Health and Healthcare Systems

3 lessons from India in creating equal access to vaccines

Vaccines are placed on a tray inside the Taipei City Hospital October 1, 2010. In preparation for the start of the flu season, health authorities in Taiwan started a mass immunisation program on Friday providing vaccines against the H1N1 flu virus and pneumonia. REUTERS/Nicky Loh (TAIWAN - Tags: HEALTH SOCIETY) - GM1E6A10WGP01

Vaccines can be an important entry point for children and families to the rest of the primary healthcare system Image: REUTERS/Nicky Loh

Keith Klugman
Director of the Pneumonia programme, Bill & Melinda Gates Foundation
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When I completed my medical degree in South Africa in 1981, the country had one of the highest burdens of infectious disease in the world. Nine percent of children died before their fifth birthday. As a newly minted doctor, I had the knowledge and skills to treat some of these illnesses, but it was devastating that I couldn’t do more to prevent them.

At the time, vaccines for many diseases, including for polio, diphtheria and measles, were widely available to children in rich countries, but those in poorer countries such as South Africa often did not receive the same protection. It was this stark inequity that led me to shift my career from medicine to research, and focus on expanding access to lifesaving vaccines around the world.

In the decades since, there is one disease that, for me, has become a potent symbol of the consequences of unequal access to healthcare: pneumonia. The first vaccine for pneumonia was licensed in 1977 in the US. In 2000, a vaccine effective for children was added to the childhood vaccination schedule, leading to an 80% drop in pneumococcal disease in American children.

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In the same year, I completed a vaccine trial that showed for the first time that the new vaccine also prevented pneumonia in African infants. Yet 18 years later, this highly effective vaccine, known as the pneumococcal conjugate vaccine (PCV), is still unavailable in many parts of the world. Pneumonia remains the biggest infectious killer of young children worldwide - the vast majority of them in low and middle-income countries - and has remained stubbornly so for decades.

Prevention in India

In recent years, the scale has finally started to tip. Since 2017, India - home to roughly a third of the world’s most vulnerable children and one of the greatest pneumonia burdens in the world - has introduced PCV into its routine immunization programme in the six states with the highest rates of infant mortality. With this rollout, millions more Indian families can rest assured that their children will be protected from life-threatening pneumonia. Here are three important lessons from India for other countries now planning their own PCV rollout.

1. Innovate for efficiency

In addition to introducing the vaccine, India has also upgraded technologies in recent years that help ensure PCV and other lifesaving vaccines get to children across the country swiftly and safely. It launched the Electronic Vaccine Intelligence Network (eVIN), an innovative digital platform that remotely monitors the temperature of vaccines and sends alerts if temperatures fluctuate beyond safe levels. The platform also tracks vaccine stocks, ensuring that every clinic and hospital along the supply chain has enough vaccines to meet its patients’ needs, and that nobody is turned away because a vaccine is not available.

2. Vaccines are a gateway to health

Furthermore, by continuing to invest in a strong routine immunization programme that reaches those who need it most, India is providing an important entry point for children and their families to the rest of the primary healthcare system. When a parent brings a child in to receive PCV, a healthcare worker can also assess the child for signs of malnutrition and ensure they are up to date on other immunizations. The health worker can act as a resource for the parent, linking them to other services they may need, such as family planning.

3. Every aspect of vaccine delivery counts

As part of the PCV rollout, India has also prioritized health worker training, data collection, disease surveillance, community outreach and record-keeping. These assets help improve the delivery of multiple health services, develop and scale health infrastructure and mobilize domestic resources, all of which are vital to strong primary healthcare systems.

On a recent trip to India, I was fortunate enough to visit some of the clinics where children were receiving PCV for the first time. I saw the progress that the country has made in a short time to get this vaccine to the children at highest risk. India’s experience offers important lessons for other nations.

Every child, whether born in a rich or poor country, deserves to live without fear of dying from a preventable disease such as pneumonia. For too long, the global community has kept this promise for some children, but not for others. I call on leaders from all nations to join me in working to achieve the UN’s Sustainable Development Goal 3 to “end preventable deaths of newborns and children under 5 years of age by 2030”.

Stronger primary healthcare systems, coupled with innovative approaches to reaching all children with vaccines and the introduction of vaccines like PCV in India, will make sure we are tipping the scale toward a more equitable world for future generations.

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