Polio immunisation falls casualty to Covid as fear, staff shortage halt drive across India
New Delhi: With Covid-19 outbreak, the pulse polio immunisation drive across the country has come to a halt, ThePrint learnt.
The polio immunisation drive is usually conducted in four to six rounds annually, starting from January.
States such as Delhi, Maharashtra, West Bengal and Haryana, which completed the first round, have yet to begin the second round, whereas in Madhya Pradesh and Uttar Pradesh, the second round has partially begun in a few selected districts.
While the delay was anticipated due to the Covid-19 pandemic, the Centre had ordered states to resume the immunisation drive, considered an essential service, in April.
On 14 April, Preeti Sudan, secretary, Ministry of Health and Family Welfare (MoHFW), sent a letter to all principal secretaries, chief secretaries and administrators, stressing on the need to maintain non-Covid essential services.
According to the guidance note enclosed with the letter, these services include “reproductive, maternal, new-born and child health, prevention and management of communicable diseases, treatment for chronic diseases to avoid complications, and addressing emergencies”.
“It’s a matter of concern that immunisation services are not fully functional and we have highlighted the issue in appropriate forums. Due to the corona outbreak and fear of spreading among the community, the immunisation programme across categories of vaccine preventable diseases was suspended. Despite orders to start again, it is still not fully functional,” Dr Naveen Thacker, executive director of International Pediatrics Association told ThePrint.
“However, it should start on a priority basis and the government must analyse the risk versus benefits. We cannot afford another epidemic at the cost of one epidemic,” said Thacker, who is among the top influencers for the fight against polio according to UNICEF.
According to him, the primary reasons why the drive has not yet begun are shortage of community workers, fear among healthcare workers (HCWs) over contracting Covid-19, issues over availability of PPEs, and resistance from village or panchayat heads in rural areas to allow HCWs to carry out the drives during the pandemic.
According to a study by the World Health Organization (WHO) on 129 countries, the disruption to inoculation services may put 80 million babies at risk of getting diseases such as diphtheria, measles and polio.
The WHO in March had already recommended that “if immunization services must be suspended, it recommends urgent catch-up vaccinations as soon as possible, prioritising those most at risk.”
ThePrint reached Vandana Gurnani, additional secretary and National Health Mission director, and Manohar Agnani, joint secretary, MoHFW, for comment via text messages and calls, but had not received a response until the time of publishing this report.
Report from the states
Maharashtra, the state with the highest number of Covid-19 cases, has kept the polio drive on a back burner citing shortage of staff.
“During the lockdown, there were no pulse polio days. There is also a shortage of staff,” said Dr Pallavi Bhatt, paediatrician who runs a private clinic in Maharashtra.
A state health department official, who requested anonymity, confirmed the same.
In West Bengal, the drive is likely to start this month. “The preparations are underway and we will start the drives soon,” said a senior health officer requesting anonymity.
Atin Ghosh, deputy mayor in charge of health, Kolkata Municipal Corporation, said, “We will start polio drive in Covid-19-free zones from this month.”
This would likely mean that children inside containment zones in Kolkata won’t have access to the immunisation drive for now. There are currently 288 containment zones.
Dr Praveen Chopra, chief medical officer in Muzaffarnagar, Uttar Pradesh, said the drive is yet to start. The polio drive is pending in Delhi and Haryana as well.
In Madhya Pradesh, the Chief Medical Officer of Indore, Pravin Jadia confirmed that the drive had not kicked off yet.
Meanwhile, the routine immunisation drives for preventable diseases including diphtheria, pertussis, tetanus as well as polio was started in Indore in the end of May.
The state government in March had issued orders to all the district collectors and chief medical officers to resume all routine programmes for maternal and newborn health.
“The orders were issued, but in reality, regular immunisation in Indore has just started last week. Even then it is going on in selected areas here,” said Fiza Fatima, an ASHA worker from Indore.
The area under Fatima has over 150 children, who, she claimed, haven’t been immunised.
“I told the collector a few days back to start the immunisation. He just said he’ll look into it but there hasn’t been any response,” she said.
Jadia said the immunisation drives had begun only in 19 areas of the city which aren’t containment zones.
“We can’t do it in the containment area. Only once after the containment opens we can do it,” he told ThePrint.
Amulya Nidhi, who represents Jan Swasthya Abhiyan, a national platform that coordinates healthcare services across the country, said the drive is unlikely to start soon in villages in Madhya Pradesh since anganwadis (rural childcare centres) are closed.
“Anganwadi workers have no protective measures, so they say that they won’t work and ASHA don’t have protective measures either. So, if you go to any district, you will see that all the programmes have stopped. That is the ground reality,” Nidhi said.
According to a survey by Rajasthan-based NGO Prayas, around 250 children in Pratapgarh district, a tribal belt with a hilly terrain that makes it quite inaccessible, missed their polio shot.
“We did a rapid survey in 30 villages just to find out how many children were there who should have gotten immunised in the month of March and April. We found out that 250 children missed the immunisation during that period,” Chhaya Pachauli, director, Prayas.
The outreach health services from immunisation and antenatal services in Rajasthan resumed on 30 April. “If the health department does the catching-up well, the delay may not be harmful,” Pachauli added.
Antenatal care services also take a hit
In anganwadi centres, pregnant women also receive antenatal care on days the immunisation drive takes place, health care experts said. With immunisation days being temporarily shelved, pregnant women have also lost out.
“This involves registration of new pregnancies, it involves four to five important tests like haemoglobin tests, abdominal examination. These essential services were missed out,” Pachauli said.
According to Nidhi, several maternal deaths were reported across Madhya Pradesh since these services remained inaccessible in the last few months.
However, Dr Shailesh Sakalle, the deputy director of the National Health Mission in Madhya Pradesh, said the lockdown wouldn’t have posed a problem to outreach services since ASHA workers work in their own wards and villages and don’t have to go elsewhere.
“Till we don’t get authentic data published by HMIS (Hospital Management Information System), it wouldn’t be ok to make such estimates,” he said.