CHRISMED Journal of Health and Research

LETTER TO EDITOR
Year
: 2019  |  Volume : 6  |  Issue : 2  |  Page : 128--129

Role of Electronic Vaccine Intelligence Network (eVIN) system for quality improvement in immunization data in India


Arulmani Thiyagarajan1, Sudip Bhattacharya2, Deepika Khaladkar3,  
1 Public Health Scientist, SRMIST, School of Public Health, Chennai, Tamil Nadu, India
2 Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
3 Consultant Epidemiologist, Department of Public Health, NUHM, Mumbai, Maharashtra, India

Correspondence Address:
Sudip Bhattacharya
Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand
India




How to cite this article:
Thiyagarajan A, Bhattacharya S, Khaladkar D. Role of Electronic Vaccine Intelligence Network (eVIN) system for quality improvement in immunization data in India.CHRISMED J Health Res 2019;6:128-129


How to cite this URL:
Thiyagarajan A, Bhattacharya S, Khaladkar D. Role of Electronic Vaccine Intelligence Network (eVIN) system for quality improvement in immunization data in India. CHRISMED J Health Res [serial online] 2019 [cited 2021 Apr 19 ];6:128-129
Available from: https://www.cjhr.org/text.asp?2019/6/2/128/258968


Full Text



Sir,

On progressing through sustainable development goals, India is steadfast in ensuring healthy lives and promoting well-being for all. According to the WHO report, the leading causes of death among children under five in 2016 were preterm birth complications, acute respiratory infections, intrapartum-related complications, congenital anomalies, and diarrhea.[1] In India, around 1.7 million children died before reaching the age of 5 years in 2010, and more than half of them (52%) died in the 1st month of life. Immunization is one of the most cost-effective interventions to prevent the suffering that comes from avoidable sickness, disability, and death. To achieve the global efforts, India is anticipated to make progress in achieving universal health coverage particularly in provisioning of essential healthcare services. The National program's immunization coverage is a key indicator to monitor the progress toward child health-related SDGs. According to the National Family Health Survey Report (2015–2016), there was an increase in coverage from 2005–2006 to 2015–2016 but not able to keep up with the required targets.

The immunization supply chain (ISC) is critical to ensure the full health benefits of vaccines are understood. Improving ISC systems becomes more expensive vaccines are planned for introduction in low- and middle-income countries, thereby adding a public finance imperative, in addition to the public health one, to effective vaccine delivery.

The root causes of ineffective ad hoc distribution are lack of stock visibility across the supply chain, weak inventory and stock visibility across the supply chain, weak inventory and stock-flow record-keeping practices, and the absence of distribution planning by qualified personnel.

An effective ISC plays a key role in improving the immunization coverage with quality and equity by the timely supply of safe and potent vaccines along with other required logistics. India conducts one of the largest Universal Immunization Programs in the world, targeting approximately 26 million newborns and 30 million pregnant women each year translating into more than 300 million doses of vaccines each year.

Data from the states where vaccine management assessment tool, effective vaccine management, and/or deep dives were conducted by UNICEF, and Immunization Technical Support Unit (ITSU) indicates that the distribution of vaccines through the system is uneven with some cold chain points with excess stock while others have stock-outs. Even when there are few stock-outs reported, there is evidence that store managers are slowing down outflow to cold chain points below them or to session sites as a means of preventing stock-outs, although this kind of stock management leads to insufficient vaccines reaching the field.

Without real-time data, program managers in National, State, and District headquarters have little information on the basis to manage the supply side of vaccines, perform course corrections, or ensure accountability from those further down the chain.

Electronic vaccine intelligence network (eVIN) was implemented by the United Nations Development Program in 12 out of 36 states and union territories in India, with Gavi's Health System Strengthening support during 2015–2017. The Global Alliance for Vaccines and Immunizations (GAVI) has proposed to help for rolling out in all remaining states from 2017 to 2021.[2] The state governments are expected to sustain the implementation of eVIN through state-owned funding mechanism. Even though the rollout of eVIN is through Gavi support, it is important to know the programmatic usefulness of this system.

A vaccine wastage assessment study conducted by UNICEF in India in 2010 revealed that vaccine wastage documentation was poor at all levels. Service delivery level had the highest vaccine wastage as compared to the supply chain levels. Session size, vial size, and formulation also influence vaccine wastage. The study recommended to optimize session size, usage of smaller vials, refresher trainings of health workers, and revised microplanning (UNICEF India, 2010).[3]

A study to estimate the frequency of exposure of vaccines to freezing temperatures at various levels in vaccine cold chain was conducted by the National Institute of Epidemiology (NIE). The findings revealed that the exposure to sub-zero temperature and >8°C occurred at all levels, from state vaccine store to healthcare facility. Exposure to higher temperatures was noted as well. The exposure to <0°C and >8°C was frequently noted during transportation as well. The manual temperature records did not match with data logger readings. Further, noncalibrated temperature monitoring devices, long hours of power cut and shortage of trained cold chain handlers affected the maintenance of cold chain. The key recommendations to improve the maintenance of the vaccine cold chain and to avoid temperature excursions were to identify the reasons for exposure to suboptimal temperatures, to have a real-time data logging system to monitor temperature (NIE, 2012).

To tackle the challenges of vaccine supply chain management and to deliver potent vaccine to the beneficiaries, improvement is needed in five fundamental areas as follows: leadership, oversight, design, data, and cold chain equipment's.[4] The challenges can be addressed by better oversight mechanisms to monitor performance and recommend policy changes to improve the performance of the supply chain.[5] The experiences of country, such as Mozambique and Tanzania, which have redesigned their supply chains and achieved better supply chain performance should be adopted.[6],[7] Further, electronic data systems can help in reduced stock-outs and increased vaccine availability.[4] To tackle the challenges of vaccine supply chain, continuous innovative solutions are required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1WHO/Causes of Child Mortality.WHO. Available from: http://www.who.int/gho/child_health/mortality/causes/en/. [Last accessed on 2018 Jul 02].
2Electronic Vaccine Intelligence Network (eVIN). Available from: http://www.itsu.org.in/Electronic-Vaccines-Intelligence-Network. [Last accessed on 2018 May 02].
3UNICEF, India. Assessment of Effective Vaccine Management in Maharashtra; 2011. Available from: http://www.itsu.org.in/repository-resources/20. MaharashtraEVM-2011.pdf-GoogleSearch; https://www.google.co.in/search?safe=off& rlz=1C1GGR. [Last accessed on 2018 May 02].
4Rao R, Schreiber B, Lee BY. Immunization supply chains: Why they matter and how they are changing. Vaccine 2017;35:2103-4.
5Ashok A, Brison M, LeTallec Y. Improving cold chain systems: Challenges and solutions. Vaccine 2017;35:2217-23.
6Prosser W, Jaillard P, Assy E, Brown ST, Matsinhe G, Dekoun M, et al. System redesign of the immunization supply chain: Experiences from Benin and Mozambique. Vaccine 2017;35:2162-6.
7Mwencha M, Rosen JE, Spisak C, Watson N, Kisoka N, Mberesero H, et al. Upgrading supply chain management systems to improve availability of medicines in Tanzania: Evaluation of performance and cost effects. Glob Health Sci Pract 2017;5:399-411.