Hexavalent Vaccine Could Strengthen India’s Universal Immunisation Programme

Why in News?

A multi-institutional study led by the Union Ministry of Health and Family Welfare has concluded that introducing the Hexavalent Vaccine into India's Universal Immunisation Programme (UIP) can improve operational efficiency and reduce the logistical burden of childhood immunisation. 

What is the Hexavalent Vaccine?

A Hexavalent Vaccine is a combination vaccine that protects infants against six life-threatening diseases through a single injection. It combines multiple antigens into one dose, thereby reducing the number of injections required during routine immunisation visits.

Diseases Covered

• Diphtheria
• Tetanus
• Pertussis (Whooping Cough)
• Hepatitis B
• Haemophilus influenzae type b (Hib)
• Polio (Inactivated Polio Vaccine – IPV)

Combination vaccines are recommended globally because they improve vaccination compliance, reduce discomfort for children, and simplify immunisation schedules.

About India's Universal Immunisation Programme (UIP)

The Universal Immunisation Programme (UIP) was launched in 1985 and is one of the world's largest public health programmes. It aims to provide free vaccination against vaccine-preventable diseases to all eligible children and pregnant women.

Key Facts

• Implemented by the Ministry of Health and Family Welfare.
• Covers nearly 26 million infants and around 29 million pregnant women annually.
• Provides free vaccines through an extensive network of government health facilities.
• Supported through initiatives such as Mission Indradhanush and Intensified Mission Indradhanush to improve immunisation coverage.

Key Findings of the Study

The study evaluated two implementation scenarios:

• Replacing the current Pentavalent Vaccine and Fractional IPV with the Hexavalent Vaccine during the primary immunisation schedule.
• Replacing both the primary schedule and the DTP booster dose with a Hexavalent Booster.

The researchers assessed costs from both the government's perspective and the household perspective, including:

• Vaccine procurement costs
• Syringes and injection equipment
• Cold-chain logistics
• Healthcare worker time
• Caregiver travel and waiting time

The findings indicate that while the Hexavalent Vaccine has a higher procurement cost, it generates significant operational savings by reducing injections, simplifying logistics, and lowering programme management costs.

Major Benefits of Introducing the Hexavalent Vaccine

1. Fewer Injections for Infants

Instead of receiving multiple injections during immunisation visits, children can receive protection against six diseases through a single shot. This reduces pain, anxiety, and vaccine hesitancy among caregivers.

2. Improved Convenience for Families

Parents spend less time visiting vaccination centres, reducing travel expenses and loss of daily wages, particularly in rural and economically weaker households.

3. Reduced Workload for Frontline Health Workers

ANMs, ASHAs, and other frontline workers can administer fewer injections, improving service delivery and allowing more time for counselling and community outreach.

4. Better Cold-Chain Management

Since fewer vaccine vials need to be transported and stored, the demand for refrigeration, storage space, and transportation is reduced, making the immunisation programme more efficient.

5. Operational Efficiency

A simplified vaccination schedule reduces inventory management challenges, lowers vaccine wastage, and streamlines immunisation sessions.

Economic Implications

• The study identified vaccine procurement price as the most significant factor influencing programme costs.
• Researchers estimated that if the price of the Hexavalent Vaccine decreases by around 50%, the savings generated through reduced logistics, cold-chain requirements, healthcare worker time, and caregiver costs would outweigh the additional expenditure on vaccine procurement.
• This indicates that long-term adoption could become economically sustainable, particularly if domestic manufacturing expands and procurement costs decline.

Significance for India's Public Health System

Introducing the Hexavalent Vaccine aligns with India's broader goal of strengthening primary healthcare and improving immunisation coverage.

It could:

• Improve vaccination compliance.
• Reduce missed or delayed doses.
• Enhance healthcare efficiency.
• Strengthen India's progress toward reducing child mortality.
• Support Sustainable Development Goal (SDG) 3 on ensuring healthy lives and promoting well-being for all.

With India operating one of the world's largest immunisation programmes, even small improvements in efficiency can have significant national-level health and economic benefits.

Challenges

Despite its advantages, several challenges remain:

• High initial procurement cost of the vaccine.
• Need for sustainable financing mechanisms.
• Domestic manufacturing capacity must be expanded.
• Updating national immunisation guidelines and training healthcare workers.
• Ensuring uninterrupted vaccine supply across all states and Union Territories.
• Careful evaluation by the National Technical Advisory Group on Immunization (NTAGI) before nationwide introduction.

Way Forward

India should continue evaluating the Hexavalent Vaccine through cost-effectiveness studies and phased implementation strategies. Strengthening indigenous vaccine production under the 'Make in India' initiative can help reduce procurement costs. Policymakers should also consider long-term operational savings, improved programme efficiency, and better health outcomes while making decisions regarding its inclusion in the Universal Immunisation Programme.

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