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The “demand enhancement model” of increasing vaccination coverage in high income countries does not apply to a low and middle income country like India

Posted by bidyutksarkar on 12 Mar 2013 at 17:54 GMT

Sadique et al have done an excellent analysis of determinants of demand for vaccination in high income country settings to increase coverage. They must be commended for generating very useful evidence that it is the severity of disease and adverse effects which primarily influences decisions for mothers of children which has been a subjective perception in the minds of many who implement immunization programmes but never presented as scientific evidence earlier.

However, in a country like India which has a population bigger than United States and Europe combined and still has health system issues, using a high income country model focusing only on demand enhancement would not suffice and fail miserably. Increasing vaccination coverage in India would have to go beyond demand issues, entail analyzing not only the determinants of demand but also the major issues of vaccine procurement, vaccine supply, cold chain and logistics management. A crucial systemic weakness for addressing all these immunization related issues is lack of trained, motivated and accountable manpower for delivery and management of routine immunization. Unless, India is able to identify, train and recruit appropriate public health personnel for delivery of interventions, findings of reports or research will never translate into action.

There is an urgent need for India to understand and replicate in a modified and more sustainable manner the dedicated, accountable and motivated manpower model used for polio eradication in India which achieved more than 90 percent vaccination coverage with polio vaccine across all geographic, cultural, resource divides including hard to access, in-transit and mobile populations.

No competing interests declared.