Vaccines against deadly diseases like polio, tuberculosis and hepatitis B have to be stored, transported and administered with abundant caution or else the results can be disastrous, as was demonstrated to a group of journalists this past week during a field trip to villages around Jabalpur in Madhya Pradesh. The trip was organised by the UNICEF in partnership with the Indira Gandhi National Open University.
Madhya Pradesh has been facing the uphill task of trying to achieve full immunisation with regard to its migrant tribal and rural population. “Data for the State shows it is not up to the mark and that there is lack of awareness, lack of education and lot of misconception regarding vaccination,” said UNICEF communication specialist Anil Gulati.
The National Rural Health Mission funds the vaccine process, with the UNICEF providing all the technical help. The vaccine is administered at the village health centres, called sub-centres. In Darai village, a few km from Jabalpur, the anganwadi doubles up as health centre to service its 1,100 population.
The anganwadi, the Accredited Social Health Activist (ASHA) and the Auxiliary Nurse-Midwife (ANM) workers under the NRHM scheme are directly responsible for the actual administration of the vaccine. The cycle of the vaccination process starts with the ASHA worker. It is the ASHA worker's job to mobilise villagers and convince them to get vaccinated, which is not an easy job.
“There was this eight-month-old child suffering from malnutrition and the mother was not allowing us to vaccinate the child. I pestered her and stood outside her house for almost a month before the child was finally brought in…. I feel the child is alive today only because of me” said ASHA worker Sulochana, adding she does not get a salary but incentives whenever she manages to convince mothers to bring their children for immunisation or when she convinces an expectant mother to opt for institutional delivery.
In the next step, the anganwadi worker makes arrangements for the process and finally the ANM worker administers the vaccine . The vaccines have to be handled with extreme care, as they are extremely sensitive to slight changes in temperature, some being averse to heat and some to cold. There are special temperature-equipped storage and transportation facilities for both types of vaccines.
“Even though wrong administration of vaccine cannot result in death, it has to be administered within four hours of removal from storage or else the results could be deadly,” said District Immunisation Officer Satish Upadhya.
The responsibility, in a way rests on the ANM worker. “I have been trained especially to administer all vaccines and I take care to do a quality check on each and every vaccine, one mistake and the entire village will stop getting their children vaccinated,” said Lahera, who is the ANM for five villages.
Preventable disease is still the main reason for high infant mortality rates, despite efforts to provide vaccines against them, mainly because of unwilling parents due to misconceptions arising out of adverse reactions like fever and swelling immediately after the vaccine is administered.
A vaccine is not administered to the public unless it has been tested for years and it is continuously monitored for safety and effectiveness. However, every human body is different and a rare reaction following vaccines may occur but it is the only way in which to fight against death and morbidity due to disease.
According to the Census, infant mortality rate, considered to be a significant indicator of the overall health status of the country, has been on a steady decline from 129 per 1,000 live births in 1971 to 58 in 2005.
Although the country is far from achieving the legacy of the small pox eradication programme, the sustained campaign by the Government to provide vaccination against these pestilential and epidemic diseases is partially responsible for this decline.