Immunization coverage and antibiotic use: Is India missing an opportunity?

South and Southeast Asia accounts for 6.5% of global antibiotic use, including 54.9% of antibiotics classified by World Health Organization Watch. Photos are used for representative purposes only. Photo credit: Getty Images/iStockphoto

Immunization is one of the world's greatest public health success stories, after sanitation and water security. vaccination Sand polio has been eradicated in India and is no longer the scourge it once was. However, the country's vaccination efforts continue to leave many opportunities untapped, with real costs down the road.

of COVID-19 pandemic demonstrates the importance of educating the public and administrators about the benefits of vaccination at all ages and the need for adult vaccination. Unfortunately, associated lockdowns also led to massive disruption of pediatric vaccination programs around the world. UNICEF data A study from 2023 found that 73 countries reported significant (more than 5%) declines in childhood vaccination coverage following the pandemic. Of these, only 15 have returned to pre-pandemic levels, 24 have recovered and 34 remain the same or have worsened. What is attracting attention in India is One of the success stories In this regard, a recovery on the ground is expected based on the successful completion of the third dose of the DPT vaccine.

Lack of data on disease burden

While India's post-pandemic success is commendable, it is unfortunate that many other vaccines, such as the vaccine against pneumococcal pneumonia (pneumococcal conjugate vaccine-PCV) and the Haemophilus influenzae vaccine (Hib), have There is no exact data. These two vaccines are very recent additions to the government's immunization program and were designed to be rapidly rolled out during the coronavirus outbreak. Data on the burden of these two pathogens are not currently available, but the last estimates in 2015 were 1.84 million cases and 84,000 deaths.

The importance of this is that these two pathogens, Streptococcus pneumoniae and Haemophilus influenzae, are the leading causes of upper and lower respiratory tract infections throughout all decades of life and are an important concern for children under 5 years of age. It lies in the fact that These are among the most common causes of ear infections (otitis media), lung infections (pneumonia), and brain infections (meningitis). Some of these problems are life-threatening and can leave survivors with long-term complications.

The introduction of PCV as a pediatric vaccine has been achieved in most developed countries and in 60 out of 73 countries worldwide. Countries covered by Gavi Vaccine Alliance. As a result, pneumonia cases and deaths among children have decreased significantly. paper In 2020, it was estimated that 175 million infections were reduced as a result of infant vaccination, in addition to around 625,000 deaths prevented over 10 years.

What happens to those who are unvaccinated or undervaccinated?

While the immediate, short-term effects are often reported, it is generally not recognized that not getting vaccinated poses a larger problem of global concern. Current research shows that unvaccinated or undervaccinated children are more susceptible to preventable diseases, require more medical visits, and often have higher out-of-pocket costs. Importantly, we know that there is a lot of unnecessary overuse of antibiotics, which worsens the social situation. The spread of antimicrobial resistance. There is also concern that this will disproportionately impact the most vulnerable members of society and increase costs for them.

South and Southeast Asia account for 6.5% of global antibiotic use; Antibiotics classified as “surveillance” by the World Health Organization. This is alarming, but the nightmare is underway, compounding the problem of widespread drug-resistant infections against a virtually depleted drug development pipeline. A number of interventions are planned to address this as part of the “One Health” approachHowever, insufficient attention has been paid to the value of vaccination in reducing antibiotic use. In monetary terms, AMR could cost India 5-7% of GDP annually by 2050.

a recent papers in lancet Chirag Kumar and his colleagues at Regional Health South Asia assessed the potential benefits of expanding coverage of both these vaccines. This assessment examines the vaccine uptake across India and its expected benefits in terms of reduced infection rates by the two pathogens mentioned above, as well as the potential reduction in antibiotic use driven by these diseases. It was something.

First, the disease burden is expected to be significantly reduced, with the benefits being most pronounced in vulnerable states such as Rajasthan, Madhya Pradesh, Odisha and West Bengal, the paper said. are. It is also expected to reduce the burden of disease and mortality for all groups, regardless of their economic background. When a population is segmented by wealth, the least economically advantaged will benefit the most, including reduced mortality. Additionally, it is estimated that 67,000 deaths per year would be reduced.

Second, regarding the problem of antibiotic overuse, this model strongly suggests a significant reduction in antibiotic consumption in children, and this reduction is most pronounced in economically advantaged groups for cost reasons. It is thought that there is. However, this reduction in usage could lead to more equitable use of antibiotics and a reduced burden on the most economically disadvantaged.

Other outcomes, such as the need for hospital visits or hospitalization, were not estimated, but these are certainly separate estimates, as this could reduce pressure on an overburdened public health system. This could prove to be an important advantage. in fact, Research conducted in Ecuador in 2020 noted a 27% reduction in hospitalizations for pneumonia in the <1-year age group and a 33% reduction in the <5-year age group.

Overall, this is an area that needs more attention, and the measures taken by the government are not bearing fruit, as evidenced by childhood DPT vaccination rates returning to pre-COVID-19 levels. I'm here. Further steps to improve uptake of PCV and Hib vaccines could certainly improve health indicators and provide benefits that are not routinely monitored but may have far-reaching implications.

(Dr. Subramanian Swaminathan is Head of Infectious Diseases and Infection Control at GHC, Chennai, Bengaluru and Vice-President of the Indian Society of Clinical Infectious Diseases. [email protected])