Government's plan to expand coverage of Pneumococcal Conjugate Vaccine (PCV) that prevents pneumonia among children to all states by 2022 may face a delay as an valuation of the vaccine's impact on citizens remains pending.
Two years the ministry of health and family welfare rolled out PCV, the vaccine’s impact study is yet to start. The only evaluation study that was supposed to start in November 2018 and finish by July 2022 couldn’t take off due to technical reasons, government officials told Mint.
“Sponsored by Johns Hopkins Bloomberg School of Public Health, the research titled —Evaluating the Impact of the PCV in India (INSPIRE)—was to be conducted by International Clinical Epidemiology Network (INCLEN) Trust and Christian Medical College, Vellore, India. Since the impact evaluation is pending, the further scale up of the expansion plan may take a while," said a health ministry official.
In 2017, India began a phased, national introduction of PCV. As of October 2019, PCV has been rolled out in Himachal Pradesh, Madhya Pradesh, Haryana, and Bihar as well as in select districts in Uttar Pradesh and Rajasthan. Interestingly, as per India’s Comprehensive Multi-year Plan on Immunization, PCV expansion has been targeted for 10 states till 2022 and to all thereafter.
The study, the health ministry official said, aimed to gather data that would provide robust evidence on changes in pneumococcal disease burden in young children, pneumococcal community transmission changes as a result of PCV introduction, and economic evidence that can help policy makers optimize the expansion of the PCV immunization program in India and in other countries.
The pneumococcus (Streptococcus pneumoniae) is one of the most common causes of severe pneumonia among children. It can also lead to severe medical conditions like meningitis and sepsis.
“When the government plans to expand the vaccine’s coverage, there should be a proper surveillance system and impact studies to further take policy decisions," said Naveen Thacker, member of the India Expert Advisory Group on Polio and the International Scientific Advisory Board of Voices for Vaccines. He is also member of steering committee, Gavi and Civil Society Organisation (CSO).
“Once we know the impact it is easier to further scale up the expansion plan. The PCV has over 90 serotypes (strains). Currently, we are targeting the most common 10-30 strains. With evaluation of the vaccines, we can also keep ready the alternatives of the vaccine," said Thacker.
Between 2017 and 2019, India received $175 million from Gavi as new vaccine support for the introduction of PCV. India will transition out of Gavi eligibility in the coming years, and Gavi’s commitment to India for PCV is scheduled to end in 2019, requiring the government to self-finance scale-up of PCV to remaining states and fund the full program beyond this year.
According to recent estimates, introducing PCV at US $3.30/dose and 77%2% coverage would cost the UIP approximately US $240 million annually. Increasing coverage to the government’s target immunization level of 90% would raise this annual cost to US $328 million.
“We have a surveillance system in place for PCV and all other vaccines. So far, there have been no adverse effects or any other complaints regarding the PCV vaccines," said Narendra Kumar Arora, Member of the National Advisory Group on Immunization of the Ministry of Health and Family Welfare.
“Finances shouldn’t be a problem, there are ample funds for the vaccines and government is scaling up its plans for expansion of PCV vaccines across the country," he said.
A study done by the Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry in association with Wellcome Trust Research Laboratory, Christian Medical College, Vellore, estimated that, over a 10-year period (2018-2027), PCV introduction would avert: 25 million cases of disease, 19 million outpatient visits, 2.2 million hospitalizations, 407,000 deaths, and over 10.1 million disability adjusted life years (DALYs). It was published in the Vaccine journal in January 2019 issue.
Studies also illustrate the impact of PCV on averting out-of-pocket expenditures for households. The financial risks associated with pneumonia disproportionately affect the most vulnerable and impoverished families, and PCV is expected to have the greatest financial risk protection impact among this population. Pneumonia which is the leading infectious cause of child deaths globally caused 1,58,1761 under-5 deaths in India in 2016.