When I first traveled to India as part of my master of public health program,
Participants at Hib Symposium in Odisha, India in July.
I left feeling inspired to do something to help India’s children and families. Less than a year later, now at The Johns Hopkins University as a new research associate for IVAC, I had the opportunity to return to India as part of a team working to accelerate vaccine introduction to reduce child deaths from pneumonia and diarrhea. While there, I was able to see in real terms the impact efforts by IVAC and its partners have had.
I traveled to Bhubaneswar, a “small” city, if only by Indian standards, with a population of less than 900,000, that is the capital of Odisha. There, on July 9th, technical experts, government officials and other key stakeholders gathered for a one-day Hib Symposium, hosted by the policy unit of the National Institute of Immunology along with the Asian Institute of Public Health and designed to share data and experiences related to Hib disease and available interventions, including vaccines. While lesser known than pneumococcus, Hib or Haemophilus influenzae type b is a leading cause of pneumonia, the top killer of children in India and worldwide. It is also the leading cause of meningitis, which can result in death or serious neurological sequelae.
In 2010, nearly 400,000 deaths of Indian children under five were caused by pneumonia. While Hib vaccines have been proven to reduce cases of pneumonia and have been available for more than a decade, uptake has been slow in India especially in the public sector. However, that seems to be changing now, as more Indian states have expressed interest in adding Hib vaccines to their immunization programs, which would make them available at government clinics that reach the lower income populations who are at greater risk of dying from diseases like pneumonia and meningitis.
Media coverage of Hib Symposium.
Two states, Tamil Nadu and Kerala, have already introduced Hib vaccines (in the form of the pentavalent vaccine, which also protects against diphtheria, pertussis, tetanus and hepatitis B), and six more are slated to do so by the end of 2012. At the symposium, Ministry of Health and Family Welfare officials shared that eight more states have expressed interest. Judging from press coverage of the event, other states may not be far behind. All of this is great news for champions who have been advocating for Hib vaccines for several years, and a sign that Hib vaccine support may have reached a tipping point in India. The current momentum is driven by Indian technical experts and advocates like those who gathered in Bhubaneswar and other stakeholders at the center who recognize the important contribution of the vaccine. Our team at IVAC and its partner Global Health Strategies, Emerging Economies, are proud to offer technical assistance and opportunities to provide insight from other countries’ experiences and enable forums like the Hib Symposium.
However, many pieces of the puzzle still need to fall into place to gain widespread coverage of Hib vaccines among Indian children. In that light, state government representatives from Tamil Nadu and Kerala gave their peers at the symposium helpful insights from their rollouts, in particular highlighting the importance of pre-launch activities including evaluating the cold chain, training staff, establishing monitoring systems for adverse events and sensitizing policymakers and the media. They noted it was especially important to prepare stakeholders for the potential of adverse events following immunizations (AEFIs). One child died in Kerala after receiving the pentavalent vaccine, but thanks to sensitization efforts for government officials and a swift and clear response to the media, the state was able to quickly confirm the death was not caused by the vaccine and avoid derailment of the vaccine rollout. With careful preparation, Kerala and Tamil Nadu were able to carry out smooth launches and vaccinate more than 600,000 children in the two states combined through June.
I am excited to join the team here at IVAC at a time of such promise for India and look forward to seeing more progress in the coming months and years.
Kelly Healy, MPH, is a Research Associate at IVAC.