Dear viewers
I wish to share the following concerns keeping in view of COVID-19 pandemic.
According to the “Guiding principles for immunization activity during the COVID-19 pandemic”, there is a need to sustain Routine Immunization (RI) services along with adherence to COVID-19 preventive measures for preventing accumulation of susceptible, widening population immunity gap, leading to emergence of sporadic cases, untimely / unwanted out-brakes of Vaccine Preventable Diseases (VPDs) and postponing the achievement of national and global goals.
Occurrence of out-brakes of VPDs at this juncture of COVID-19 pandemic will over fatigue already overburdened Health Care Service providers. Hence, it is wise to sustain routine immunization services to pregnant women during their Antenatal checkups, administering newborn vaccines at birthing facilities (ongoing), vaccines to <2 year healthy children brought by healthy parents at least in the well established fixed strategically placed centers like Planning Units / GH / Dist Hosp / Medical Colleges in the dedicated venue preserving required social distancing.
Up to about 8% infants permanently miss the opportunity of attaining FIC before one year if RI service is suspended for one month. If this is extended for more than a quarter, it may reverse our control / elimination / eradication reverting back to the square. In a planning unit attached to our college with >95% FIC and 1st booster coverage, Expected Due Children (EDC) is around 50% of annual target which has now crossed 80% of annual target with suspension of RI services for one month. If this gets extended for a quarter, EDC will cross 2 to 3 times the annual target.
India with 65% FIC as per Rapid Survey Of Children (RSOC), launched Mission Indradhnush (MI) in Dec 2014; through recurrent phases since then is unable to attain 90% FIC till now. Hence, once again attaining to sustain >90% FIC will be a herculean task and may take a few years – not just 4 rounds (apprehension).
Timely vaccination of children can potentially minimize vulnerable children population to the ongoing pandemic too through extra targeted (extra vaccinial) property of boosting “innate immunity” especially by the live attenuated vaccines. As a spin off, parental contact while delivering vaccination service can be better utilized for programme specific IEC / IPC.
In view of the above requesting the stakeholders / policy makers / programme managers to issue country / state / district specific guidelines as WHO has already alerted and issued for the world as a whole. Now, as per WHO directives, country specific directives and local innovations for effective operationalization with due respect to COVID-19 prevention are very much needed – a stitch in time saves nine.
With warm regards for promoting universal health
Dr Narayana Holla
Professor, Community Medicine,
KVG Medical College, Sullia
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t is a mistake of some authorities to think that VHND is overcrowded and sub centre walk-in is preferable. Agree with Dr Holla
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Small planned village level sessions of 20 patients coming in batches of 5- with physical distancing is more appropriate.
Imagine the same 20 patients (village population 1000, birth rate 20/1000 means around 20 injections every month) walking up to 5kms to the sub centre and possibly going by mistake on the day that another village has reached.
Giving the ANM mobility is more sensible. Second ANM or MPW or CHO (Bridge Course MLHP in HWC) could sit at the SHC/ HWC
Dear viewers
I thank Dr prabirkc for his views.
I wish to share the following which may be happening in all the urban pockets in India.
Circular was issued to suspend vaccination services till 03 May 2020 in Karnataka State, but well in advance, RI services are resumed, RCH Officers were oriented, State Immunization officer and WHO senior consultant conducted online classes viewed by the service providers. Guidelines are very much adequate as long as the services are delivered only by the public sector which is true for remote areas, villages with sparse population and the areas served by ASHAs/AWWs/ANMs. However in urban areas, ~30 to 40% vaccination services are provided by the private stakeholders who do not have fixed catchment areas, neither the NIS is adhered, e.g. child may receive easy six 3 doses with no VVM but no OPV - just one exapmple of many aberrations. This often happens to the children of doctors/nursing staffs working in the private tertiary care centers, corporate hospitals + the elites. Beneficiaries are hardly listed as the infrastructure is not adequate nor the elite beneficiaries opt public service. These institutions are generally not within the radar of authorized sustained supportive supervision. This can result in accumulation of susceptible among “vaccinated but not immunized”.
There is an urgent need for proactive mutual participation for updating “ourselves” in the interest of community health.
This I thought of sharing with both national and global viewers following the dialogue with an orthopedic surgeon today in the dedicated vaccination clinic of our college whose child is due for the first dose and we have no vaccines to administer for the past one week, anticipating supply shortly – a temporary inconvenience to the public.
This is just a qualitative true example of an iceberg.
best wishes
KVG Team
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