New Delhi: Is the recent case of re-emergence of Diptheria in Malappuram district of Kerala a wakeup calls for the health policy makers? A disease that was thought to have been eliminated years ago, has suddenly sent alarm signals to concerned authorities. Although there are many underlying factors that are responsible for this, it is surprising that these were perhaps not taken too seriously earlier.
Diphtheria is a bacterial infection affecting the membranes of the throat and nose. If left untreated, diphtheria can cause severe damage to kidneys, nervous system and heart. Although it spreads easily, the silver lining is that the diphtheria can be prevented through vaccines. Notwithstanding this fact, the sixty-two diphtheria cases were reported from different parts of the two districts of Kerala within few weeks of July, 2016. Seventeen of them were confirmed positive and two children died.
In Indian context, there are many socio-economic and social factors that play a role in the success or failure of any health campaign. What makes it more complicated is when the certain sections try to bring in the religious beliefs to stop the vaccination. Even the freedom of choice under constitution too is being quoted by them to justify their viewpoint.
As per reports, Delhi has witnessed the highest number of diphtheria cases in 2014 out of a total of 4,071 cases in India. Also, 104 deaths in 2014 were reported due to diphtheria, while Delhi also had the highest number of deaths at 60. Haryana recorded the second highest diphtheria cases at 663. However, it was West Bengal that saw the second highest number of deaths at 10. Assam recorded the third highest figure of cases at 506, followed by Maharashtra at 444.
Kerala fights anti-vaccination forces
While it can’t be denied that there are health officials who have been ignoring this self-harming resistance to educate people about the benefits, it is equally true that not all the areas have been covered in such conditions. Many radical Muslim organizations in the state are reported to have allegedly distributed pamphlets that cautioned the community against the vaccination, calling it a ploy to kill the children. Quite ridiculous but true, such kind of propaganda is very difficult to counter and few times even skipped by health officials.
Several organizations, including the Indian Academy of Pediatrics, Indian Medical Association, and Ethical Medical Forum, as per reports, have been preparing the ground to move legally against anti-vaccine lobby leader, Mr Jacob Vadakkanchery, who had publicly challenged the health officials, including Minister K.K. Shylaja, to take action against him.
“Many vaccination workers don’t want to get into any kind of arguments with the religious preachers as it is a sensitive issue. Even politicians too try to stay away from this as it might hurt their constituencies. However, there is a need to rise above all this and try to sensitize such people by organizing community dialogue,” mentioned a senior official associated with various health programmes. “Shouldn’t it be implemented without any such hurdles in a democratic set up like India?” he asked rightly on the basis of anonymity.
Kerala’s opposition leader, Mr Ramesh Chennithala urged the government to carry out a state-wide awareness drive, coordinating various departments, to persuade people for vaccination. He also suggested the government to make vaccination mandatory for getting school admissions.
Meanwhile, the Kerala Health Minister, Ms K K Shylaja denied the opposition’s charge that there was a scarcity of preventive vaccine as the minister told the state’s assembly that the government had already launched a massive vaccination drive in the worst-hit Malappuram district with an aim to immunize over 2.30 lakh children.
Replying to a notice for adjournment motion for a debate on the matter, the minister said few cases of diphtheria were also reported in Kozhikode and Palakkad districts and steps have already been taken to check the spread of the disease. “The reluctance of a section of a people in Malappuram to go for vaccination was one of the reasons for the sudden spurt of the disease in the district. Superstition and some unethical treatment methods, which have been under practice in the area, also contributed to the present situation,” she admitted.
“Following the intervention of the government, a large number of children in Malappuram have already been vaccinated under the special immunization drive. There is no scarcity of preventive vaccines. Steps have been taken to ensure the stock of at least 4.50 lakh doses necessary for the programme,” she said.
Polio eliminated yet threat perception persists
India continues to maintain highly sensitive surveillance system for Polio and maintains quality parameter checks for surveillance like non polio AFP rate, adequate stool collection rate etc. Surveillance reviews are conducted from time to time to ensure quality of surveillance. In addition, country has also started environmental surveillance in selected sites in the country to detect polio virus in sewage samples.
As per the Minister of State (Health and Family Welfare), Mr Faggan Singh Kulaste, government of India has already introduced inactivated polio vaccine (IPV) in the country over and above existing doses of oral polio vaccine (OPV) to provide additional protection to children of the country against polio. “In response to the event of Vaccine Derived Polio Virus detected in sewage in Hyderabad, even though there was no human case, a special immunization drive was carried out in high risk areas of Hyderabad as a preventive measure to build population immunity and 3,11,000 children were vaccinated with a dose of IPV,” he said.
World Health Organization (WHO) too has been carrying out Acute Flaccid Paralysis (AFP) surveillance where all suspected cases of Acute Flaccid Paralysis are examined to rule out polio. The suspected case in Uttar Pradesh investigated by WHO and result of the two stool samples pertaining to this case, tested in the laboratory reported that there is no poliovirus. Hence, the case is classified as Non Polio Acute Flaccid Paralysis case and the child is under treatment of district hospital, Balrampur.
Immunization efforts so far….
With the addition of four new vaccines–Inactivated Polio (IPV), Rotavirus, Measles, Rubella (MR) and Adult Japanese Encephalitis (JE)–UIP will provide free vaccines against 12 life threatening diseases to 27 million children annually, according to the health ministry.
Under Mission Indradhanush, a total of about 200.8 lakh children have been vaccinated till 16th July 2016. Japanese Encephalitis (JE) vaccine is given in districts with JE disease burden called JE endemic districts and as on date all 197 JE endemic districts across 19 states are covered for providing Japanese Encephalitis (JE) vaccine. All States and Union Territories are providing Haemophilus influenza type B vaccine which is provided in a combination of five vaccines i.e. Pentavalent vaccine.
As per the government sources, the aim to increase full immunization coverage in India to at least 90 percent children by 2020. Full immunization coverage has increased by about 5-7 percent after the launch of this mission. During the first and second phase of operation, about 148.4 lakh children were vaccinated of which 38.7 lakh children were fully immunized. In addition, 38.1 lakh pregnant women were vaccinated with tetanus toxoid vaccine.
Vaccine phobia a global syndrome?
India is not alone but there are many countries where few anti-vaccination campaigns have tried to justify opposition to vaccines. Infact, the war torn nations or those with authoritarian regimes don’t even care to talk about such initiatives. Yet, there are a section of intellectuals even in well developed nations who have called for a choice to choose the vaccines.
Let is just take one example of Australia where there is a forum called as Australian Vaccination Skeptics Network that propagates the theory that vaccination might not be of any help to prevent diseases. In fact, a study published in the Medical Journal of Australia analyzed the Australian Immunization Register between 2002 and 2013 for children aged between one and six years old. The author of this study, Dr Frank Beard, University of Sydney found that the number of parents registering objection increased from 1.1 percent to 2 percent between 2002 and 2013. This definitely takes us to the fact that the impact of anti-vaccination drives can’t be just ignored or pushed under the carpet.
As the arguments around pros and cons of vaccines rage on, few experts say that it is the time government adds some seriousness to it. In a country like in India, few argue that it should be made legally mandatory to undergo vaccination to avail the incentives from other government run schemes. The suggestion surely is debatable but we must remember that we cannot let the children in India die due to preventable diseases. It surely wouldn’t be considered a sign of a progressive nation. So what is the solution to begin with? The awareness on vaccinating ourselves on time and word of mouth on the issue from every household are the keys.
Mission Indradhanush Coverage Report (Phase-1 & 2)
(Figures in lakhs)
|S. No||Indicator||Phase 1||Phase 2||Total|
|1||No. of sessions held||9.7||11.6||21.3|
|2||No. of antigen administered||191.9||174.9||366.8|
|3||No. of pregnant women immunized||21.1||17||38.1|
|4||No. of pregnant women completely immunized||11.2||9||20.2|
|5||No. of children immunized||76.8||71.6||148.4|
|6||No. of children fully immunized||20.2||18.5||38.7|
|7||No. of children vaccinated for the first time||N/A||9.3||9.3|
|8||No. of Vit A doses administered||20.5||21.2||41.7|
|9||No. of ORS packets distributed||17.1||13.9||31|
|10||No. of zinc tablets distributed||57.3||45.2||102.5|
Credit: Ministry of Health, GOI.