Modeling Possible Inclusion of Pneumococcal Conjugate Vaccine into the National Immunization Program for Infants in India

Background: India is home to up to 28 million infants born annually, and yet to a large extent these children do not benefit from the protection provided by a pneumococcal conjugate vaccine (PCV) immunization program. The Government of India, with support from Gavi, The Vaccine Alliance (in short, Gavi), has committed to a pilot implementation of PCV. There are few public health impact evaluations available for India, and equally limited epidemiologic data.

Objectives: To estimate the potential impact of an infant pneumococcal vaccination program in India.

Methods: Using a well-established pneumococcal disease impact model parameterized with local data to the extent possible, we calculated the potential impact of introducing an infant PCV program in India. The model considered direct vaccine protection by PCV10 or PCV13, focusing on children younger than 5 years, while varying vaccine uptake according to the implementation method (i.e., state-level programs [Gavi funding] or a government-supported national immunization program [NIP]).

Results: With state-level PCV13 programs comprising 25% uptake across the country, approximately 1.9 million cases of pneumococcal disease and approximately 77,000 deaths could be prevented annually. An NIP with PCV13 could prevent approximately 7.6 million cases of pneumococcal disease and approximately 0.3 million pneumococcal deaths annually, compared with no vaccination, considering 100% vaccine uptake. These results are likely to have underestimated the additional potential benefits of herd effects in unvaccinated children and adults.

Conclusions: Incorporation of PCV into an Indian vaccination program for infants is predicted to have a substantially positive health impact. Gavi funding of state-level programs is an important step toward achieving the full benefits of an NIP in India.