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Can India Afford To Not Vaccinate?

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India has taken giant leaps forward for improving the state of public health in the country in the past few weeks.  In an unprecedented move, Finance Minister Arun Jaitley promised the country complete sanitation by 2019 and announced that the government would allocate Rs. 3,600 crore to help ensure safe drinking water.  Excise duties on cigarettes, gutka and other tobacco products have been hiked to discourage the use of these harmful substances.

Perhaps the most significant announcement preceded the budget by a week, when the Prime Minister announced the introduction of three new vaccines in the country’s Universal Immunisation Programmes. In a country where a large majority of children still die from vaccine preventable diseases, the introduction of vaccines against rotavirus, the leading cause of diarrhoea associated deaths and hospitalisations, as well as rubella, one of the leading causes of congenital defects in newborns, will doubtless breathe new fire into India’s historic battle against infectious diseases.  India is also joining hands with 125 other countries to introduce the injectable polio vaccine in a bid to speed up global eradication efforts.
The nationwide use of these vaccines is estimated to prevent at least 50,000 deaths of children under-5 every year, a significant figure for a country that (regrettably) leads the pack in under-5 mortality globally. Importantly, the new vaccines will have far-reaching effects on the quality of lives of children, preventing a million hospitalisations and illnesses every year, and protecting thousands from life-long crippling disabilities such as blindness, deafness and heart-defects (attributable to rubella). The introduction of these vaccines in India’s Universal Immunisation Programme (UIP) will make their benefits available to children from all sections of the society,ensuring equity in health. Fewer diseases not only mean a healthier childhood and less expenditure on the treatment of diseases but also a healthier and more productive community and country.

As far as investments go, immunisation is the insurance policy that promises both demographic and economic dividends.For detractors worried about the increase in expenditure on immunization, here are some facts to think about. India accounts for nearly a fifth of the global disease burden and loses about 6 per cent of its GDP to premature deaths and preventable illnesses. Hospitalisations remain a major cause for indebtedness, pushing 2.2 per cent of the population below the poverty line every year on account of out-of-pocket expenditure. Yet, public expenditure on health comprises only 1.4 per cent of the GDP and public expenditure on vaccines an even more miniscule 0.03 per cent. For perspective, India ranks 171st out of 175 countries in public expenditure on health care, lagging behind many resource strapped countries in sub-Saharan Africa. In contrast, India ranks third in out-of-pocket expenditure on health.Governments in the four other BRICS countries spend, per citizen, nine to twenty-seven times more and vaccinate their children against more illnesses than India.  Even Rwanda provides vaccines against more diseases in its immunization programme than India.

In terms of budget allocation, the Ministry of Health and Family Welfare ranks 9th, with a total allocation of Rs. 35,163 crore. Out of this, nearly 21,912 crore have been allocated to the National Health Mission. According to the Comprehensive Multi Year Plan for 2013-2018, the projected cost of procurement of these vaccines and injection supplies (including the cost of pentavalent vaccine, which is provided free of cost till 2015 by GAVI) will not exceed Rs 2,800 crore in 2016.  That is, even with these four new vaccines, the cost of procurement for both vaccines and injection supplies will comprise 13 per cent of the National Health Mission budget. Importantly, the introduction of these new vaccines will increase the total expenditure on immunisationfrom 0.03 per cent to 0.07 per cent of GDP. This means, by spending 0.04 per cent more of its GDP the country is set to rescue lakhs of children from death, disability and illnesses.The question to be asked, then, is: Can India, the country home to the greatest burden of maternal and child deaths in the world, afford not to vaccinate?

The author, Prof. Ramanan Laxminarayan, is Vice President of Public Health Foundation of India