UNIVERSAL IMMUNIZATION PROGRAM
Universal immunization program (UIP), launched on November 19th 1985 to enhance immunization coverage in India, is currently a component of Reproductive
Maternal, Newborn, Child and Adolescent Approach (RMNCH+A) since 2013, under National Health Mission.
India has one of the largest immunization program in the world targeting 2.6 crore newborns each year. First country-wide immunization program in India, i.e. expanded program of immunization (EPI) was launched in 1978, which was later modified as universal immunization program (UIP) to widen the coverage. In 1992, it was incorporated in Child Survival and Safe Motherhood Program and then in Reproductive and Child Health Program (1997) under National Rural Health Mission (2005) and then National Health Mission (2013).
Aims: UIP currently aims to provide coverage against twelve vaccine preventable diseases in infants (tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, H. influenzae B, rotavirus, pneumococci, measles and rubella) as well as Japanese encephalitis in endemic districts, using National Immunization Schedule (NIS). It also provides for tetanus immunization in pregnant mothers.
Components: Important components of UIP are:
• Universal immunization of infants and pregnant mothers,
• Improved vaccine production and quality control,
• Spread of public awareness,
• Training of health personnel, and
• Surveillance of vaccine preventable diseases.
Strategies: Important strategies adopted by UIP are as follows:
• For universal immunization:
± Routine immunization as per NIS,
± Intensified immunization programs, e.g. Mission Indradhanush, pulse polio immunization, MR campaign
± Targeted immunization in high-risk areas, e.g. mop-up rounds.
• For vaccine production:
± Encourage and support private sector participation.
± Increasing production in public sector.
India is self-sufficient in production of all UIP vaccines except OPV.
• For quality control:
± Maintenance of adequate cold-chain.
± Batch-wise testing of vaccines at production/ import level and random testing at field level.
± Adequate supply of refrigerators, vaccination materials, e.g. syringes, etc. and electricity.
• For public awareness:
± Information, education and counseling (IEC) activities, using mass-media.
± Involvement of local community leaders and nongovernmental organizations.
• For regular training:
± Periodic training of field workers.
± Distribution of training material and guidelines.
• For vaccine surveillance:
± Periodic immunization coverage studies.
± Periodic review of the local disease prevalence. Evaluation: Reported coverage for all UIP vaccines in India at present is ~76.4% according to NFHS-5 2021 data (Table 28.3), with best coverage for BCG (95.2%) and least for second dose of MR (31.9%). There is also gross disparity between immunization coverage in different states and urban vs. rural areas.
While targeted 100% immunization coverage is yet to be achieved, success of this program is reflected in marked decline in morbidity and mortality rates due to vaccine preventable diseases.
9.5.2