Vaccination Education in India

Running Head: VACCINATION EDUCATION SERVICES 1
VACCINATION EDUCATION SERVICES IN INDIA
Name
Institution Affiliation
Contents

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Introduction......................................................................................................................................4
Distribution of Population in India..................................................................................................5
Vaccinations Currently Available in India......................................................................................7
Health Risks associated with lack of immunization in India...........................................................8
Barriers and strategies of overcoming the barriers........................................................................10
How vaccination Education is presented by Healthcare providers in India..................................12
References......................................................................................................................................14

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Introduction

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Immunization or vaccination is one of the essential aspects of public health. Vaccinations
help protect individuals from getting infectious diseases such as polio, measles tetanus and
hepatitis B among others. By getting immunized, individuals help to protect themselves and
those around them. Immunization is necessary for both adults and children. Vaccination has been
recommended by a large number of health professionals, professional medical organizations and
medical researchers. They are considered to be the best way of preventing infectious diseases.
Through the use of vaccination in the United States of America, the cases of dangerous
infections have significantly declined (Vaccineinformation.org, 2019). Vaccination programs in
the country are highly prioritized to ensure that most infectious infections which are quite
common in developing countries are not spread by a high number of travelers coming into the
country. Lack of vaccination could make children more prone to these infections. According to
the World Health Organization, outbreaks of measles in many regions have been caused by low
coverage.
As a consequence, many people have died. This also points out to the evidence of the
failure by many national immunization programmes to achieve their goals (Global Vaccine
Action Plan, 2018). Many outbreaks of preventable infections arise also arise as a result of
failure by parents to vaccinate their children. It is therefore important that a collaborative
approach is utilized when rolling out immunization programs to facilitate the success of the
program. Stakeholders play an important role in the achievement of the objectives of the
program. They not only participate in the delivery of the immunization but also help
policymakers to understand the perspectives and needs of their communities. This report focuses
on the Indian population, the available vaccinations in the country health risks of lack of

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immunization in the country. It also provides a comparison of India and Australia identifies any
barriers in the rolling of immunization programs.
Distribution of Population in India
The Republic of India is the second most populous country in the world, coming after China
whose population is currently estimated at 1.4 billion people. Based on current United Nations
estimates India’s population currently stands at 1,362,335,715 which represent 17% of the
world’s global population. Recent statistics have put Uttar Pradesh as the most populous states in
India with a population of 199,812,341 according to 2011 census. It is closely followed by
Maharashtra, Bihar, West Bengal, Madhya Pradesh, Tamil Nadu, Rajasthan, Karnataka, Gujarat,
Andhra Pradesh, and Odisha respectively. Lakshadweep and Sikkim are ranked as the states with
the lowest populations in the country. The country’s population is concentrated around the first
five states. This population is however not dependent on the sizes of each of the states. For
example despite Rajasthan being the largest state it has only contributed about 5.5% of India’s
population (Toppr, 2019).

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Population density Map
Source: www.toppr.com
Cultural groups in India
The Republic of India has enormous ethnic and racial compositions. Scholars have
defined it as the most ethnically diverse country in the world. The country's main ethnic groups
include Indo-Aryans, Western Brachycephalics, Mediterranean, Mongoloid, Proto Australiods
and Negrito. This population also comprises huge linguistic diversity. The Indo-Aryans are the
largest ethnic group primarily located in central and North India. The group also doubles up as
the most ethnically diverse group among the six (Sousa, 2019). The Brachycephalic who have an
African descent are considered to be the earliest people to arrive in India. They live in the
Nicobar Islands and Andaman which are their original habitats. The present diversity among the
Indian population is believed to have been contributed by the large scale migration of people

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from Asia into India. This population speaks a wide range of languages including Hindi,
Malayalam, Kannada, Gujarati, Urdu, Tamil, Marathi, Telugu and Bengal. The languages spoken
by the people of South India are significantly different from those spoken by People who live in
the North. Apart from language differences, these ethnic groups also have different customs,
traditions, and beliefs (Sousa, 2019). These differences in language and customs are likely to
have an impact on the uptake of the immunization.
Both positive and negative perceptions of vaccination exist among the Indian population.
The attitude towards immunization is largely dependent on the attitude towards healthcare
providers. For example, mothers who perceive healthcare providers negatively are unlikely to
adhere to vaccination programs. Consequently, mothers with a positive perception on the
healthcare providers are likely to complete vaccination (Streefland, Chowdhury & Ramos-
Jimenez, 2009).
Vaccinations Currently Available in India
In an attempt to minimize the spread and infection of vaccine-treatable infection, the
government of India launched the universal immunization program in 1985. With this program
which is among the largest in the world, the government of India looked forward to covering all
the districts in the country (Nigam, Saxena, Acharya, Mishra & Batra, 2014). The basic vaccines
under this policy include:
Oral polio vaccine
Oral polio vaccine is administered to protect children from poliomyelitis. The first dose
of oral polio vaccine is administered at birth. Other doses are administered at 6,10, and 14 weeks.
It is administered orally (Rastogi,2018).

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Calmette-Guerin vaccine
The administration of this vaccine is intended to protect children from disseminated Tb
and tubercular meningitis. The vaccine is administered between the time of birth and when a
child is one year old. It is administered through a left arm injection (Rastogi,2018).
Hepatitis B Vaccine
This vaccine protects from an infection caused by the Hepatitis B virus. The vaccine is
administered at birth or within 24 hrs .subsequent doses are combined with Hib and DPT and
administered at 60, 10 and 14 weeks through an injection(Rastogi,2018).
Pentavalent Vaccine
This is a combined vaccine intended to protect children from Hepatitis B, Influenza type
B infection, Haemophilis, Pertusis, Tetanus, and Diptheria. The vaccine is made up of three
doses administered at 6,10 and 14 weeks respectively(Rastogi,2018).
Rotavirus vaccine
Rotavirus vaccine is intended to protect children and infants from rotavirus diarrhea in selected
states. The vaccine is administered orally at 6, 10 and 14 weeks (Verguet, Murphy, Anderson,
Johansson, Glass & Rheingans, 2013).
Pneumococcal Conjugate vaccine
The administration of the vaccine is meant to children and infants against infections
caused by Streptococcus Pneumoniae Bacterium. Primary doses are administered at 6 and 14
weeks. At nine months, an infant is then given a booster dose at the age of 9 months. It is
administered through an injection(Rastogi,2018).

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Fractional Inactivated Poliomylitis
This vaccine boosts protection against Poliomylitis. It is administered through an
injection at 6 and 14 weeks(Rastogi,2018).
Measles vaccine
This is administered to protect against measles at between the age of 9 months and one
year. The second dose is administered at between the age of 16 months and two years. In case it
is not administered during this period, an administration can be done before an infant attains five
years. It is administered through an injection (Rastogi,2018).
DPT Booster
This vaccine is a combination meant to protect children from Diptheria, Pertussis, and
Tetanus. The first booster of the vaccine is given at between 16-24 months while the second
booster is administered at the age of 5-6 years (Rastogi,2018).
Tetanus Toxoid vaccine
The vaccine is administered to protect against Tetanus.Its administration is done early
during pregnancy for pregnant women and between the age of 10 and 15 years(Rastogi,2018).
Japanese encephalitis Vaccine
This is administered in selected districts to protect against Japanese Encephalitis disease.
Its two doses are administered between the ages of 9 months and 24 months(Rastogi,2018).
Health Risks associated with lack of immunization in India
Immunization is meant to prevent individuals from acquiring dangerous infections. It is
also meant to minimize the spread of such infections. India being a populous country, lack of

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immunization can have many impacts on the country's population (Vaccineinformation.org,
2019). Being one of the most populous countries in the world, India also has the highest number
of births estimated at over 26 million annually. With its high birth rates, India also accounts for
20% mortality rates globally. Several immunization sessions are organized annually in the
country targeting over 30 million pregnant women and infants. Despite these concerted efforts to
curb the spread and prevalence of Infectious infections in the country, the country still has the
highest number of non immunized children estimated at over 7 million (UNICEF, 2019).
There are many health risks associated with lack of vaccination in India.
The first health risk associated with lack of immunization is that it leaves the population
weak and unprotected from preventable infections. The Lack of vaccination makes the Indian
population not be protected from deadly infections such as tetanus, polio; hepatitis B among
others. It makes the population unhealthy and prone to preventable disease
(Vaccineinformation.org,2019). An unhealthy population is a sick nation. Therefore the lack of
vaccination is likely to drain health care resources hence becoming an economic burden to the
country.
Secondly, lack of vaccination can leave children and adults unprotected from
complications and illnesses associated with preventable diseases. These complications include
brain damage, convulsions, loss of hearing capacity, paralysis of limbs, or amputations of both
legs and arms(Vaccineinformation.org,2019). In extreme cases, it can also lead to death.
Thirdly, lack of vaccination is likely to increase the cases of hospitalization resulting
from illnesses such as immunizable diseases such as a whooping cough and measles. These
infections can also lead to death(Vaccineinformation.org,2019). It can also lead to the coming

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back of diseases of immunizable which have already been eliminated from India bust still
available in other parts of the world.
Fourthly, although India has experienced a decline in the number of some infections in
recent years, lack of immunization can leave its populations exposed to infections brought from
other countries. Every year, a high number of people travel to India from countries where these
diseases are extremely common (Vaccineinformation.org,2019). In the absence of vaccinations,
therefore, there is an increase in the likelihood of the spread of these infections by travelers.
Additionally, in the absence of vaccinations the possibility of the spread of infections to
people with weak immune systems such as cancer patients or children under the vaccination age
increases. The consequence of these could be lasting health complications or death. It also leaves
family members of an infected person exposed to infection (Vaccineinformation.org,2019).
Finally, lack of vaccinations increases the prevalence of outbreak of infectious disease
which is preventable through vaccines. These outbreaks can lead to deaths of a high number of
people and lead to multiple health complications. Lack of vaccination is also likely to derail the
efforts made from the 1980s when the first institutions dedicated to medical research were
established as a way of enhancing the protection of the public against preventable diseases
(Lahariya, 2014).
In Australia lack of vaccination is linked to increased death and illnesses as well as the
increase in the rates of spread of infectious diseases. These risks are especially high among
Adults who form the largest percentage of under-vaccinated Australian population compared to
children (The Conversation, 2019).

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Barriers and strategies of overcoming the barriers
Many challenges have contributed to the current under-vaccination of the Indian population.
Some of these barriers include the presence of gaps in critical areas such as cold chain
management, logistics and predicting demand. The little number of staff is also a challenge. This
is particularly a big challenge at the field level and within the poor performing states
(Madhivanan, Krupp, Yashodha, Marlow, Klausner & Reingold, 2009). One of the major barriers is also
the lack of a dynamic system to track the prevalence of diseases that can be prevented through
vaccination.T here are also differences in gender intake, geographical barriers, regional and
urban-rural differences are also some of the important barriers. Gender barriers are also a
contributing factor. The number of girls receiving immunization is relatively lower compared to
that of Boys UNICEF, 2019).
Regional inequalities are a major barrier to the realization of vaccination targets in the
country. As a consequence of these inequalities, the likelihood of a rural child getting a full
vaccination is very dismal. States that are most affected by this inequality include Uttar Pradesh.
There is also high inequality between urban and rural areas. The most affected states are
Haryana, Chhattisgarh, and Kerala (UNICEF, 2019).
Another notable barrier is the amount of money set aside by the government for routine
immunization. The government of India spends very little on regular immunization with only
2.1% of its total budget being set aside for this exercise. Adequate funding is a critical
component for the successful implementation of an immunization (Lahariya, 2014). Given
India’s high population and the increasing number of births, the amount set aside is insufficient
hence it is one of the barriers.

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Other barriers include the lack of good data on the immunizable disease to put in the picture
the priorities of the vaccination. There is also a lack of surveillance data that is necessary for
monitoring the impact of the vaccination (Lahariya, 2014). Additionally, the process is also
likely to be hampered by the absence of trained personnel at both state and National levels.
Lack of demand for vaccination services is also a major barrier to coverage. The lack of
demand has been associated with poor education levels in India (Shrivastwa, Gillespie, Kolenic,
Lepkowski & Boulton, 2015). The lack of education, especially in rural areas, pose a major
challenge in the completion of vaccination schedules (Lahariya, 2014). This has also been
contributed by cultural barriers attributed adverse effects attributed to vaccination by certain
media houses. In most cases, however, these adverse effects are not related to vaccination
The administration of poor quality vaccines in India has led to poor performance of past
vaccines such as Pulse polio program. The poor quality of vaccines has been attributed to the fact
that a significant number of the manufacturers of these vaccines are not prequalified WHO
(Lahariya, 2014). This is likely to have an impact on the on the public perception and confidence
in vaccination programs.
Strategies to overcome these barriers
These barriers can be overcome by improving communication regarding the benefits and
side effects of vaccinations. Improving public awareness on the benefits of being vaccinated and
offering clarifications on the notion that treatment is associated with certain adverse effects can
help to increase demand (Megiddo et al., 2014).
Secondly, adequate funding can also play a role in overcoming coverage barrier. The
2.1% of the budget set aside by the government is not sufficient for putting in mind the country's

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high population and a high number of births annually (Megiddo et al., 2014). This can improve
the confidence that the public has in the immunization program. Increasing this amount can,
therefore, enable the barriers to be overcome.
Thirdly, these barriers can be overcome by minimizing regional inequalities in the
country. Doing away with the regional inequalities will improve the chances of both urban and
rural populations getting a full vaccination (UNICEF, 2019).
How Healthcare providers in India present vaccination Education
Healthcare providers play a significant role in reducing the prevalence of immunizable
diseases in India. They on a daily basis attend to patients affected by these infections or interact
with the families of those who are affected. Because of their privileged position Healthcare
providers play an informative role by creating awareness on immunizable diseases(Johri et
al.,2015). They also inform the public on various ways in which they can identify noticeable
signs and symptoms of such diseases.
Health care providers also provide accurate information on vaccine-preventable
infections to the people they interact with. By providing precise information, they ensure that
people receive appropriate vaccinations in appropriate doses and at the recommended times (Johri
et al.,2015). They also demystify various myths about vaccines that exist within the society
making parents o realize the necessity of vaccines and minimizing exposure to vaccine-
preventable diseases.
Conclusion
In conclusion, India is one of the most populated countries in the world. The country also
has one of the highest birth rates in the world. This high population makes it and birth rates make

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India an important population of study in as far as vaccination is concerned. India's is currently
estimated at 1.3 billion people who are concentrated in its five main states. The population is
however not distributed in any specific order and is not dependent on the size of a state as well.
Some small states have higher populations than larger states. India also has the most ethnically
diverse country in the world which s attributed to the large migration of people from Asia into
India. Its main ethnic groups include Indo-Aryans, Western Brachycephalics, Mediterranean,
Mongoloid, Proto Australiods and Negrito. With this multiple ethnicities, the country is
characterized by multiple languages and different customs. In these multiple entities, varied
opinions exist about vaccinations. People's perception of vaccination is largely dependent on
their perception of health care providers. To those who perceive them negatively, they are also
likely to perceive vaccination negatively and vice versa. India has multiple vaccines classified
under its national vaccination program. These vaccines include Oral polio vaccine, Hepatitis B
vaccine, Calmette Guerin vaccine, pentavalent vaccine, rotavirus vaccine, pneumococcal
conjugate vaccine, measles vaccine among others. There are many health risks associated with
lack of vaccination in India. These include an increase in the number of complications associated
with vaccine preventable diseases. Leaving the public unprotected from various preventable
diseases, an increase in the rates of hospitalization and deaths. Some of the barriers include a
lack of sufficient funding from the government, lack of sufficient data on immunization, regional
imbalance, and poor public education. These can be overcome by increasing funding, improving
public awareness and bridging the gap between different regions.

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References
Global Vaccine Action Plan. (2018, November 12). Retrieved January 24, 2019, from
https://www.who.int/immunization/global_vaccine_action_plan/en/
Johri, M., Subramanian, S. V., Sylvestre, M. P., Dudeja, S., Chandra, D., Koné, G. K., ... & Pahwa, S.
(2015). Association between maternal health literacy and child vaccination in India: a cross-
sectional study. J Epidemiol Community Health, Jech-2014.
Lahariya, C. (2014). A brief history of vaccines & vaccination in India. The Indian journal of
medical research, 139(4), 491.

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Madhivanan, P., Krupp, K., Yashodha, M. N., Marlow, L., Klausner, J. D., & Reingold, A. L. (2009).
Attitudes toward HPV vaccination among parents of adolescent girls in Mysore,
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Megiddo, I., Colson, A. R., Nandi, A., Chatterjee, S., Prinja, S., Khera, A., & Laxminarayan, R.
(2014). Analysis of the Universal Immunization Programme and the introduction of a
rotavirus vaccine in India with IndiaSim. Vaccine, 32, A151-A161.
Nigam, A., Saxena, P., Acharya, A. S., Mishra, A., & Batra, S. (2014). HPV vaccination in India: a critical
appraisal. ISRN obstetrics and gynecology, 2014.
Rastogi, A. (2018). Universal Immunisation Programme | National Health Portal Of India. Retrieved from
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Shrivastwa, N., Gillespie, B. W., Kolenic, G. E., Lepkowski, J. M., & Boulton, M. L. (2015). Predictors of
vaccination in India for children aged 12–36 months. American journal of preventive
medicine, 49(6), S435-S444.
Streefland, P. H., Chowdhury, A. M., & Ramos-Jimenez, P. (2009). Quality of vaccination
services and social demand for vaccinations in Africa and Asia. Bulletin of the World
Health Organization, 77(9), 722.
Sousa, G. (2019). Biggest Ethnic Groups In India. Retrieved from
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The Conversation. (2019). Millions of Australian adults are unvaccinated and it's increasing
disease risk for all of us. Retrieved from http://theconversation.com/millions-of-
australian-adults-are-unvaccinated-and-its-increasing-disease-risk-for-all-of-us-74991
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Retrieved from https://www.toppr.com/guides/geography/population/population-of-india/
UNICEF.(2019). Immunization | UNICEF. Retrieved from
http://unicef.in/whatwedo/3/immunization

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Vaccineinformation.org.(2019). Vaccine Basics - Importance of Vaccines. Retrieved from
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Verguet, S., Murphy, S., Anderson, B., Johansson, K. A., Glass, R., & Rheingans, R. (2013). Public
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