Experts have voiced concerns about the potential for the COVID-19 pandemic to disrupt routine immunisation services – and a possible resurgence of vaccine-preventable diseases. Health Issues India talks to Dr Badri Patnaik, Head Medical, India and South Asia for Sanofi Pasteur on these themes.
The World Health Organization and GAVI, among other organizations, have spoken of the challenge of maintaining routine immunisation (RI) in the era of the coronavirus. Yet it is widely recognized that it is important that RI programmes continue. How do countries ensure that vaccinations continue in a safe manner?
Amid COVID-19, safety measures must be followed by maintaining social distancing in order to continue routine immunisation programmes. Hence, mass immunisation campaigns are not advisable currently. The Ministry of Health and Family Welfare (MoHFW) has declared immunisation as an essential health service that has to be continued and re-organized during COVID-19 outbreak. To protect children and pregnant women from vaccine-preventable diseases (VPDs), we need to utilise every opportunity for immunisation.
The Government has issued specific guidelines for hotspots, non-hotspots and non-infected districts. Within the hotspot and non-hotspot districts, birth doses should continue. However, immunisation sessions at health facilities should be put on hold for containment and buffer zones but can continue for areas which fall beyond the buffer zone. MoHFW has guided for immunisation services to be delivered through three platforms
- Birth dose vaccination: Birth dose vaccinations (BCG, DPT, pneumococcal conjugate and rubella) to be administered at maternity health facilities
- Fixed sessions: immunisation services are to be provided at health facilities wherever feasible, for walk-in beneficiaries
- Outreach sessions: At the village/ward level immunisation to be as part of Urban/Village Health Sanitation and Nutrition Days (UHSND/VHSND) services
Additionally, there could be specific days in a week or specific areas that can be designated as vaccination days and sites. There should be separate days for vaccination of infants, toddlers and children. The MoHFW guidelines are well laid out and should guide all. It is essential that every state does its part to reinstate the value of vaccination and ensure that the routine immunisation programmes are continued during times like these.
What should those in the medical profession be doing to make sure that, even during coronavirus, families still vaccinate their children?
All risk groups, babies, children and expecting mothers, should be considered for vaccination. The medical fraternity is playing a pivotal role in managing COVID-19 cases in India. As a part of the broader infection control policy for healthcare facilities, vaccination of healthcare workers should be considered as they are on the frontlines managing the COVID-19 with constant exposure.
There are guidelines issued by the MoHFW and Indian Academy of Paediatrics (IAP) on vaccination during COVID-19 period. Medical professionals need to take adequate COVID-19 infection prevention related precautions and schedule the vaccinations on separate days for infants and older children. Medical professionals with multiple practice sites must consider using one location for immunisation and delegate immunisation tasks to colleagues who are unexposed to COVID-19-related duties.
How do you envision the role of the private sector in promoting RI both during and after the coronavirus?
Based on Ministry of Home Affairs (MHA) guidelines we believe that private sector pediatricians have already started with routine vaccination. IAP has also played a major role in extending guidelines further on managing risk of delayed vaccination. As far as the private sector is concerned, they play a crucial role in terms of utmost support at every level. As Sanofi Pasteur, we understand the anxiety faced by parents in the current times. We have introduced Vaxline (https://bit.ly/VaxLine & toll-free# – 18001235011) which is a helpline for parents to navigate through delayed vaccination situations due to COVID-19 pandemic. We have also ensured adequate and uninterrupted supply of vaccines to meet the increased demand post lockdown. We believe that the public and private sectors need to work together to meet the immunisation needs post COVID-19 lockdown.
Maintaining RI in low- and middle-income countries during COVID-19 can present as a particular challenge due to the combination of the disruption due to the pandemic and the existing gaps in their health system. What support is needed for particularly vulnerable health systems to provide RI while tackling coronavirus?
The current situation has reinstated the importance of vaccination for battling infectious diseases. Every country today is facing their own share of challenges with routine immunisation. Vaccines are an essential part of every country’s health investment which helps them keep the nation safe. As mentioned earlier, while following the COVID-19 precautional guidelines, it is advisable to have specific days in a week or specific spots in villages/towns/cities are to be designated as vaccination days and site especially for areas beyond the buffer zone
What would the lasting implications be of RI programmes being stalled as a result of coronavirus?
Interrupted RI can lead to outbreaks related to VPDs This can have an adverse impact or strain the healthcare system. Hence, we need to implement solutions like VPD surveillance and viable immunisation programmes.
Do you see the potential for a resurgence in diseases such as polio and measles given the halted vaccination programmes?
Over the past years, India has gained mileage over some infectious diseases through initiatives such as the Pulse Polio Program and Mission Indradhanush as part of the National Immunisation Programme. Routine immunisation should continue following the guidelines from the MoHFW so that we can minimize any risk of VPDs like Measles and Polio.
Vaccine-preventable diseases such as measles were already making a comeback in many parts of the world even before the coronavirus, in part due to misinformation and fake news. Do you think the same scrutiny applied to fake news on the coronavirus pandemic will be applied to the fake news surrounding vaccines going forward?
Vaccines protect individuals and communities. Any medical advice or news not based on science and research can hurt the health of individuals and threatens to bring back diseases that we work tirelessly to eliminate. Please refer to qualified Government of India (GoI) sources and qualified healthcare professionals.
What are the main challenges to countering fake news about vaccines?
Please do not believe in any information which has not come from credible sources. It is imperative to seek guidance from a doctor and follow official guidelines. We always need to have faith in our medical fraternity and healthcare system.
What lessons can the world learn from the coronavirus pandemic so that, in a future health emergency of this kind, both the emergency itself can be dealt with and immunisation programmes can be sustained?
COVID-19 pandemic has taught us various lessons in the form of our preparedness, strategy and dynamics of immunisation. We need to continue strengthening the epidemiology and surveillance for Infectious Diseases while extending our outbreak response beyond geographies. immunisation services can probably be treated as quasi-emergency practice. However, a risk benefit-based assessment should be given to the public on vaccination matters by the authority.
Do you have anything further you wish to add?
Vaccinations are a strong pillar of any country and we are only as strong as our last vaccination. While our healthcare system is burdened, public and private sector needs to join hands to meet the immunisation requirements of the country. With combined efforts we will indisputably triumph over the current situation and reinstate our vaccination pillars.
About Dr Badri Patnaik
Dr Badri Narayan Patnaik is Head Medical – India and South Asia at Sanofi Pasteur. He is a qualified MD with two decades of experience in medical practice, clinical research and medical affairs in India and global markets.
Dr Badri comes with extensive experience in bringing together a variety of basic and clinical research teams from the industry, academia and government institutions. He has also actively contributed in product discovery, regulatory/research project management in the fields of infectious disease epidemiology, immunopathogenesis, vaccines and antibody-based therapeutics, and In vitro diagnostics.
Prior to joining the Sanofi Group, Dr. Badri has led various prestigious development programs like, rotavirus vaccine development program at PATH, India (ARVAC) and document development for International study at Bangladesh (Cholera vaccine) along with IVI, Korea at Shantha Biotechnics Limited (now Sanofi Healthcare India Private Limited). He was also associated with Indian Immunological limited (IIL) as the Head of Medical and Veterinary Vaccine Development. He has contributed to several research papers on Human Vaccines, Rotavirus, Gastroenteritis, Cholera, immunogenicity and Immunotherapeutic. Dr. Badri is an MD in Clinical Pharmacology and holds a Diploma in Vaccinology from Pasteur Institute, Paris 2009.
Dr Badri has also served the Indian Armed Forces and carried out medical and crisis management of the advance formations in the field.
An avid beekeeper and horticulture enthusiast, he enjoys wine making when he is home in Hyderabad. Dr Badri is based in Mumbai.