Build Back Immunity- Intensified Mission Indradhanush (IMI)

India launched its flagship programme, Mission Indradhanush (MI), a periodic immunization intensification drive in December 2014, with an aim to strengthen Routine Immunization under the Universal Immunization Program (UIP). The mission, over the last nine years, has shown a positive impact on immunization coverage. The mission was further intensified in 2017 with increased focus on urban areas with better interdepartmental coordination.

These efforts resulted in India achieving a substantial increase in the full immunization coverage of 76.4% (NFHS-5, 2019-21) as compared to 62% (NFHS-4, 2015-16) and for Nagaland at 58% ((NFHS-5, 2019-21) as compared to 35% (NFHS-4, 2015-16).

However, globally and in India, the achievements made in the past have been hindered by the COVID-19 pandemic along with other factors limiting vaccination coverage which includes large, mobile, and isolated populations that are difficult to reach, low demand from under-informed or misinformed populations and fear of side effects after vaccination.

By focusing on such populations where these programmatic challenges exist, IMI drives target to vaccinate these left out and dropped out children and eligible pregnant women who were missed in Routine Immunization activities.

The objective of IMI 5.0 is to identify all children up to 5 years for missed doses, register them on U-WIN and vaccinate them in specially planned IMI sessions. Three rounds of Intensified Mission Indradhanush will be conducted in 2023
Round 1: 7-12 August, Round 2: 11-16 September and Round 3: 9-14 October 2023
Unique features of IMI 5.0

1. Scope: All districts of the country

2. Target beneficiaries: All children up to 5 years of age and pregnant women who have missed any of their due doses

3. Headcount survey (HCS): Headcount surveys will be conducted for all the districts across the nation.

4. Session timings: Flexible session timings to ensure a better turn out of beneficiaries.

5. U-WIN roll out: Digital portal for data recording and reporting. This will be database for all the states, registration and vaccination status on real time basis, individualized tracking of beneficiaries, booking of appointments and digital vaccination certificates.

For Round 1 of IMI, the State has created 209 IMI sessions with updated child target of 1155 (0-2 years), 730 (2-5 years) and 179 pregnant women. These are beneficiaries who are unvaccinated and partially vaccinated children and pregnant mothers who did not take up timely immunization schedule. If some beneficiaries are missed in the headcount, there is the option for onsite registration for which an ID card will be required (Aadhaar card, PAN card, passport, driving license, service card, ration card or any government approved ID card). Nagaland along with rest of India is committed to eliminating Measles and Rubella (MR) by 2023 by achieving at least 95% vaccination coverage and so IMI 5.0 will provide a big opportunity to help achieve and push towards the goal for MR Elimination too.

Challenge of high dropout rates: Drop outs are those beneficiaries who are partially vaccinated and they fail to complete the adequate dose of immunization schedule for full protection. According to NFHS-5, the dropout rate for OPV1-OPV3 showed the highest dropout in Nagaland (23.8%), followed by Manipur (20.7%). The highest dropout rate for Penta 1-Penta 3 was observed in Nagaland (15.0%) and Manipur (12.9%), followed by Kerala (11.0%) and Uttar Pradesh (11.05%) (OPV and Penta vaccines are given in three doses at 6 weeks, 10 weeks and 14 weeks respectively)

Advocacy and awareness is one of the key areas for which support has to be mobilized to create demand generation of services. The community needs to know the importance of immunizing the child at the right age to ensure that the child receives full protection. The vaccines are available free of cost at all Government health facilities and that every unvaccinated or partially vaccinated child is at risk of life-threatening disease.

The upcoming IMI Rounds and the Routine Immunization activities can be sustained only through multi-stakeholder approach – Support from allied departments, Faith Based Organizations (FBOs) Civil Society Organizations (CSOs), Village Council Chairperson, Women leaders and members of IMA, IAP, IDA, Rotary, Lions etc. We have to ensure that all children under 5 years of age in your family or community complete their dose during this special immunization sessions being organized in your area as part of IMI.

The factors limiting vaccination coverage usually include large, mobile, and isolated populations that are difficult to reach, low demand from under-informed or misinformed populations and fear of side effects after vaccination. By focusing on such populations where these programmatic challenges exist, IMI drives target to vaccinate these left out and dropped out children and eligible pregnant women who were missed in Routine Immunization activities.

Dr. Imkongtemsu Longchar

State Immunization Officer

Directorate of Health & Family Welfare, Kohima: Nagaland