Background

In 2015, Pneumococcus caused 317,000 childhood deaths globally, of which 68700 (23%) are from India. India started phased introduction of PCV in 2017 and expanded to 47% birth cohort by 2020. This paper documents the key lessons learnt from PCV roll-out in India.

Methods

Desk review was conducted using implementation documents, coverage reports and monitoring data. Key stakeholders were interviewed, followed by a thematic analysis to identify the roll-out and system-strengthening activities.

Results

Competing priorities of MR campaign, Rota scale-up and Mission Indradhanush called for synergistic planning for PCV roll-out. A 2p+1 dose schedule at 6^th week, 14^th week and 9^th month, with the partial provincial introduction, posed the challenge of high drop-out in this vast country with internal migration. Adding another injection challenged provider and care-giver compliance.

Leveraging country-wide polio assets was key to the timely PCV roll-out. Self-reporting system-assessment tools prompted the states to preparatory actions. Adult learning methods in cascaded trainings oriented the workforce. Positive communication approach, online tracking of supplies and mobile-based real-time monitoring helped the most phase 1 and 2 districts reach >80% PCV1 coverage with slower PCV-booster uptake.

Conclusions

PCV introduction in India seized the opportunity to strengthen system, for sustaining high coverage.