Table 1 Major events and its influence on immunization coverage

EPI

1978

State supported immunisation programme, lower coverage due to lesser vaccine acceptability and supply constraints.

Low vaccination coverage.

Introduction of UIP

1985

Strong political commitment to immunisation, extensive organisation for the delivery of immunisation service, weekly immunisation.

Improvement in vaccine acceptability. Overall coverage began to improve.

Introduction of polio eradication initiative

1995

Introduced as special event and additional vaccines in addition to routine. Polio eradication drive was well received by community. Active participation of civil society in its implementation. Doubts against oral polio vaccines raised by some from public health community.

Improved coverage for routine immunisation. Successful implementation of polio eradication drive.

Last case of polio reported in Kerala

2000

Widely reported in Kerala. This was seen as a failure of public health system.

No specific impact on immunisation programme.

Opposition of IPPI immunisation strategy by KGMOA

2002

The opposition coincided with the strike call by the association. The issues were widely discussed in the media. The association backtracked after the strike was resolved.

No immediate impact on vaccination coverage, however, first open debate in Kerala on any immunisation programme.

Organised opposition against from IPPI by various groups

2005 onwards

Opposition was mainly from homeopathy groups and some experts of naturopathy, also supported by some religious organisations. Motive of continuing IPPI was openly discussed from both a technical and conspiracy angle.

Immunisation coverage in northern districts showed a decline. Coverage is intact in southern districts.

Increased reporting of VPD cases in northern Kerala.

Death reported after school vaccination programme in a northern district

2006

Eruption of immediate public protest and violence against the local public health staff and facilities. Widespread anguish felt among public as the safety of vaccines were challenged.

Reported to have had an impact on vaccination coverage in northern districts.

Special school based Japanese encephalitis vaccination programme in Kerala

2008

Wider public debate, on the rationality and safety of vaccination programme. Media reports of vaccine side-effects impacted the programme. At the implementation level, difficulties in organising events in collaboration with schools.

Limited success in Japanese encephalitis vaccination programme.