Despite sustained and dedicated efforts by Government of India, the immunisation coverage in India remains pretty low and data shows that only about 65% of eligible children receive all the recommended vaccines in their 1st year of life. Back in 2014, GOI launched the ambitious Mission Indradhanush to improve vaccination coverage in childhood and pregnancy and targeted 90% coverage by 2022 but so many years since its launch we are still far from our targets.
As efforts intensify to improve outreach of our immunisation drives, let us understand what it is that still bothers people when it comes to vaccinations. In an interview with HT Lifestyle, Dr Somalika Pal, Senior Consultant, Department of Neonatology and Pediatrics at Cloudnine Group of Hospitals in New Delhi’s East of Kailash, shared, “The WHO defines Vaccine hesitancy as a delay in the acceptance or refusal of a vaccine despite its availability. At no other time in the recent history, than at the present during the Covid pandemic has the world so badly yearned the emergence of an effective vaccination to put an end to all its woes. Yet when the vaccines came and were granted emergency use authorisation, there were apprehensions and wary refusals from several corners of the globe about the safety of these vaccines.”
She revealed, “This was a public health challenge that threatened to thwart vaccination campaigns in certain countries like the United states among many others. In India, by and large, after the initial mistrust there was widespread acceptance to the vaccinations making it one of the most successful campaigns globally. Currently, we are all probably witnessing an epidemiological shift where Covid is affecting children as well, in larger numbers than it did at the start of the pandemic and yet a recent survey on the acceptance of Covid vaccines among 6–12-year-olds revealed that as many as 41% respondents would prefer to wait and defer vaccination for their children, when its available for use.”
Talking about the other routine childhood immunisations, Dr Somalika Pal said, “The reasons for the poor immunisation coverage in the country is not just limited to vaccine hesitancy among parents. The most important aspects remain poor accessibility to health facilities, low socio-economic conditions, lack of awareness about vaccines, misinformation ,lack of good commute facilities to and from remote areas etc. A lot of effort, energy and funds is being focussed by the GOI to address these gaps. Vaccine hesitancy remains an unfortunate reality even among the literate and affluent classes, and not just in developing nations but developed countries as well. The main reasons cited are misinformation especially from internet and social media, religious and cultural beliefs, lack of scientific temperament and giving into controversy hypothesis surrounding vaccinations. Despite the proven efficacy of vaccines in protection against so many diseases, we as paediatricians continue to get a lot of queries about the safety, efficacy and even necessity of certain vaccines.”
Myths vs facts:
Determined to bust some myths and address some concerns about vaccinations in children, Dr Somalika Pal highlighted:
1) Are vaccines safe?
Yes. Vaccines are launched into the market only after rigorous field testing and only when the benefits of vaccination far outweigh the risks. Of course there may be some side effects to vaccinations –most of which are minor like mild fever, local pain and swelling and body ache. Some major side effects or allergic effects are known to occur with some vaccine components in some individuals, but these are extremely rare. If such a thing occurs, you should report to a nearby health facility immediately and inform your doctor before taking the same or any vaccine again in the future.
2) Are the adjuvants (like aluminum) in vaccines safe?
Aluminium adjuvants are added in vaccines to increase their immunogenicity and have been in use since 1930s. After such a prolonged history of use, there is no scientific data to back the apprehension against adjuvant containing vaccines
3) Is there an association between vaccine components and Autism?
Several studies have refuted such claims.
4) Why are there so many vaccines recommended together especially before 6 months of life? Isn’t it too much for a baby to tolerate?
When babies are born they are protected against some infections by antibodies that are passed onto them via the placenta and thereafter via breastmilk. Gradually this protection wanes. It is very important to vaccinate the child against the illnesses that are responsible for most of the childhood deaths and hospitalizations at the earliest. Studies have shown that these vaccines administered together do not interfere with antibody responses. So multiple vaccines in a single setting are given only when these have been proven to not interfere with the immune responses in the child.
5) Why should I vaccinate my child against diseases I never hear of anyone ever contracting?
The vaccinations which are currently recommended for all children under universal immunization schedule and those recommended by Indian Academy of Pediatrics are against diseases which have caused and still has a potential to cause major public health crisis. Most of these have not been “eradicated” and the only effective way to keep them from spreading /re-emerging as a public health problem, so that you don’t hear about them is timely vaccinations.
6) India is polio free. Why then do doctors continue to recommend Polio vaccine?
Although India has been declared polio free since 2014, many of our neighboring countries have reported cases of wild type polio virus in the recent past, and are not polio free. In these times of widespread travel across borders, it remains more important to maintain a very high vaccination coverage rate of polio so that the virus does not re-emerge in our country.
7) Is it true that some additional vaccinations are provided at private health facilities as compared to Government hospitals ?
Yes. Not all vaccinations recommended by Indian Academy of Pediatrics , are part of the Universal Immunization Schedule (UIP) of GOI at the moment. However these additional vaccines eg. Influenza, Hepatitis A, Chicken Pox, cervical cancer etc are a cause of significant illness and hospitalizations and it is prudent to get your child vaccinated against these as effective and safe vaccines are currently available.
8) My child is fully vaccinated, yet why do I have to take some special vaccines before travelling abroad?
The vaccines recommended in a particular country are mostly based on the difference in disease prevalence in the host country and the country you are about to visit. So you are required to take vaccinations for all such communicable diseases which you may accidentally carry to the country you are travelling to (eg Yellow fever vaccine for travellers coming to India from Africa),or to protect you from diseases prevalent in the country or state you are travelling to (eg. yellow fever vaccine for visit to Africa from India, Meningococcal vaccine for visit to US, JE vaccine for long stay in JE endemic states in India)
9) My child was born in India but we will be shifting abroad soon? Which vaccination program do I follow?
You should vaccinate your child according to the immunization schedule at the country of residence at any given time. That way he/she is protected from the diseases that are prevalent at a particular geographical area. If you travel back, make sure you share all vaccination records with your paediatrician so that he /she can “catch up” with anymissed doses.
10) Covidvaccines are now available for children? Should you vaccinate?
Covid vaccine for chidren above 12 years was introduced in Jan 2022 and since then crores of adolescents have been vaccinated. Immunization may not protect against mild symtoms of Covid but are known to protective against severe forms requiring hospitalization and ventilation including the dreaded multisystem inflammatory syndromes and long Covid. Very soon we may have vaccines for those younger than 12 years.
11) Are annual flu shots really required?
The flu virus is unique in its ability to undergo minor antigenic changes making it different from one year to the next. This helps the virus to evade the body’s defenses. Every year WHO releases the relevant strains of the virus in circulation after studies, and and then vaccines are tweaked accordingly and launched into the market. Influenza has caused horrible pandemics in the past, and to this day , lakhs of hospitalizations and thousands of death attributable to the flu are reported by the CDC
12) Can vaccines cause severe life-threatening reactions like sudden cessation of breathing, severe allergic reactions or neurological complications like the Guillian Barre syndrome.
This is true. Vaccines, although very very rarely, may cause sudden severe reactions. All such events are notified to appropriate authorities and investigated to understand if the vaccine caused the symptoms. However, the benefits of vaccination far outweigh this risk. Inform your health care provider if your child is allergic to anything and if any reaction was ever suspected to be due to a vaccine.
Dr Somalika Pal concluded, “I hope with answers to these FAQs many fears will be allayed and parents will not be hesitating in vaccinating their children. Staying away from misinformation circulated on social media and reaching out to your health care professional when in doubt will help curb vaccine hesitancy and improve immunisation coverage.”
Courtesy – www.hindustantimes.com