When her children were in a mainstream school, this parent fudged records to show they’re vaccinated. “I don’t need to do that now because they’re enrolled in an alternative school,” she adds.
Two fathers—Noel D’Costa, a Hyderabad-based IT salesman, and another who also requested anonymity—bring up the issue of cold chains. Do you know how terrible our vaccine supply chain is, they ask? How poor refrigeration makes vaccines deadly?
Most routine vaccines should be preserved between 2 and 8 degrees Celsius. So, how dangerous is a vaccine at room temperature? Answer: Not at all.
When the city sleeps
A routinely administered vaccine loses potency or becomes useless—not lethal—at temperatures above 8 degrees Celsius. This doesn’t, however, mean there’s no problem.
The lack of temperature record registers, over-dependence on ice packs and absence of stabilizers for deep and ice-lined refrigerators in pockets of India portend poorly for immunization coverage. A 2016 survey by the Bill and Melinda Gates Foundation-funded Immunisation Technical Support Unit (ITSU) found that India has a 25% wastage rate for vaccines other than BCG (the vaccine against tuberculosis, which had a whopping 50% wastage rate).
“Vaccine logistics have always been a concern, but since newer vials come with temperature indicators, cold chain complications aren’t as pronounced as they were decades ago,” says global health, policy, and bioethics researcher Anant Bhan, president of the International Association of Bioethics. “This is an area ripe for technological innovation, but in no way can this be used to question immunization itself.”
The seemingly urban anti-vax stance is markedly different from vaccine resistance in rural pockets, Bhan adds. When a hobbled public health system otherwise cold shoulders the people most dependent on it, doubts linger when a drive is announced. Vaccine programs do, after all, presuppose trust in the state. Which was why after the Emergency—during which the Indian government carried out forced sterilization programs—pockets of people across the country believed immunization was a cover for sterilization.
Measles-Rubella Vaccination Drive
Orthodoxy also plays a role, as was seen in Malappuram, Kerala, during the 2017 measles-rubella (MR) vaccination drive. Reports of medical staff being assaulted and parents storming schools has been the district’s undoing in a state that otherwise has about 90% immunization coverage among children aged 16 and below.
In neighboring Pakistan, distrust in the US government once adversely affected inoculations. Take the fake drive organized by the CIA to obtain Osama Bin Laden’s DNA. After English daily The Guardian published this story, the Taliban began shooting doctors administering the polio vaccine and later banned it outright.
Back in India, Muneer Masoodi, former head of social and preventive medicine department at Srinagar’s Government Medical College, names pockets where resistance hinders national Universal Immunisation Programme (UIP) efforts: Ballabhgarh in the Delhi-NCR, East Khasi Hills in Meghalaya, and parts of Nagaland and Mizoram.
Raj Shankar Ghosh, deputy director of vaccine delivery and infectious disease at the Bill and Melinda Gates Foundation, wastes no time getting to the point. Within seconds of our meeting in New Delhi, he shares a paper listing the return on each dollar invested in vaccines from 2011 to 2020—the ongoing Decade of Vaccines, earmarked by the World Health Organisation (WHO)’s 194 member states.
Economics and Social Value
Taking into account the broader economic and social value of preventing death and disability, every dollar invested in vaccination during the decade was estimated to result in a return of 44 times the costs incurred. The highest returns were associated with averting measles, at 58 times the cost through two routine immunization doses and outreach campaigns, he says.
Although the paper that Ghosh shares does not cover polio, he says that all vaccines included in the UIP have an ROI that is manifold the investment. This return on investment points to costs that’d otherwise be borne by governments or parents for hospitalization of a disease-afflicted child. Monetary setbacks would also include wage loss incurred by parents and the cost of medications.
The argument being that the vaccine is a cheaper solution.