Research Paper on "Immunization and Public Organization Administration India"

Research Paper 12 pages (3532 words) Sources: 1+

[EXCERPT] . . . .

Immunizations and Public Org India

Vaccinations, associated with the prevention of many once common and deadly diseases that cannot be combated by traditional medicine have saved millions of lives all over the world. As vaccines provide prevention from viruses, pathogens that modern medicine has had very little success with in post-treatment they are indispensable to the ability of medicine to help people avoid serious disease in individual and in large outbreaks. Herd immunity is one of the most important aspects of the success and/or failure of global immunization, as without it diseases that can be prevented through immunizations can recur locally, regionally and even globally among those lacking immunizations. Additionally without herd immunity even immunized individuals are at risk when viruses have the opportunity to evolve in their natural manner through repeated infection, exposure to combatants and increased spreading. "Childhood immunisation programs currently save 3 million lives per year throughout the world and are one of the most cost effective public health interventions" (Ali, Zwar & Wild Web- 833). One of the most troubling aspects of immunization coverage is that the public may begin to become apathetic toward immunizations as soon as incidence of disease begin to decline, something that is a serious concern in the present, because immunization rates are high and donor nations tend to have even lower (or no) numbers of immunization preventable diseases than do developing nations (Mark & Rigau-Perez Web-64).

The World Health Organization and many other national and international health organizations seek to increase vaccination rates internationally as part of struggle that began in the 1970s and has expanded exponentially since, through expanded vaccination schedules as well as broader coverage. The goal of the current administrative policy is to increase immunization rates to 90% for most vaccinations and to do so globally.

When the World Health Organization (WHO) began the Expanded Programme on Immunization in 1974, <5% of the world's children had been fully vaccinated with bacille Calmette-Guerin (BCG), diphtheria-tetanus-pertussis (DTP) vaccine, oral poliovirus vaccine, and measles-containing vaccine (MCV) during the first year of life (3) ("Global Routine Vaccination…" Web- 1367).

According to WHO the expansion of vaccination has been a huge international success as access and routine immunizations have been fundamentally expanded to meet this huge social need, "Since then, increased vaccination coverage has resulted in substan-tial reductions in morbidity and mortality, including a >99% decline in polio incidence since 1988 (4), with eradication on the horizon, and a 78% decline in measles-associated mortality from 2000 to 2008 (5)" ("Global Routine Vaccination…" Web- 1367). In addition WHO notes that combined efforts that support the above outcomes have also expanded with additional vaccinations including the recent: Haemophilus influenzae type b (Hib) vaccine, HepB vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine into many countries' routine vaccination schedules…" (1367) from that WHO expects great future outcomes.

One document, that opens with the history of the first ever planned and applied vaccination program for small pox in the 19th century goes on to offer the best example in the literature as to the laundry list of goals and needs of a good immunization program:

Current immunization programs must pursue high coverage of a clearly defined target population, manage a reliable logistics and transport system, employ trained health workers, reduce administrative and geographical barriers (with fixed and, if necessary, mobile delivery sites), and inform and motivate the population to make use of the vaccine…. personal involvement of political, religious, and social leadership mobilizes communities; communication is a critical component of a program and uses multiple channels (face-to-face, print, mass media) to deliver the message; staff training provides the technical skills for planning and management; successful programs have a process measure (coverage) as well as outcome indicator (disease incidence); disease surveillance helps focus efforts on areas of greatest risk; decentralization of resources, coupled with a national plan of action, permits more effective and rapid activities; research and development provide a technical basis for advancing program goals; unbalanced concerns over risks, and public apathy toward immunization, as disease incidence declines, must be countered everywhere (Mark & Rigau-Perez Web-64).

The above quote illuminates, better than any other statement the multi-variant tactics that are needed for modern immunization programs for real change to occur in rates. Everything from proper communication tools to adequate program training are essential to the process.

Having said all of this, establishing a need for vaccinations as well as the monumental positive effects of these changes the organization would also like to make sure to express that there is still much work to do as it notes that, "based on an annual global birth cohort of approximately 130 million, an estimated 23 million infants worldwide still do not receive the benefits of routine vaccination (i.e., 3 doses of DTP during the first year of life)" (1367). WHO also goes on to say later in the work that much of this area of weakness occurs locally and regionally, in certain poor areas of the world that lack other basic necessities, such as compulsory education and access to basic preventative medicine (1371).

In response to this concern WHO has collaborated with UNICEF to create a comprehensive action plan called the Global Immunization Vision and Strategy (GIVS). The goal of the plan is to assist challenged nations in strengthening their immunization programs and overall in vaccinating more individuals. The overall goal of the program is to create a 90% DTP 3 dose vaccination in all nations among children by age 12 months by 2010 and to maintain this into the distant future (1367).

India is one of the largest nations in the world and has one of the largest populations of poor in the world as well. For this reason many children have limited access to health care and education, on a regional basis. Among the 23 million children who have not received the 3 dose DTP by age 1 year about half of them live in India and Nigeria and neither nation is expected to meet the 2010 percentage goal (1371). It must also be noted that India lags behind on nearly all its immunization rates, including polio, which was once on the brink of eradication but has resurfaced in India and other nations (Hull Web-300). The vaccination rate is improving but the concern is that there are still many holdouts, particularly in minority faith communities in the nation (Web-300). Lastly, it must also be noted that immunization documentation and reporting is one of the most important aspects beyond actually providing vaccinations to children as without record there is no way to know what real immunity rates are, as was evident in the Australian, practitioner visit model where teachers visited health clinics to teach practitioners how to report vaccinations and rates improved dramatically (Ali, Zwar, Wild Web- 833-835). Having established what we know in a general sense about immunization needs and rates this work will then go on to provide a systematic review of immunization rates in India.

Evidence Review

From an extensive review of relevant literature comes an illumination of the particular case of India. In a review of a recent failed attempt to eliminate Polio in India, an endemic nation, there is a profound message about how and why certain strategies have failed there. "In the midst of these virological considerations, the key lesson that emanates from the Indian experience is that the social determinants of programme implementation are as important as the technical ones -- and this lesson has a significant bearing on other disease elimination programmes as well" (Arora, Chaturvedi & Dasgupta 232). What Arora, Chaturvedi & Dasgupta found is that small pockets of unimmunized individuals in densely populated underdeveloped areas, with limited access to health care, poor hygiene conditions, intestinal parasitic and other common ailments exist nearly all the time as well as a general undernourishment exist in the population even very high rates of immunization will not counter occasional outbreaks of disease, in this case polio. The reason for this is that these small populations that are disenfranchised can carry low levels of the disease and spread it to each other or to outsiders as a matter of their living conditions. The consensus among these researchers is that these areas are particularly troubling not simply because of lack of access to affordable (which means free in many cases) access to routine vaccinations and medicine in general, though access is highly essential (Sahu, Pradhan, Jayachandran & Khan) but also because they also harbor resistant populations who object to vaccination on several levels

In areas of poor development and inadequate health care, marginalized communities, regardless of religion or social group, are mistrustful of SIAs [supplemental immunization activities]. Some circulating rumours pointed to elements of religious and cultural resistance as well.7 Allaying the fears and suspicions of these marginalized segments of the population will require improved primary health care and the visible involvement of volunteers from local communities in the microplanning of SIAs (Web- 233).

The researchers above conducted research in just such areas and attempted… READ MORE

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