By eradicating polio from India we are contributing ₹600 crore per annum for our national wealth. If we eradicate measles and rubella (MR), though I have not calculated the health economics, I can assure you that our nation will become healthier and wealthier,” said virologist Dr Jacob John. Health is not only a measure of a nation’s development but a means to its development, he said, addressing Rotarians, Inner Wheel members, Rotaractors and Interactors from 30 Rotary districts at a multi-district virtual seminar titled ‘Battle against Rubella’ organised by RID 3232. Dr John heads the government’s India Experts Advisory Group (IEAG) for eliminating MR and is member of RC Vellore, RID 3231.
Rubella or German measles, as it is also known, is harmless. But if a pregnant woman contracts the virus in the first trimester of her pregnancy there is 90 per cent chance that the child will be born with multiple birth defects.
To a question from an Interactor of the TNPL Public School, Karur, on the dangers of rubella, Dr John explained that rubella and zica are the only two viruses that will cross the placenta and infect the foetus, consequently affecting its ears, eyes, bones and marrow. The child will be born with birth defects such as hearing impairment, cataract, heart abnormalities and mental retardation.
“What can be the greatest pleasure in life will turn out to be a trauma for the child and the parents. Unlike polio, the task here is easy,” said RIPE Shekhar Mehta. “All we have to do is create awareness and identify young girls who have not been vaccinated.” Recalling how deeply involved the late PRID Y P Das was in this programme, he added, “eradicating MR will be our best tribute to him.”
Dr John said the WHO deadline of 2023 for MR eradication is achievable because 95 per cent of the work is already done. MR vaccine is part of the routine Universal Immunisation Programme (UIP). “If all Rotary districts gear up social mobilisation for routine immunisation in their regional areas, we can eradicate the disease in three years.”
Sri Lanka had already eradicated MR, he said and “we could learn from this island country.” The MR vaccine was safe, if properly handled, Dr John said, dismissing reports that people had fallen ill after being given the MR vaccine. “Even if you inject water children will fall ill. MR vaccines will never cause illnesses. The child might have mild fever for a couple of days as that is the body’s response to the vaccine.”
The meet emphasised the need for Rotary to spread awareness about rubella in a committed manner as Rotarians did for polio eradication, said PRID P T Prabhakar, who moderated the seminar. He said RIDE Mahesh Kotbagi, who participated, has done measles vaccination for 100,000 rural girls through a global grant.
INPPC chair and member of the IEAG Deepak Kapur detailed Rotary’s action plan for MR elimination by 2023, and said Prabhakar wouldn’t have been able to put together “this wonderful programme without being prodded by his wife Nalini” who had done a lot of work on rubella eradication. Vaccines against diseases like measles and rubella are sometimes languishing in government storage and PHCs while 90,000 people, mostly children, die of measles every year. Thousands of vials are being destroyed because their expiry dates have passed. There is not enough demand from the community, he rued.
Kapur recalled Dr John’s initiative that led to Rotary’s participation in the programme. “I remember how he convinced past RI presidents Rajendra Saboo, Kalyan Banerjee, past director Sushil Gupta and me that MR elimination was a ‘low-hanging fruit and tailormade fit for Rotary.’ Given the extreme recognition that Rotary has garnered due to its proactive role in the fight against polio, this programme would be right up Rotary’s ally, with its 3,400-plus Rotary clubs and 150,000 Rotarians.”
When Rotary proposed this action plan to the then Union Health Minister J P Nadda, he welcomed it. On Dec 6, 2017, an MoU was signed between the health ministry and Rotary to promote ‘Mission Indradhanush’ or routine immunisation with special focus on MR. “We proposed advocacy, assisting the government in operations and basically helping to fire up people’s movement. We were certain that the programme will be successful if people demanded the vaccine instead of the government imposing it on them,” he added.
Rotary’s structure against the fight
RI’s National PolioPlus Committee in India has two tasks — to ensure that India remains polio-free and to fight MR. INPPC has a district coordinator (DC) in each Rotary district. Nalini Prabhakar is the DC in RID 3232. The DCs should set up a committee of Rotarians, their spouses, Rotaractors and Interactors to coordinate the efforts of Rotary clubs in the district.
Rotarians can visit the district chief medical officer (CMO) or the immunisation officer, get a list of the PHCs that carry out MR vaccinations and ensure the task is done on the designated days. Rotarians can check if the centres have adequate stock of the vaccine and its efficacy.
The target was tantalisingly close but the deadline had already passed, the Covid pandemic, inflicting a 30 per cent drop in immunisations across the country. “But the process has restarted. It is time to put our shoulder to the wheel once again. You are on the cusp of creating history by eradicating polio, and now MR,” urged Kapur.
DGE N Sridhar, RID 3232, wanted to know if oral polio vaccine and injectable MR immunisation can be made simultaneously on the NIDs. Dr John replied that oral polio vaccine can be given the same day along with the MR injectable vaccine but cannot be linked with the polio NIDs as MR vaccine must be given in a routine manner.
Nalini said, “our advocacy should reach girls until their child-bearing age. Even now many parents and girls are not aware of this. It is a one-time vaccine that should be given to girls before they conceive their first child.” She urged Rotarians to visit colleges and create awareness among girls. Prabhakar suggested that marriage halls should insist on rubella certificate from the bride. “This practice is in vogue in several marriage halls in South India.”
Dr Nalini Ramamurthy, deputy director, Department of Virology, Kings Institute, explained about rubella and its debilitating effects. DG S Muthupalaniappan welcomed the participants.