Impact of Campaign-Style Delivery of Routine Vaccines during Intensified Mission Indradhanush in India: A Controlled Interrupted Time-Series Analysis

Journal Article
  • Emma Clarke-Deelder
  • Christian Suharlim
  • Susmita Chatterjee
  • Logan Brenzel
  • Arindam Ray
  • Jessica Cohen
  • Margaret McConnell
  • Stephen Resch
  • Nicolas Menzies
MedRxiv
May 2020. DOI: https://doi.org/10.1101/2020.05.01.20087288.

Abstract

Introduction

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. In India, only 62% of children had received a full course of basic vaccines in 2016. We evaluated the Intensified Mission Indradhanush (IMI), a campaign-style intervention to increase routine immunization coverage and equity in India, implemented in 2017-2018.

Methods

We conducted a comparative interrupted time-series analysis using monthly district-level data on vaccine doses delivered, comparing districts participating and not participating in IMI. We estimated the impact of IMI on coverage and under-coverage (defined as the proportion of children who were unvaccinated) during the four-month implementation period and in subsequent months.

Findings

During implementation, IMI increased delivery of thirteen infant vaccines by between 1.6% (95% CI: -6.4, 10.2%) and 13.8% (3.0%, 25.7%). 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, IMI reduced under-coverage of childhood vaccination by between 3.9% (- 6.9%, 13.7%) and 35.7% (-7.5%, 77.4%). The largest estimated effects were for the first doses of vaccines against diptheria-tetanus-pertussis and polio.

Interpretation

IMI had a substantial impact on infant immunization delivery during implementation, but this effect waned after implementation ended. Our findings suggest that campaign-style interventions can increase routine infant immunization coverage and reach formerly unreached children in the shorter term, but other approaches may be needed for sustained coverage improvements.