinate 405 million children by 2019

India stands at the cusp of yet another public health feat. Having successfully overcome the challenges of diseases like polio, maternal and neonatal tetanus and yaws in the recent past, the country is making confident strides to triumph over measles and rubella.

India, along with ten other WHO South-East Asia Region member countries, has resolved to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020.

To take this agenda forward, Ministry of Health & Family Welfare, Government of India, under the leadership of the Union Health Minister, Mr J.P. Nadda is introducing Rubella vaccine in its universal immunisation programme (UIP) as Measles-Rubella vaccine.

Reflecting the government’s commitment to improving the health status of its children, Prime Minister Mr Modi said, “Let no child suffer from any vaccine-preventable disease,” while launching the Intensified Mission Indradhanush in October 2017.

A major public health concern

Despite the availability of a safe and effective vaccine since the 1960s, both measles and rubella are major public health concerns in the country. In India, more than 1.3 million children acquire measles infection and around 49 000 infected children die each year, contributing nearly 36% to the global figures. Rubella infection in pregnant women may cause fetal death or congenital defects; it leads to the development of birth defects in almost 40 000 children annually in the country.

The MR campaign

To address this public health concern, India launched the ambitious Measles-Rubella (MR) vaccination drive in February 2017 in Karnataka, Tamil Nadu, Pondicherry, Lakshadweep and Goa. It is the largest such effort anywhere in the world with the target to cover 405 million children in the age group of 9 months–15 years by 2019.

This massive public health effort has been undertaken in partnership at all the levels - Central government, state governments, development partners, civil society and a committed health workforce across the country.

“The campaign once again demonstrates India’s commitment to improve health and well-being of its people by protecting children against vaccine preventable diseases,” says Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia.

The MR campaign aims to rapidly build up population immunity by reaching out to all target children with the vaccine, knocking out the susceptible cohort and, eventually, reducing the associated morbidity and mortality. Measles immunisation directly contributes to the reduction of under-five child mortality. In combination with the rubella vaccine, it will help control rubella and prevent CRS.

As part of the MR campaign, as of early July 2018, 92 million children have been successfully vaccinated in 20 states across the country.

The MR vaccine, a World Health Organization (WHO) pre-qualified vaccine, is safe and effective. New auto-disable syringes are being used for each child. All immunisation sessions – whether in schools or in the community – are linked to health centres with trained staff to manage side effects, if any.

Operationalising the campaign

“A major challenge is the sheer scale of the campaign and this is where WHO- National Polio Surveillance Project (NPSP) comes in,” says Dr Henk Bekedam, WHO Representative to India.

WHO-NPSP has a proven track record. Along with other partner organisations, it played a critical role in India’s monumental public health accomplishment of becoming polio-free. WHO-NPSP has worked tirelessly to maintain India’s polio-free status, while gradually transferring knowledge, lessons learned and assets to routine immunisation and other immunisation programme activities and select priority public health programmes. Accordingly, the NPSP is also providing technical support for accelerated implementation of measles and rubella control activities across the country.

The NPSP team has helped the government in developing the operational guidelines, training materials and organising capacity-building workshops. The network has helped monitor over 200 000 sites and verified over 350 000 children in the community for their vaccination status in the phased measles catch-up campaign across multiple states.

With insights gained from the past measles catch-up campaign, WHO-NPSP has set up a Rapid Response Team in the states to support training, micro-planning and outreach to private sector doctors, the community, partners and other stakeholders. It has also facilitated an accountability framework at district, state and national levels for MR campaign preparedness and progress review through establishing task forces at each level.

A key strategic support is the monitoring and feedback by Surveillance Medical Officers (SMOs) of the WHO-NPSP network, external monitors, local communities and field volunteers. This has helped source real-time feedback at multi-levels to enable high-quality vaccination coverage with safety.

As one of the key elimination strategies, a network of 19 proficient MR laboratories have been established; they are supporting the ongoing MR surveillance system across states, with technical assistance of WHO-NPSP. In coordination with the Indian Council of Medical Research, it has also supported benchmark research on measles that has helped generate evidence for guiding and accelerating India’s elimination goal.

Forging a strong collaboration

Under the stewardship of the Immunisation Division of the Ministry of Health & Family Welfare, a strong partnership of various stakeholders is ensuring the successful roll-out of the MR campaign. The partners include state health, education, and women and child welfare departments; WHO, UNICEF, GAVI, UNDP; professional bodies such as the Indian Academy of Paediatrics, Indian Medical Association, Lions Club; civil society organizations and influencers from the community.

Overcoming vaccine hesitancy

A significant challenge has been addressing vaccine hesitancy, creating awareness about the value of vaccines and managing misinformation, particularly on social media. Media has been a supportive partner in disseminating correct information during these campaigns. Regular briefings have been conducted where WHO-NPSP experts and government officials have jointly addressed queries from journalists. In addition, a strong Adverse Events Following Immunization (AEFI) Surveillance program is in place to address community concerns and maintain public confidence.

Looking ahead

India’s recent public health successes give cause for optimism. The MR vaccination initiative is making rapid strides to ensure better life chances for India’s children.

“The MR elimination goal is achievable. India is making steady progress towards the goal of measles elimination, and rubella and CRS control. The WHO Country Office for India is committed to going the extra mile along with its NPSP field network to help the country achieve the goals of the measles-rubella campaign,” says Dr Bekedam.