In response to the above we like to share "Immunizing The Vaccinated".
Population Immunity gap: Timely and completely closing the population Immunity is mandatory to control / eliminate / eradicate any vaccine preventable disease including COVID-19 which is repeatedly emphasized at all platforms. For countries like ours [India] till date, the equation of Population Immunity gap is very simple: the gap between eligible population [Target – the Denominator] and fully vaccinated [Numerator]. Gap includes un and under vaccinated beneficiaries. “India experienced a relatively large drop in DPT3 coverage in 2020 (91% in 2019 to 85% in 2020) and overtakes Nigeria (stable at 57%)” having the dubious distinction as the number 1 among the 10 countries being the 2nd most populous country in the world attributed to Covid-19 pandemic and associated disruptions which over strained health systems.
This is also attributable to absence of simplest, surest, sustainable model for delivering vaccination services wherein the grass root level service providers themselves are "self supervisors/monitors" sparing specialists and hence to improve the coverage marginally also it takes multiple years in multiple phases as evidenced by Mission Indradhanush launched on 25 Dec 2014.
Since the absolute number itself is too big, additional criteria is yet to be included to define the immunity gap. For majority, both service providers and the beneficiaries, just “pushing” the vaccine [=vaccination] is equated as Immunization, the CDC rights are not adhered, especially the potency of the vaccine, cold chain quality, universal availability of Vaccine Vial Monitor (VVM): very conspicuous by its absence in the private sector except for a few like bOPV, some brand of Rota Vaccine, even if it is present often found in discard stage by the monitors, quantity [0.05mL / 0.1mL / 0.5mL], route of administration etc as a result vaccination may not result in “sero-conversion – immunological response”; thus the vaccinated may remain un-immunized especially in the private sector with considerable high risk practices.
Any one monitoring Routine Immunization Sessions using standard short checklist can easily identify and can rectify also to a large extent through supportive supervision. Children of the elites are mainly affected especially of doctors / nurses / corporate by default in the urban area. Hence real denominator of population immunity gap should include un and under vaccinated children + vaccinated but unimmunized as detected through sero-survey among the vaccinated also. In one of the Indian studies it is ~20% among the vaccinated in private sector who contribute ~40% in the urban area and ~10-12% in rural India with regional variations.
With the introduction of COVID-19 vaccines, private sector is warmly roped in for delivering vaccination services. Supportive supervision prior to approval of COVID Vaccination Centers [CVCs] infused more awareness in the private sector and overhauled “RIGHTS” including cold chain to a considerable extent - all most all Private Medical Colleges / Tertiary Care Centers came to know & procure Ice-Lined Refrigerator, appointing a dedicated person to look after cold chain and the like.
The key goal of the Immunization Agenda 2030 is to make vaccination available to everyone, everywhere, by 2030; but needs to be served with quality – practicing all the CDC RIGHTS + COVID-19 pandemic compliance.
Professor and HOD
Community Medicine; KVGMCH – Sullia