When the entire programme is for 3 days, how can you selectively report on one day's achievement, asks Malappuram District Medical Officer.

Health Health Wednesday, January 22, 2020 - 18:41

On Tuesday, a Mathrubumi report on the pulse polio immunisation programme in Kerala reignited the conversation on resistance to vaccines in the state. The report claimed that Malappuram was among the worst performing districts in the state, with 46% of its children under five years of age not administered polio drops on the first day of the Pulse Polio Immunisation programme held on January 19.

This report was quick to be republished by others. A headline on OpIndia read, "Nearly 5 lakh children miss polio vaccination, Muslim-majority Malappuram sees only 54% vaccination". The emphasis was on the fact that Malappuram is a Muslim majority district, which is why the immunisation numbers were abysmally low.

However, data from the state health department that have now emerged prove that this report was only partially true, thereby misleading readers. 

According to the District Medical Officer of Malappuram, the polio immunisation drive held between January 19 and 21 succeeded in vaccinating a total of 88% of children below five years of age on its third day. By January 22, 91% of kids were vaccinated as volunteers and health staff undertook door-to-door campaigns.

"When the entire programme is for three days, how can you selectively report on one day's achievement? The report has only mentioned the number of children who were administered pulse polio drops on Day 1 of the drive, when we administer drops for a total of five days here in Malappuram (three days as part of the programme and two days unofficially)," Dr K Sakeena, Malappuram DMO, told TNM. 

The OpIndia report also mentioned that 5 lakh children in Kerala ‘missed out on getting Pulse Polio drops as parents were not ready to take the children to the centres’. This is again false as a total of 24,50,477 kids were to receive polio immunisation in Kerala and by January 21, 96% had got polio drops.

On January 19, the immunisation drive was conducted all over the country and health departments in various states had arranged booths, transit booths, and also mobile booths. January 20 and 21 are called mop-up days when volunteers go to houses to check if any child is left out.

On the first day - January 19 - only 2,43,057 children out of 4,50,415 (53%) turned up at the vaccination booths. 

"The first day of the drive required parents to bring their kids to the booth to administer polio drops, while health volunteer themselves go from house to house to administer the vaccine on days 2 and 3. So usually we see parents not turn up for the first day as they can get their children vaccinated at home itself on the remaining days. This does not mean that they are resistant to vaccines. I have personally had fathers call me up saying that their child had been left out or that the booth had run out of vaccines. This is a pattern we have been seeing in the last few years," DMO Dr Sakeena told TNM.

On January 20, 77,467 kids received immunisation and 75,169 children received the immunisation on January 21. By January 22, 4,09,159 kids were immunised. All other districts of Kerala, however, recorded more than 94% immunisation in this drive, with at least five districts recording 100% immunisation.

Malappuram's demographic pattern and the health department's limited human resources too contribute to the additional mop-up days that the district sees.

"While in other districts, each volunteer may have to administer drops to 5000 to 7000 children, in Malappuram this ratio is very high. In some areas, the ratio of target population per volunteer is as high as 13,000 and this is a difficult target to achieve within 3 days, as these volunteers also have to update the data and ensure that all eligible children have been covered," she added.

However, it is true that up until 2017, the district fared poorly in terms of immunisation levels, with only 52% of its children covered under vaccination drives. This was pegged to a lot of factors including superstitions, religious orthodoxy, proliferation of quacks and lack of awareness among the public. Many religious groups, had asked parents to reject immunisation and incidents of volunteers being attacked too had been reported before.

However, since 2017, extensive and dedicated awareness campaigns and drives by the district administration has resulted in remarkable changes in its health statistics. 

In 2017 and 2018, the district recorded 96 and 93% pulse polio immunisation rates respectively. According to 2018 data, Malappuram's urban areas record 94% immunisation while rural areas lagged by just 1% at 93. 

Malappuram's immunisation statistics has improved to such an extent in recent years that in 2019, the district was also dropped from the Central Government's special drive named Mission Indradhanush, which aimed to achieve 90 per cent vaccination all over the country.

Globally, a 5% resistance to vaccination is considered to be the norm. "The 95% of immunised children will ensure minimum risk of an outbreak," the DMO added. However, in Malappuram the resistance reduced to less than 2% in recent years, thanks to sustained awareness campaigns.

"A recent survey conducted in Vallavanur block - which has has been the worst performing block in the district in terms of health - the resistance to vaccines has reduced, with only 1.08% of  children remaining unvaccinated" she added.

Various officers do agree that more can be done to convince people to opt for other vaccinations like the MR vaccine and Rubella.