Mission Indradhanush, a health mission launched by Health Ministry of India with a target to achieve full immunization coverage by 2020. This scheme targeting 201 critical districts in the first phase, has been instrumental in increasing the rate of immunization to 6.7% year on year, from just 1% yearly during 2009-2013. This scheme has vaccinated over 3.28 crore children and more than 55.4 lakh pregnant women. Mission Indradhanush might just be the most successful scheme of the NDA government.

A brief history of Immunization programs in India

Immunization Programme in India was introduced in 1978 as ‘Expanded Programme of Immunization’ (EPI) by the Ministry of Health and Family Welfare, Government of India. In 1985, the programme was modified as ‘Universal Immunization Programme’ (UIP) to be implemented in a phased manner to cover all districts in the country by 1989-90 with the one of largest health programme in the world.

Need for better immunization program

Despite being operational for many years, UIP had been able to fully immunize only 65% of children in the first year of their life. Between 2009-2013 immunization coverage had increased from 61% to a mere 65%, indicating only a 1% increase in coverage every year.

The launch of Mission Indradhanush

Mission Indradhanush is a health mission of the government of India, launched by Union Health Minister J. P. Nadda on 25 December 2014. It aims to immunize all children under the age of 2 years, as well as all pregnant women, against seven vaccine-preventable diseases. To accelerate the process of immunization by covering 5% and more children every year, Indradhanush mission has been adopted with an aim to achieve the target of full immunization coverage by 2020.

The mission of Indradhanush

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To strengthen and re-energize the programme and achieve full immunization coverage for all children and pregnant women at a rapid pace, the Government of India launched “Mission Indradhanush” in December 2014.

As seen from the infographic, immunization coverage grew by only 1% per year since 2009. The Health Ministry under the guidance of Shri Narendra Modi has set a target of 5% vaccination per year, by identifying critical 201 districts throughout India.

The goal of Mission Indradhanush

The ultimate goal of Mission Indradhanush is to ensure full immunization with all available vaccines for children up to two years of age and pregnant women. The Government has identified 201 high focus districts across 28 states in the country that have the highest number of partially immunized and unimmunized children. The Mission Indradhanush aims to cover all those children by 2020 who are either unvaccinated or are partially vaccinated against vaccine-preventable diseases.

The strategy of Mission Indradhanush

The broad strategy, based on evidence and best practices, has included 4 basic elements:

Meticulous planning of campaigns/sessions at all levels: Ensuring revision of microplans in all blocks and urban areas in each district to ensure availability of sufficient vaccinators and all vaccines during routine immunization sessions. Developing special plans to reach the unreached children in more than 400,000 high-risk settlements such as urban slums, construction sites, brick kilns, nomadic sites and hard-to-reach areas. Effective communication and social mobilization efforts: Generating awareness and demand for immunization services through need-based communication strategies and social mobilization activities to enhance participation of the community in the routine immunization programme through mass media, mid-media, interpersonal communication (IPC), school and youth networks and corporates. Intensive training of the health officials and frontline workers: Building the capacity of health officials and workers in routine immunization activities for quality immunization services. Establish accountability framework through task forces: Enhancing involvement and accountability/ownership of the district administration and health machinery by strengthening the district task forces for immunization in all districts of India and ensuring the use of concurrent session monitoring data to plug the gaps in implementation on a real-time basis.

The Ministry of Health and Family Welfare established collaboration with other Ministries, ongoing programmes and international partners to promote a coordinated and synergistic approach to improve routine immunization coverage in the country.

The Ministry is being technically supported by WHO, UNICEF, Rotary International and other donor partners. Mass media, interpersonal communication, and sturdy mechanisms of monitoring and evaluating the scheme are crucial components of Mission Indradhanush.

Diseases being targeted by Mission Indradhanush

The diseases being targeted are as follows:

diphtheria

whooping cough

tetanus

poliomyelitis

tuberculosis

measles

Hepatitis B

In addition to these, vaccines for Japanese encephalitis and Haemophilus influenza type B are also being provided in selected states. In 2016, four new additions have been made namely Rubella, Japanese Encephalitis, Injectable Polio Vaccine Bivalent and Rotavirus. In 2017, Pneumonia was added to the Mission by incorporating the Pneumococcal conjugate vaccine under Universal Immunization Programme.

Areas under focus

Mission Indradhanush targeted 201 high priority districts in the first phase, 297 districts for the second phase in the year 2015 and 216 districts in the third Phase during 2016.

Within the districts, the Mission focused on high-risk settlements identified by the polio eradication programme. These are the pockets with low coverage due to geographic, demographic, ethnic and other operational challenges. Evidence has shown that most of the unvaccinated and partially vaccinated children are concentrated in these areas.

The following areas were targeted through special immunization campaigns:

High-risk areas identified by the polio eradication programme, including populations living in areas such as: Urban slums with migration

Nomads

Brick Kilns

Construction sites

Other migrants (fisherman villages, riverine areas with shifting populations etc.) and

Underserved and hard to reach populations (forested and tribal populations etc.) Areas with low routine immunization (RI) coverage (pockets with Measles/vaccine-preventable disease (VPD) outbreaks). Areas with vacant sub-centres: No ANM posted for more than three months. Areas with missed Routine Immunisation (RI) sessions: ANMs on long leave and similar reasons Small villages, hamlets, dhanis or purbas clubbed with another village for RI sessions and not having independent RI sessions.

Regions covered during the first phase of immunization

201 districts were covered in the first phase. Of these, 82 districts are in the states of Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh. The 201 districts selected had nearly 50% of all unvaccinated children in the country. The mission followed planning and administration like PPI (Pulse Polio Immunization).

The rate of immunization from 2005 to 2016, has increased from a mere 43.5% to over 70% today. The rate of immunization faced a massive slump from 2009 to 2013, growing at just 1% per year.

Intensification of Mission Indradhanush (IMI) efforts

To further intensify the immunization programme, Prime Minister Shri Narendra Modi launched the Intensified Mission Indradhanush (IMI) on October 8, 2017. Through this programme, the Government of India aims to reach each and every child up to two years of age and all those pregnant women who have been left uncovered under the routine immunisation programme/UIP. The special drive will focus on improving immunisation coverage in select districts and cities to ensure full immunisation to more than 90% by December 2018. The achievement of full immunisation under Mission Indradhanush was at least 90% coverage to be achieved by 2020 or earlier. With the launch of IMI, the achievement of the target has now been advanced.

Under IMI, four consecutive immunization rounds were conducted for 7 days in 173 districts (121 districts and 17 cities in 16 states and 52 districts in 8 northeastern states) every month between October 2017 and January 2018. Intensified Mission Indradhanush covered low performing areas in the selected districts (high priority districts) and urban areas. Special attention was given to unserved/low coverage pockets in sub-centre and urban slums with the migratory population. The focus was also on the urban settlements and cities identified under the National Urban Health Mission (NUHM).

Implementation of the Mission

Focused and systematic immunization drive was successful in covering all the children who have been left out or missed out for immunization. Also, the pregnant women were administered the tetanus vaccine, ORS packets and zinc tablets are distributed for use in the event of severe diarrhoea or dehydration and vitamin A doses are administered to boost child immunity.

Mission Indradhanush Phase I was started as a weeklong special intensified immunization drive from 7th April 2015 in 201 high focus districts for four consecutive months. During this phase, more than 75 lakh children were vaccinated of which 20 lakh children were fully vaccinated and more than 20 lakh pregnant women received tetanus toxoid vaccine.

Mission Indradhanush Phase II covered 352 districts in the country of which 279 are medium focus districts and the remaining 73 are high focus districts of Phase-I. During Phase II of Mission Indradhanush, four special drives of weeklong duration were conducted starting from October 2015.

Special Drive Phases I and II had 1.48 crore children and 38 lakh pregnant women additionally immunized. Of these nearly 39 lakh children and more than 20 lakh pregnant women have been additionally fully immunized. Across 21.3 lakh sessions held through the country in high and mid-priority districts, more than 3.66 crore antigens have been administered.

Mission Indradhanush Phase III was launched from 7 April 2016 covering 216 districts. Four intensified immunization rounds were conducted for seven days in each between April and July 2016, in these districts. Apart from the standard of children under 2, it also focussed on 5-year-olds and on increasing DPT booster coverage and giving tetanus toxoid injections to pregnant women.

Mission Indradhanush Phase IV was launched from 7 February 2017 covering the North-eastern states of Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura. It has been rolled out in rest of the country during April 2017.

Use of technology in the Mission

Photographs from December 2017 of the Intensified MI programme, on the official WhatsApp group set up to monitor the project, tell the tale of a mission whose success depends overwhelmingly on the dedication of workers on the ground — from Muslim religious leaders in Patna signing a vaccination pledge to health workers tracking a group of nomads in Sagar, and Assam’s boat clinics taking the precious vaccines to far-flung islands on the Brahmaputra.

The district administration decided to hold supplementary vaccination sessions from evening till late into the night, to support people who missed out on vaccination drives.

The eVIN (Electronic Vaccine Intelligence Network) digitised vaccine stocks and monitored the temperature of the chain through a smartphone application. eVIN is presently being implemented across 12 states and aims to support the Immunisation Programme by providing real-time information on vaccine stocks and storage temperatures across all cold chain points in the states. The technological innovation is implemented by the United Nations Development Programme and has been categorised as a global best practice.

The success of the mission

Coverage of Mission Indradhanush during first 3 phases. Over 208 lakh children have been vaccinated, of which 54.5 lakh have been fully immunized. In addition, 55.4 lakh pregnant women have been vaccinated for tetanus toxoid.

Overall, in the first three phases, 28.7 lakh immunisation sessions were conducted, covering 2.1 crore children, of which 55 lakh were fully immunised. Also, 55.9 lakh pregnant women were given the tetanus toxoid vaccine across 497 high-focus districts. Since the launch of Mission Indhradhanush, full immunisation coverage has increased by 5 per cent to 7 per cent. Mission Indradhanush has resulted in a 6.7 % annual expansion in the immunization cover.

The four phases of Mission Indradhanush have reached to more than 2.53 crore children and 68 lakh pregnant women with life-saving vaccines until August 2017. The figure has reached over 3 Crore, as on 2nd January 2019.

Mission Indradhanush was successful in increasing the rate of full immunization coverage was 1% per year, to 6.7% per year through the first two phases of Mission Indradhanush.

The success of vaccinating over 3 Crore children under Mission Indradhanush as on 2nd January 2019. The figure standing at 3,20,00,000 is a testament to the dedication of the Ministry of Health in expediting vaccination efforts since 2014.

Worldwide accolades

The Pneumonia and Diarrhoea Progress Report, 2017, brought out by the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, noted: “The original aim of MI was to immunise all children under the age of 2 years against seven vaccine preventable diseases, a number that has expanded as new vaccines are added to UIP (Universal Immunisation Programme). With MI, India actualises its vision towards equitable immunisation and demonstrates its commitment to the nation’s health.”

Conclusion

The importance of immunization cannot be stated enough, for the realization of a healthy country. Immunization never received enough attention during the UPA government as evident from the 1% rate of immunization year-on-year. The immunization reached only 65% of children. The task of immunization is very critical and difficult, but nevertheless, the NDA government has been able to overcome challenges and increase immunization coverage to 6.7%, vaccinating over 3.28 Crore children. Silently, efficiently and diligently the Ministry of Health and Family Welfare under the astute guidance of PM Shri Narendra Modi is inching closer to ‘Mission Indradhanush’s target of full immunization coverage by 2020. Due to the massive success of this initiative, Mission Indradhanush may be regarded as one of the most successful schemes of the NDA government in India.