Potential Impact of Rotavirus Vaccine Introduction in India's Universal Immunisation Programme on Private Sector Vaccine Utilisation: an Interrupted Time Series Analysis

Overview

Journal BMC Med

Publisher Biomed Central

Specialty General Medicine

Date 2024 Oct 11

PMID 39394601

Authors

Habib Hasan Farooqui

Anup Karan

Aashna Mehta

Giridhara Rathnaiah Babu

Onno C P van Schayck

Affiliations

Soon will be listed here.

Abstract

Background: Despite free immunisation services through the Universal Immunisation Programme (UIP), around 14% of Indian households seek immunisation in the private sector. We examined the potential impact of rotavirus vaccine (RVV) introduction in the Universal Immunisation Programme (UIP) on private-sector rotavirus vaccine utilisation.

Methods: We analysed nationally representative private-sector vaccine sales data. The intervention under consideration is RVV introduction in the UIP in selected Indian states. The outcome is the 'monthly RVV sales volume'-a proxy for vaccine utilisation. We performed a Poisson regression interrupted time series analysis to detect the pre-intervention trend, post-intervention level change and trend change relative to the pre-intervention for monthly rotavirus vaccine utilisation.

Results: Poisson segmented regression analysis showed that immediately after RVV introduction in the UIP private-sector RVV sales showed a decline in Rajasthan by 37.4% (Incidence Risk Ratio (IRR): 0.626; 95% CI: 0.504-0.779), in Tamil Nadu by 26% (IRR: 0.740; 95% CI: 0.513-1.068), in Uttar Pradesh-East by 72.2% (IRR: 0.278; 95% CI: 0.178-0.436) and in Kerala by 3% (IRR: 0.970; 95% CI: 0.651-1.447). Rajasthan, Tamil Nadu and Kerala had sustained reduction in the postintervention trend relative to the preintervention trend by 20.1% (IRR: 0.799; 95% CI: 0.763-0.836), 6.4% (IRR: 0.936; 95% CI: 0.906-0.967) and 3.3% (IRR: 0.967; 95% CI: 0.926-0.960) per month, respectively. However, in Haryana and UP-west, in the first-month post-UIP introduction, the private-sector RVV sales increased by 101% and 3.8%, respectively which was followed by a sustained decrease of 14.2% (IRR: 0.858; 95% CI: 0.688-1.070) and 5.8% (IRR: 0.942; 95% CI: 0.926-0.960) per month, respectively. In terms of long-term impact, the private sector RVV sales post-UIP introduction decreased at a monthly rate of 4.4% (IRR: 0.956, 95% CI: 0.939-0.974) in Rajasthan but increased by 5.5% (IRR: 1.055; 95% CI: 1.040-1.070) in UP-east, 0.3% (IRR: 1.003, 95% CI: 0.976-1.031)) in Kerala and 0.2% (IRR: 1.002, 95% CI: 0.993-1.011) in Tamil Nadu whereas Haryana and UP-west had a reduction in RVV utilisation by 2.8% (IRR: 0.972; 95% CI: 0.955-0.990) and 1% (IRR: 0.990; 95% CI: 0.982-0.998), respectively.

Conclusions: The study provides evidence that access to RVV through UIP leads to a reduction in private-sector RVV utilisation. We recommend strengthening UIP to expand the basket of new vaccines.

References

Gurnani V, Haldar P, Aggarwal M, Das M, Chauhan A, Murray J . Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy. BMJ. 2018; 363:k4782. PMC: 6282735. DOI: 10.1136/bmj.k4782. View

Kang G, Desai R, Arora R, Chitamabar S, Naik T, Krishnan T . Diversity of circulating rotavirus strains in children hospitalized with diarrhea in India, 2005-2009. Vaccine. 2013; 31(27):2879-83. DOI: 10.1016/j.vaccine.2013.04.030. View

Bhandari N, Rongsen-Chandola T, Bavdekar A, John J, Antony K, Taneja S . Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian infants: a randomised, double-blind, placebo-controlled trial. Lancet. 2014; 383(9935):2136-43. PMC: 4532697. DOI: 10.1016/S0140-6736(13)62630-6. View

Hasan Farooqui H, Karan A, Mathur M, Hussain S, Selvaraj S . Out-of-pocket expenditure on childhood infections and its financial burden on Indian households: Evidence from nationally representative household survey (2017-18). PLoS One. 2022; 17(12):e0278025. PMC: 9794050. DOI: 10.1371/journal.pone.0278025. View

Nair N, Reddy N S, Giri S, Mohan V, Parashar U, Tate J . Rotavirus vaccine impact assessment surveillance in India: protocol and methods. BMJ Open. 2019; 9(4):e024840. PMC: 6502045. DOI: 10.1136/bmjopen-2018-024840. View

Ruiz-Palacios G, Perez-Schael I, Velazquez F, Abate H, Breuer T, Clemens S . Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006; 354(1):11-22. DOI: 10.1056/NEJMoa052434. View

Debellut F, Clark A, Pecenka C, Tate J, Baral R, Sanderson C . Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study. Lancet Glob Health. 2019; 7(12):e1664-e1674. PMC: 7024955. DOI: 10.1016/S2214-109X(19)30439-5. View

Mathur M, Mathur N, Khan N, Kumar D, Verma A . Predictors of 'Out-of-Pocket Expenditure' on Routine Immunization of Under-Five Children: A Regression Analysis. Cureus. 2021; 12(12):e11859. PMC: 7781551. DOI: 10.7759/cureus.11859. View

Barnighausen T, Berkley S, Bhutta Z, Bishai D, Black M, Bloom D . Reassessing the value of vaccines. Lancet Glob Health. 2014; 2(5):e251-2. DOI: 10.1016/S2214-109X(13)70170-0. View

10.

Ikilezi G, Micah A, Bachmeier S, Cogswell I, Maddison E, Stutzman H . Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000-17: a financial modelling study. Lancet. 2021; 398(10314):1875-1893. PMC: 8844562. DOI: 10.1016/S0140-6736(21)01591-9. View

11.

Sharma A, Kaplan W, Chokshi M, Hasan Farooqui H, Zodpey S . Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data. BMJ Open. 2015; 5(2):e007038. PMC: 4342586. DOI: 10.1136/bmjopen-2014-007038. View

12.

Rheingans R, Anderson 4th J, Anderson B, Chakraborty P, Atherly D, Pindolia D . Estimated impact and cost-effectiveness of rotavirus vaccination in India: effects of geographic and economic disparities. Vaccine. 2014; 32 Suppl 1:A140-50. DOI: 10.1016/j.vaccine.2014.05.073. View

13.

Yunus M, Donaldson C, Perron J . COVID-19 Vaccines A Global Common Good. Lancet Healthy Longev. 2021; 1(1):e6-e8. PMC: 7574693. DOI: 10.1016/S2666-7568(20)30003-9. View

14.

Chatterjee S, Das P, Pinheiro A, Haldar P, Ray A, Brenzel L . The incremental cost of improving immunization coverage in India through the Intensified Mission Indradhanush programme. Health Policy Plan. 2021; 36(8):1316-1324. PMC: 8428614. DOI: 10.1093/heapol/czab053. View

15.

Vesikari T, Matson D, Dennehy P, Van Damme P, Santosham M, Rodriguez Z . Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006; 354(1):23-33. DOI: 10.1056/NEJMoa052664. View

16.

George M, Negandhi P, Farooqui H, Sharma A, Zodpey S . How do parents and pediatricians arrive at the decision to immunize their children in the private sector? Insights from a qualitative study on rotavirus vaccination across select Indian cities. Hum Vaccin Immunother. 2016; 12(12):3139-3145. PMC: 5215569. DOI: 10.1080/21645515.2016.1219824. View

17.

. Rotavirus vaccines WHO position paper: January 2013 - Recommendations. Vaccine. 2013; 31(52):6170-1. DOI: 10.1016/j.vaccine.2013.05.037. View

18.

Bloom D, Fan V, Sevilla J . The broad socioeconomic benefits of vaccination. Sci Transl Med. 2018; 10(441). DOI: 10.1126/scitranslmed.aaj2345. View

19.

Clarke-Deelder E, Suharlim C, Chatterjee S, Brenzel L, Ray A, Cohen J . Impact of campaign-style delivery of routine vaccines: a quasi-experimental evaluation using routine health services data in India. Health Policy Plan. 2021; 36(4):454-463. PMC: 8128004. DOI: 10.1093/heapol/czab026. View

20.

Bernal J, Cummins S, Gasparrini A . Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2016; 46(1):348-355. PMC: 5407170. DOI: 10.1093/ije/dyw098. View