Impact of campaign-style delivery of routine vaccines: a quasi-experimental evaluation using routine health services data in India

Abstract

The world is not on track to achieve the goals for immunization coverage and equity described by the World Health Organization’s Global Vaccine Action Plan. Many countries struggle to increase coverage of routine vaccination, and there is little evidence about how to do so effectively. In India in 2016, only 62% of children had received a full course of basic vaccines. In response, in 2017–18 the government implemented Intensified Mission Indradhanush (IMI), a nationwide effort to improve coverage and equity using a campaign-style strategy. Campaign-style approaches to routine vaccine delivery like IMI, sometimes called ‘periodic intensification of routine immunization’ (PIRI), are widely used, but there is little robust evidence on their effectiveness. We conducted a quasi-experimental evaluation of IMI using routine data on vaccine doses delivered, comparing districts participating and not participating in IMI. Our sample included all districts that could be merged with India’s 2016 Demographic and Health Surveys data and had available data for the full study period. We used controlled interrupted time-series analysis to estimate the impact of IMI during the 4-month implementation period and in subsequent months. This method assumes that, if IMI had not occurred, vaccination trends would have changed in the same way in the participating and not participating districts. We found that, during implementation, IMI increased delivery of 13 infant vaccines, with a median effect of 10.6% (95% confidence interval 5.1% to 16.5%). We did not find evidence of a sustained effect during the 8 months after implementation ended. Over the 12 months from the beginning of implementation, we estimated reductions in the number of under-immunized children that were large but not statistically significant, ranging from 3.9% (−6.9% to 13.7%) to 35.7% (−7.5% to 77.4%) for different vaccines. The largest effects were for the first doses of vaccines against diphtheria-tetanus-pertussis and polio: IMI reached approximately one-third of children who would otherwise not have received these vaccines. This suggests that PIRI can be successful in increasing routine immunization coverage, particularly for early infant vaccines, but other approaches may be needed for sustained coverage improvements.

Improving vaccination coverage and timeliness through periodic intensification of routine immunization: evidence from Mission Indradhanush

“…A survey study showed an increase in full immunization rates in IMI districts 12 . Another new study used administrative data on vaccine doses delivered and found increased delivery of doses to IMI districts during the intervention period for 13 vaccines, but reduced volume of vaccine delivery at the end of IMI 14 . This suggests that further research is needed to evaluate the longer‐term effects of PIRI activities.…”

Public finance of universal routine childhood immunization in India: district-level cost estimates

“…Immunization special drives such as Mission Indradhanush and Intensified Mission Indradhanush have succeeded in increasing vaccination rates in underserved districts ( Gurnani et al. , 2018 ; Clarke-Deelder et al. , 2021 ; Summan et al.…”

“…, 2018 ; Clarke-Deelder et al. , 2021 ), but this effect did not persist 8 months after implementation ( Clarke-Deelder et al. , 2021 ).…”

“…To address the persistently low vaccination rates in rural and marginalized communities, the Indian government launched the special immunization campaigns of Mission Indradhanush in 2014 and Intensified Mission Indradhanush in 2017. These programmes redirected resources to districts and urban areas with historically low vaccination rates to vaccinate children who were not reached by routine immunization services ( Clarke-Deelder et al. , 2021 ).…”

“…, 2021 ), and IMI increased full immunization coverage by 10.6–18.5% ( Gurnani et al. , 2018 ; Clarke-Deelder et al. , 2021 ), but this effect did not persist 8 months after implementation ( Clarke-Deelder et al.…”