Health Analytics India - An Initiative By dataLEADS
When Dr Seth Berkley met Prime Minister Narendra Modi on 6 January in New Delhi he proposed a new strategic partnership with India. The partnership envisages to give new boost to India’s vaccination campaign and will protect millions of children against causes of the biggest childhood killers, pneumonia and diarrhoea, as well as others such as measles-rubella and cervical cancer vaccines.
In an interview to Assistant Editor, Surbhi Kaul, Dr Berkley, CEO of Gavi, discusses the new strategic partnership which would see the global vaccine alliance provide an additional support of up to US$ 500 million to fast-track the introduction of childhood vaccines for all children in India.
He talks about the four vaccines that have been discussed as a part of the partnership, the biggest challenge to reach 27 million children in India and why data is important to examine the success of vaccination campaign. He also shared his optimism about Mission Indradhanush, the government of India’s ambitious initiative to ensure immunization of all children against seven vaccine preventable diseases including polio, tuberculosis, measles and hepatitis B, which kills thousands of children a year.
Excerpts from an interview:
I have been working with India since 30 years and Gavi has had an association with India since 2002. The thing I am most excited about now is that India has shifted, it has really opened up the market place for vaccines and India is now manufacturing 60 per cent of the vaccines we purchase globally. That has done a lot for the market place; it has created healthy competition and helped with pricing.
I think the most exciting thing is the level of political commitment we are now seeing from the Prime Minister to the Health Minister to the finance minister to the Health System to the state level. I think everybody is excited about trying to strengthen immunization, build better systems, reach the children who are not being reached and roll out new vaccines, specifically we discussed about rolling out four new vaccines.
The four vaccines that have been discussed are the rotavirus vaccine, that is against diarrhoea, the pneumococcal vaccines which is against pneumonia, and critically, pneumonia and diarrhoea are the two largest killers of children in India. The third is rubella vaccine and then finally the cervical cancer vaccine, which has not yet been recommended by the National Technical Advisory group for immunization but that is now under discussion. Cervical cancer is the largest cancer for women in India, currently amounting for 70,000 deaths a year. We’re excited that there is this kind of willingness to make sure that these important vaccines get out to much of the rest of the world, including all the countries surrounding India. By the way, all those four vaccines are available in India, but in the private sector. So wealthy people already have access, but what we’re talking here is to make sure the poor also have access.
It took 10 years for the Hepatitis B vaccine to roll out across India and that is the first vaccine we worked with India on. This year we hope that IPV (the Inactivated Polio Vaccine) will be rolled out in one year. It shows an acceleration of the programme. In terms of the equity issue, there are health systems strengthening work with India to focus on 11 low-coverage states. We were very excited to see India taking it to the next level by creating Mission Indradhanush, which was to target 201 low-coverage districts and try to get to children that haven’t been reached before. We’re seeing both the focus on new vaccines accelerate but we’re also seeing how vaccines are being brought to children who haven’t been reached. And that is critical because India has the largest number of under-immunised children in the world.
The challenge here is we’re trying to reach 27 million children, the birth cohort is enormous and I think the important issue here is how to extend those systems not on a one-on-one fashion. I went out and saw in Uttar Pradesh an example of how they were doing that, how they are going to some very difficult to reach population like rag pickers and brick kiln workers etc. But the challenge is making sure not just that we reach them but that they get brought into a routine immunization system. And that of course is a logistically difficult thing to do. It’s also difficult to extend out cold chain, the cold chain for vaccines, and that’s a very important part of what has to happen to make sure that there are adequate vaccines at every level to reach these children.
Data is absolutely critical. You cannot have a programme like this without understanding data because you cannot increase the number of kids being reached unless you know who is not being reached and where they are. You also need the data to ensure that you are reaching them and that they will ultimately get put in the system. So data is critical. We also need to make sure that the vaccines that reach them are still viable and can handle properly in the cold chain. We need a system to tell us if there is any problem with any vaccines. So having systems in place with good data is absolutely critical to this type of work.
We’re not going to do anything other than partnering with the Government of India, we don’t physically have people on the ground and we’re not vaccinating people. The challenge is working with the government to focus these efforts on the unreached and focus on vaccines and that’s why we’re so excited by something like Mission Indradhanush, because that is a born-in-India programme designed by the government. Some of it is overlapping with the financing we’ve given the states but this is also being financed by the Indian government and at the end that is how you create sustainability.
Well, I think that is one of the issues that is being dealt with now by this programme. As I said, the challenge here is not that India has not had access to these vaccines but that it hasn’t been available to the poor and I think that’s why attention needs to be paid to these equity issues.
I think we’re seeing innovations occur and to roll out [vaccines] on this scale, India’s going to have to innovate and the nice thing about India is that it’s a fantastic skill here. When I was in (India’s largest state) Uttar Pradesh, I saw an electronic vaccine intelligence network, a system that kept track of vaccine doses. You can put the data in through smartphones or laptops and then once it’s in, it is available to everybody. This allows fine-tuning vaccine doses. We’ll have a view on how this works and if it is really good, why not make it available to other places. Similarly, an SMS verification device for cold chain barriers where you could dial and tell people, the temperature has gone up etc. This is something commonly used around the world, but they showed me the one they made in India which was for Rs 8,000 (US $ 118) but the one that was made in other places was for Rs 40,000 (US $ 592). So if India perfects this and makes this high quality, stable and reliable, I’d much rather purchase large numbers from Indian-made more cost effective products than the ones made on international market. So those are just two examples of technology that India can use for itself but could really work towards a better market culture.
Right now with the Gavi health grants and the health systems grant and the Mission Indradhanush is going to lowest coverage areas. I’ll also point out here that ending polio meant reaching every child. There would be huge focus on mapping and understanding where under-immunised kids were for polio and that is exactly the kind of efforts we need to do for tracking down and finding out who’s being missed and where and why and how do we intervene.
Absolutely. The exciting thing is that the systems are already in place .What was done for polio can be re-purposed and used with a bit of innovation. Obviously, some things have changed and it needs different work and it needs vaccinators who can give injections, versus just polio drops but those systems can absolutely be reused.
If we can work together in partnership and coordinate our procurement and coordinate our demand forecast, that then helps manufacturers prepare and provides certainty in the market place and allows us to have more influence and to make sure there is adequate vaccine supply for all.