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Should immunisation be a mandate or could it be consensual in modern day India?

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Dr Siddharth Dutta, Senior Consultant, Stratview Research, analyses the debate between mandated versus consensual immunisation. Addressing the top concern of parents he also suggests some solutions to plug the gaps in the vaccine supply chain management

Today millennials are debating the safety of vaccines in India. Due to awareness in media, adverse effects are frequently reported, adding to the existing concern of parents in India. Parents are in a dilemma on whether they should get their children vaccinated as part of the immunisation protocol or do they have a choice of opting out? In 2018, we came across several instances in India (Gurugram, April 2018, Mumbai and Pune in November 2018, Tamilnadu and more) where parents had raised concerns over immunisation drive by the Government of India/State. Many have complied, few had opted out, and the confusion continues. Is it really necessary to get a booster dose even if your child has gone through the required immunisation chart? Will there be side effects? Are these needles safe? Is the vaccine’s quality good? Who decides?

As a parent, I think the following concerns are more relevant.

Concern#1
Dilemma of the decision maker or parents: Even though the protocols are clear on which vaccine is supposed to be administered at what age. Parents in private healthcare market are totally dependent on the recommendation of their family physicians or paediatricians when it comes to selecting a particular brand of the vaccines or the type of vaccine or timing. In public healthcare segment, the scenario is totally different, as nearly every parent is dependent on whatever vaccines are provided by government hospitals or dispensaries. Half of them are not even aware of which brand is being administered and rest half have no say even if they realise that they have never heard of the company manufacturing that particular vaccine. On top of that if immunisation is made mandatory without awareness (by the government) then it adds more confusion. So should you still go for it or opt out?

Solution: Parents should consult their pediatrician immediately if they have any doubts. Check for the brand, company, expiry date of the vaccine and also check if they are single vial use or multiple use. Make sure that there are no adverse events reported with that particular batch of vaccines, look for single use syringes. Look for any reaction after the vaccination (upto 30-45 minutes). In case of any adverse event, report immediately. Please remember that vaccination is safe, if they pass through all QA checks, but as parents you still have all the right to opt out.

Concern# 2
Gaps in vaccine supply chain management: Vaccine usually require special storage conditions while getting transported from manufacturers to the hospitals or clinics. There have been instances that due to the temperature variations or storage irregularities the vaccines are spoilt. Such cases are rarely reported in India.

Solution: Stringent policies and quality assurance processes are required to monitor the movement of these batches from factory to warehouse to distributor to pharmacists/hospitals/clinics. Many European countries are switching to digital tracking methods (bar code added with Block chain technology) so that any and every batch of consignment can be tracked real time. In India that can be adopted to ensure that the vaccine reaches the end user in the best condition. With gaps in the supply chain, mandating any immunisation programmes can be dangerous.

Finally, penalising companies which supply expired batches of vaccines, or deviating from standard protocols; this can help build the confidence among parents and paediatricians. Policy makers must realise that unless an immunisation programme is consensual it can never be successful.

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