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      Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy

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          Abstract

          Vandana Gurnani and colleagues report an analysis from the Intensified Mission Indradhanush strategy in India, showing that cross-sectoral participation can contribute to improved vaccination coverage of children at high risk

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          A brief history of vaccines & vaccination in India

          The challenges faced in delivering lifesaving vaccines to the targeted beneficiaries need to be addressed from the existing knowledge and learning from the past. This review documents the history of vaccines and vaccination in India with an objective to derive lessons for policy direction to expand the benefits of vaccination in the country. A brief historical perspective on smallpox disease and preventive efforts since antiquity is followed by an overview of 19th century efforts to replace variolation by vaccination, setting up of a few vaccine institutes, cholera vaccine trial and the discovery of plague vaccine. The early twentieth century witnessed the challenges in expansion of smallpox vaccination, typhoid vaccine trial in Indian army personnel, and setting up of vaccine institutes in almost each of the then Indian States. In the post-independence period, the BCG vaccine laboratory and other national institutes were established; a number of private vaccine manufacturers came up, besides the continuation of smallpox eradication effort till the country became smallpox free in 1977. The Expanded Programme of Immunization (EPI) (1978) and then Universal Immunization Programme (UIP) (1985) were launched in India. The intervening events since UIP till India being declared non-endemic for poliomyelitis in 2012 have been described. Though the preventive efforts from diseases were practiced in India, the reluctance, opposition and a slow acceptance of vaccination have been the characteristic of vaccination history in the country. The operational challenges keep the coverage inequitable in the country. The lessons from the past events have been analysed and interpreted to guide immunization efforts.
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            Polio vaccine hesitancy in the networks and neighborhoods of Malegaon, India.

            Eradication and control of childhood diseases through immunization can only work if parents allow their children to be vaccinated. To learn about social network factors associated with polio vaccine hesitancy, we investigated social and spatial clustering of households by their vaccine acceptance status in Malegaon, India, an area known for vaccine refusal and repeated detection of polio cases.
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              India's vaccine deficit: why more than half of Indian children are not fully immunized, and what can--and should--be done.

              Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world's unimmunized children. Fewer than 44 percent of India's young children receive the full schedule of immunizations. India's vaccine deficit has several causes: little investment by the government; a focus on polio eradication at the expense of other immunizations; and low demand as a consequence of a poorly educated population and the presence of anti-vaccine advocates. In this article we describe India's vaccine deficit and recommend that the government move quickly to increase spending on, and otherwise strengthen, national immunization programs.
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                Author and article information

                Contributors
                Role: joint secretary
                Role: deputy commissioner immunisation
                Role: deputy commissioner immunisation
                Role: director projects
                Role: senior consultant immunisation
                Role: international health consultant
                Role: executive director
                Role: additional secretary and mission director
                Role: secretary
                Journal
                BMJ
                BMJ
                BMJ-UK
                bmj
                The BMJ
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2018
                07 December 2018
                : 363
                : k4782
                Affiliations
                [1 ]Ministry of Health and Family Welfare, Government of India, New Delhi, India
                [2 ]The INCLEN Trust International, New Delhi, India
                [3 ]Iowa City, Iowa, USA
                Author notes
                Correspondence to N K Arora nkarora@ 123456inclentrust.org
                Article
                gurj47392
                10.1136/bmj.k4782
                6282735
                30530467
                b8a32507-ca5e-48db-a538-aeff001c9262
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed under the terms of the Creative Commons Attribution IGO License ( https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited.

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                Analysis
                Making Multisectoral Collaboration Work

                Medicine
                Medicine

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