Vaccination programs are among the most effective public health interventions, significantly reducing child mortality and curbing the spread of infectious diseases. Vaccines work by stimulating the body’s immune system to build protection against pathogens, thereby lowering the risk of infection and severe illness. Immunization stands as a global health success story—according to the World Health Organization (WHO), vaccines prevent an estimated 3.5 to 5 million deaths annually from diseases such as diphtheria, tetanus, pertussis, influenza, and measles. Beyond individual protection, widespread vaccination fosters herd immunity, safeguarding vulnerable populations who cannot be vaccinated due to medical reasons. As a cornerstone of primary health care, immunization is not only a fundamental human right but also one of the most cost-effective health investments.

However, sustaining high vaccination coverage is critical to preventing disease resurgence and addressing emerging health threats. Despite these successes, recent funding cuts and rising vaccine skepticism threaten to undermine decades of progress. For instance, the United States has significantly reduced its aid programs, and the United Kingdom is considering similar funding reductions. These cuts could have far-reaching consequences, particularly for low-income regions that rely heavily on external support. Many global vaccination programs, including those supported by Gavi, the Vaccine Alliance—a public-private global health partnership aimed at increasing immunization access in low-income countries—are now facing significant funding shortfalls.

Developing countries, including India, rely heavily on financial support from organizations such as Gavi, the World Health Organization (WHO), and UNICEF for vaccine procurement and immunization campaigns. However, wealthy nations have reduced their contributions to global vaccination efforts. For example, the UK has cut aid to Gavi and the Global Polio Eradication Initiative (GPEI), which has directly impacted vaccine distribution in countries like India. Global economic challenges, including the post-COVID-19 slowdown, the Ukraine war, and rising inflation, have further strained foreign aid budgets. As a result, more funds are being diverted toward pandemic preparedness rather than routine immunization.

Low-income countries often face significant hurdles in vaccine procurement and distribution. India, in particular, has a dual role: protecting its own population while serving as a global vaccine supplier. India is a global leader in vaccine production, home to major manufacturers like the Serum Institute of India and Bharat Biotech. The country also runs one of the world’s largest immunization programs, Mission Indradhanush, which covers millions of children and pregnant women. However, funding constraints may hinder its expansion. Although India’s National Health Policy 2017 aims to increase public health spending to 2.5% of GDP by 2025, the 2024-25 budget allocated only about 2.1% of GDP to health, which is lower than many other countries.

India’s role as a global vaccine hub is undeniable, but the pace of new vaccine development is slow due to limited research and development (R&D) funding. Challenges such as funding shortages, vaccine hesitancy, and logistical issues could impede disease control efforts. Reduced global funding affects India’s ability to procure vaccines for diseases like polio and measles, especially in remote regions. Developing a new vaccine is a costly endeavor, ranging from 100 million to 500 million per vaccine, and India’s current funding for vaccine R&D is insufficient. This lack of funding translates to fewer vaccine outreach programs and delays in the rollout of new vaccines, such as those for HPV (to prevent cervical cancer), dengue, and tuberculosis (TB).

The Global Polio Eradication Initiative (GPEI) has also faced funding reductions, impacting India’s polio surveillance efforts. Additionally, India is grappling with rising cases of dengue and malaria, exacerbated by climate change. While Dengvaxia, a dengue vaccine, exists, its use is limited. Emerging threats, such as the mpox (monkeypox) outbreak, further underscore the need for robust vaccination campaigns. Although India has reported low mpox cases, ongoing surveillance is critical given the global spread of the disease.

The high cost of vaccines often results in lower coverage among low-income populations, increasing the risk of outbreaks for diseases such as measles, rubella, and diphtheria. This raises a critical question: Can India sustain its global vaccine supply amidst funding cuts and geopolitical challenges?

To address these challenges, several strategies can be considered. Private companies like the Serum Institute of India and Bharat Biotech may require government subsidies to scale up vaccine production. Long-term funding agreements with organizations such as WHO, Gavi, and UNICEF could ensure vaccine affordability. Additionally, tapping into corporate social responsibility (CSR) funding from Indian pharmaceutical giants could provide a sustainable financial model. For example, Gavi’s partnership with African nations to ensure polio vaccine affordability could serve as a blueprint for India’s efforts to combat measles and HPV.

Improving cold chain logistics is another critical area. India’s “eVIN” (Electronic Vaccine Intelligence Network) has already enhanced vaccine tracking and cold storage in rural areas, but further investments are needed. Introducing new vaccines into national programs, such as government-funded HPV and dengue vaccines, could help eliminate these diseases.

While India faces significant challenges in sustaining its vaccination programs, strategic investments, international collaborations, and innovative funding mechanisms can help mitigate the impact of global aid cuts. By addressing these issues, India can continue to protect its population and maintain its vital role as a global vaccine supplier.

Author’s biography

Akhter Rasool is a veterinarian and researcher.

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The critical care environment has undergone significant alterations in the past several years. This has happened because our lifestyles in the fast-paced lives of modern India are ensuring that most people, in the age group of 30-50 years are falling prey to life-threatening cardiac diseases and strokes, in addition to diabetes, hypertension, cancers, liver, kidney and lung diseases – these diseases being called Non-Communicable Diseases or NCDs. They are now responsible for killing more than 65% of our population says Dr Arvind Lal, known for his diagnostic labs across the country.

Flagging concerns on such trends, these patients need high-cost intensive care, be it for complications of heart attacks, strokes, diabetes, hypertension, cancer or lung diseases. This is where the importance of Point-of-care testing (POCT) comes in. It helps in almost diagnosing the patient instantly and improves the physician’s ability to take immediate corrective action and decreases hospital stay. One such test is Troponin – that has revolutionized cardiac care by diagnosing heart attacks or myocardial infarction.

This article is based on the keynote address on the occasion of 2nd Annual International InnoHEALTH Conference 2017 – ‘Transforming Healthcare Through Innovation’ in New Delhi, said there are numerous promising diagnostic technologies. The key message is that in a country where 70% of the population lives in rural surroundings, ‘it is our duty to rapidly adopt disruptive innovative affordable technologies including telemedicine. Thus, our underserved population would be able to avail of the best treatment possible and bring in massive visible change’. He said the importance of bringing quality healthcare needs no reminder and the time has come for India to change the direction of healthcare for the masses.

Healthcare is a right – and access to good healthcare should not depend on where one lives and how much he or she earns. But sadly, that is exactly what plagues India’s healthcare today, he lamented. India faces a severe shortage of both hard infrastructure and talent. With about one doctor and one functional bed per 1000 population, healthcare is truly underserved in India. Add to this the regional imbalances and variations in healthcare delivery. The healthcare infrastructure is skewed towards urban over rural India.

Although rural India accounts for about 70% of the population, it has less than one-third of the nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across urban and rural India. British Medical Journal (BMJ) has observed that there is a remarkable saving of lives in India if good healthcare facilities consisting of operation theatres, surgeons, anaesthetists, blood banks are available within 50 kilometres of the patient providing quality medical services within the ‘golden hour’.

Though there has been a sea change in the last five decades, India now needs to reinvent the field of diagnostics as laboratory tests are responsible for 70% of all clinical or medical decisions.

In today’s life where internet rules the roost, the patients have become very knowledgeable, thanks to the globalisation of healthcare, and are demanding very high-quality healthcare for themselves. They are insisting on a very wholesome and satisfying experience rather than being told that the ‘treatment is over’.

Soon, a time will come when the tests shall be ordered by the patients based on clinical history and clinical findings that shall be answered by an Artificial Intelligence (AI) application. Artificial intelligence has already found several areas in healthcare from the design of treatment plans to assist in repetitive jobs to medication management and drug designing. The most obvious application of artificial intelligence in healthcare is data management. Collecting it, storing it, normalizing it, tracing its lineage – it may well be the first step in revolutionizing the existing healthcare systems.

Recently, the AI research branch of the search giant, Google, launched its Google Deepmind Health project, which is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present, they are working with Moorfields Eye Hospital of NHS Foundation Trust, UK to improve eye treatment.

Just a few years ago the patient after giving the sample used to come back in the evening to the lab to collect a physical copy of the test report. This was replaced by making the report available on the internet that could be downloaded by the patient in the comfort of his home. These days this has been further replaced by making available an App on his mobile phone wherein he can book an appointment for the sample to be collected at home and the report being later available on the same mobile App.

‘IBM Watson, whose headquarters I had the privilege of visiting a few months back in the Silicon Valley, is an AI-based engine that has launched its special program for oncologists to provide clinicians evidence-based treatment options. The program has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports in its encyclopedic memory that may be critical to selecting a treatment pathway’. IBM launched another algorithm called Medical Sieve. It is an ambitious long-term exploratory project to build a next-generation ‘cognitive health assistant’ that is able to analyze radiology images to spot and detect abnormalities faster and more reliably. This shall help radiologists in the future to look at the most complicated cases where human supervision is essential.

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The lab-on-a-chip (LOC) is another device that integrates one or several laboratory functions on a single integrated circuit (commonly called a “chip”) of only a few square centimetres to achieve automation and high throughput screening. Imagine that a patient comes to one of our 2,100 collection centres in the remote tier three or tier four towns in India with the high fever. We take a drop of blood from his finger and inform the clinician almost immediately that the patient is suffering from Chikungunya and not from Malaria or Typhoid, or Dengue fever or Japanese Encephalitis – all in a matter of minutes! The driving notion behind POCT is to bring the test conveniently and immediately to the patient. Needless to add, the patient’s data by POCT shall be made available to update the patient’s electronic health records (EHR).

Talking about POCT Instruments: Currently, two broad type of POCT instruments are available: Small benchtop analyzers (for example, blood gas and electrolyte systems) and handheld, single-use devices (such as urine albumin, blood glucose, and coagulation tests). Now let us talk about if POCT is Boon or Bane? The strong point of POCT is speed and the rapidity with which it shall save lives in emergencies. As India marches towards quality healthcare delivery, in course of time regulatory compliances shall have to be adhered to in the interest of the patient’s health.

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