Introduction

Vaccinations stand as a testament to public health triumphs, yet the journey to universal coverage remains fraught with challenges. In 2022, a stark 11% of children globally missed out on vital vaccines, such as the diphtheria-tetanuspertussis (DTP)-containing vaccine, leaving them vulnerable to deadly diseases. An article published by Oxford Academy examined India’s Intensified Mission Indradhanush (IMI) to understand the clinical and cost impact of vaccination strategies aimed at improving coverage and reaching zero-dose children.

The Urgent Need for Enhanced Vaccine Coverage

The COVID-19 pandemic has exacerbated a decade-long stagnation in vaccine coverage, threatening to reverse hard-won gains in child health. The global Immunisation Agenda 2030 is ambitious and necessitates an assessment of the cost-effectiveness of different strategies to boost immunisation rates. We can use various tactics such as supply-side initiatives and demand-side strategies. Supply-side initiatives may include training health workers or increasing vaccine delivery sites. On the other hand, demand-side strategies could involve raising awareness or offering incentives. India has the world’s largest immunisation program, supporting almost 26 million children annually.

Assessing Cost-Effectiveness: The Case of India’s IMI

A recent systematic review found that improving immunisation coverage can be cost-effective, with estimates ranging from 1.00 USD per child vaccinated against hepatitis B at birth in Indonesia to 161.95 USD per child vaccinated with DTP in Uttar Pradesh, India. This study narrows on the Intensified Mission Indradhanush, a periodic intensification of routine immunisation (PIRI) in India. This large-scale intervention aimed to bridge the immunisation gap, targeting an estimated six million children. The study’s findings suggest that IMI was not only impactful in reducing the number of zero-dose children but also proved to be cost-effective, a crucial consideration for resource-limited settings.

The Economics of Scaling Up Immunisation Efforts

As coverage expands, the costs associated with reaching the unvaccinated escalate. This study found that the incremental cost per dose delivered through IMI was more than double the cost of routine vaccine delivery. Moreover, districts with higher baseline coverage had higher incremental costs per dose administered using IMI. This raises questions about the sustainability and budgeting for such interventions, especially as the hardest-to-reach populations require more resources to vaccinate.

Towards a Cost-Effective Future in Vaccination

The study’s insights into IMI’s cost-effectiveness does provide hope for future vaccination strategies. However, the complexity of scaling up immunisation services necessitates continued research, especially in the design of social mobilisation efforts and the targeting of resources to maximise impact. One way to enhance the cost-effectiveness of IMI is to target program resources to children who would not otherwise receive routine vaccination services. The data reveals that up to 63% of children reached in this study were “incremental” and would not have been vaccinated without IMI. In contrast, about 37% of children immunised during IMI sessions were not incremental and would have been vaccinated regardless of IMI implementation.

Conclusion

The Intensified Mission Indradhanush stands as a testament to the potential of well-designed immunisation strategies to be both impactful and cost-effective. The application of PIRI at a large scale proved to be cost-effective. While cost-effectiveness varies based on implementation methods, scale, and context, PIRI interventions may be a cost-effective option to boost immunisation coverage, zero-dose children, and child health improvements. As the world strives towards the Immunisation Agenda 2030 goals, the lessons learned from IMI can inform future efforts to secure the health of children globally.