Institutionalizing early vaccination of newborns delivered at government health facilities: Experiences from India

The program aimed to strengthen the implementation of newborn vaccination in government health facilities. An assessment was conducted in 46 selected health facilities across 5 districts of the two states to study the implementation of the newborn vaccination program. Key findings from the assessment included a lack of knowledge among staff about the benefits of newborn vaccination, absence of written guidelines, unavailability of one vaccine compromising the administration of the remaining two, and poor documentation practices. Following the assessment, technical support was provided to strengthen implementation at these selected facilities, which included providing on-the-job orientations to staff members posted in delivery rooms, establishing a sound supply chain mechanism to ensure round-the-clock availability of vaccines in labor rooms, strengthening documentation by incorporating separate columns in the delivery registers for recording vaccine administration, and improved Supportive Supervision mechanisms. The intervention produced favorable results with a progressive increase in coverage of not only BCG and OPV zero dose but also Hepatitis B birth dose, which was introduced in the UIP during the course of the intervention. The practice of vaccinating newborns delivered at health facilities is easily implementable and replicable, and its sustainability should ensure improved coverage and protection against targeted vaccine-preventable diseases. The World Health Organization (WHO) recommends administration of three vaccines, viz. Oral Polio Vaccine (OPV), BCG, and Hepatitis B vaccine, as early as possible after birth. These recommendations are specified in Vaccine Position Papers that provide guidance to policy makers, public health officials, and program managers of member countries. The evidence-based benefits of early administration of these vaccines are well documented. India's Universal Immunization Program recommends a nationwide immunization schedule specifying the vaccines, doses, and appropriate ages for vaccination. This schedule is revised periodically in light of new evidence and the introduction of new vaccines and vaccine products. The national immunization schedule aligns with WHO recommendations and gives due emphasis to birth vaccines for newborns, viz. one dose of trivalent OPV (referred as zero dose) within 15 days of birth, Hepatitis B (referred as the birth dose) within 24 hours of birth, and BCG vaccine as early as possible after birth. Despite conspicuous interest shown by national and state governments, development partners, and other stakeholders, India's immunization program faces challenges in achieving high coverage of birth vaccines, except for BCG. The coverage status of birth vaccines, except for BCG, is relatively low, and shows wide variations across the states. BCG coverage is comparatively better because the age limit for this vaccine is up to one year, and may be higher than reported because there is no concrete mechanism yet to capture BCG administered to institutionally delivered newborns before they are discharged from the facility.