One Vial, One Life: The Simple Change That Could Revolutionise India's Immunisation Drive
By Dr Paritosh Baghel
India’s cardiac story reads like a tech upgrade,until you zoom out: uneven access beyond cities and missing fundamentals of water, air and food safety.
A recent JIPMER-led study found that administering the BCG vaccine (Danish strain) along with oral polio vaccine (OPV) within the first 48 hours of life to low-birth-weight newborns (under 2,000 grams) reduced overall neonatal mortality by 17% and deaths due to infections by nearly half.
India has achieved remarkable progress in child health over recent decades, but neonatal deaths are something to worry about.
Dr Paritosh Baghel, Senior Consultant Physician, SL Raheja Hospital – A Fortis Associate, Mumbai
The national BCG immunisation schedule in India recommends giving the BCG vaccine at birth or as early as possible until one year of age, with an intradermal dose of 0.05 mL for infants up to 1 month and 0.1 ml for older children. It is administered primarily on the left upper arm, usually alongside oral polio vaccine (OPV-0) and hepatitis B birth doses. This early administration aims to protect newborns against severe tuberculosis forms like tuberculous meningitis and disseminated TB. Even if vaccination at birth is missed, BCG can be given any time up to 1 year of age to protect against tuberculosis.
Statistics show that nearly 75% of neonatal deaths occur in the first week of life. That's also when vaccination with such protectants as Bacille Calmette-Guérin (BCG), preventing Tuberculosis (TB), would ideally occur. However, in large areas of India and other countries suffering from TB, only around 37–52% of newborn infants get this vaccination in that first week as data varies in each state. States such as Bihar, Uttar Pradesh, Madhya Pradesh, and parts of Maharashtra and the Northeast have rates around or below the national average, typically ranging from 40–55% for BCG within one week.
An incredibly simple though neglected reason is one fundamental cause of such delay: how vaccines are bulked and transported. The BCG vaccine is most often provided in multi-dose vials containing enough doses to immunise 10-20 babies. Once opened, it must be used in hours or all doses after it are lost. For one who works in semi-urban or rural India, this is a dilemma. If one newborn moves to one health centre, the worker will typically wait for some other babies to arrive so that one vial would be used efficiently. One child who needs immediate coverage must therefore wait at times for several number of weeks until enough others have had their shots so that opening the vial would pay economically. That system, by limiting wastage, actually denies the most vulnerable prompt vaccination.
That philosophy of “One Vial, One Life” is built upon these principles. Instead of bulk packaging vaccine doses, single-dose vials or pre-filled syringes will be supplied so that every child benefits from life-saving vaccination, precisely when needed. There will be no wait and no delay that would result in loss of lives. This appears to be a small change, but it would redefine India's immunization campaign.
Packaging in single doses also decreases the risks of contamination that are larger if multi-dose vials are reused once opened. Storage, transportation, and delivery get simplified through it, particularly in resource limited settings where infrastructure and staff are not ample. For families, it brings relief that their newborns will get ensured safety earlier than would otherwise happen without unnecessary delay. Of course, this change will create some issues.
Single-dose vials will make production costly and require modifications in supply chain logistics. India's own vaccine program is one among the largest in the world, and scaling single-dose vials would require planning. Yet benefits from fewer lost opportunities for vaccination to less dying in the first week of life to greater confidence in the system of health care far outweigh these issues. Experts believe that easing such practical controls would help India reach greater immunisation coverage and prevent preventable child deaths.
Policy makers, producers, and health groups must synchronise efforts to facilitate wider access to the vaccine in the simplest form possible. At last, “One Vial, One Life” isn’t about packaging, it’s about not getting any child exposed to harm through system failures. It teaches that sometimes the best revolutions in public health are not through advanced technology but simple, human-centred ideas that place lives before logistics.
Author: Dr Paritosh Baghel is a Senior Consultant Physician at SL Raheja Hospital – A Fortis Associate, Mumbai
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