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28 A Comparative Analysis of National Immunization Schedules: Evaluating Strategies, Antigen Selection, and Public Health Priorities in Kyrgyzstan vs. India
Abzhaparova Aiganysh
Kesavan kalaivani,
Shaoul hamid shahana firdouz,
Aarifa abdul kadar shaikh,
Raghuraman Oviya
(1, Teacher., International Medical Faculty , Osh State University , Osh, Kyrgyzstan)
2,3,4,5 Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
Abstract
Vaccination remains one of the most effective public health interventions worldwide. However, immunization schedules vary significantly across nations due to differing epidemiological patterns, healthcare infrastructure, and policy priorities. This study provides a comparative analysis of the national immunization schedules of Kyrgyzstan and India, focusing on vaccine coverage, antigen selection, implementation strategies, and public health outcomes. The analysis examines how each country’s immunization strategy reflects its disease burden, demographic structure, and health system capacity. Data were collected from official health ministry documents, WHO/UNICEF immunization coverage estimates, and peer-reviewed sources. Findings reveal that while both countries follow WHO-recommended Expanded Programme on Immunization (EPI) frameworks, India demonstrates broader antigen inclusion (e.g., rotavirus, pneumococcal, HPV vaccines) and larger programmatic scope due to its diverse epidemiology and population size. Kyrgyzstan’s schedule emphasizes sustainability, integration with primary care, and high coverage with a smaller antigen set. The comparative evaluation highlights the influence of socioeconomic and epidemiological contexts on vaccine prioritization, offering lessons for optimizing immunization strategies in both developing and transitional health systems.
Keywords:
National Immunization Schedule, Kyrgyzstan, India, Vaccination Policy, Expanded Programme on Immunization (EPI), Antigen Coverage, Public Health Priorities, Vaccine Strategy.
Introduction
Immunization has been a cornerstone of preventive healthcare, reducing morbidity and mortality from vaccine-preventable diseases. The World Health Organization (WHO) established the Expanded Programme on Immunization (EPI) in 1974, prompting countries to develop tailored national immunization schedules.
Both Kyrgyzstan (a Central Asian lower-middle-income country) and India (a South Asian lower-middle-income country) have adopted EPI but implemented it differently. Variations arise due to differences in disease epidemiology, health infrastructure, resource availability, and policy focus.
• Kyrgyzstan’s immunization program, integrated into its primary health care system, focuses on maintaining high coverage rates for basic vaccines, such as BCG, DTP, Polio, Hepatitis B, Hib, MMR, and influenza.
• India’s Universal Immunization Programme (UIP), one of the largest globally, has expanded to include additional vaccines like rotavirus, pneumococcal conjugate vaccine (PCV), and HPV in selected regions.
A comparative analysis between these two nations provides valuable insights into how immunization schedules evolve in different socioeconomic and epidemiological contexts, and how global recommendations are adapted nationally.
Objectives
General Objective
To compare and evaluate the national immunization schedules of Kyrgyzstan and India in terms of antigen selection, vaccination strategies, and public health priorities.
Specific Objectives
1. To identify the similarities and differences in the national immunization schedules of Kyrgyzstan and India.
2. To analyze the factors influencing antigen selection and scheduling in both countries.
3. To assess the coverage rates and performance indicators of immunization programs.
4. To evaluate the integration of immunization programs within the broader health systems.
5. To discuss policy implications and recommend strategies for optimizing vaccine coverage and sustainability.
Methods
Study Design
A comparative, descriptive, and analytical study based on secondary data sources.
Data Sources
• Official Ministry of Health publications (Kyrgyz Republic and Government of India).
• WHO/UNICEF Joint Reporting Forms and Global Vaccine Action Plan (GVAP) reports.
• Peer-reviewed journal articles and public health databases (PubMed, WHO Immunization Data Portal).
• National Demographic and Health Surveys (DHS).
Data Collection
Data were extracted on:
• National immunization schedules (antigen list, timing, booster doses).
• Coverage rates and dropout rates.
• Vaccine introduction timeline.
• Cold chain and logistics strategies.
• National immunization policies and budget allocations.
Data Analysis
Comparative analysis was performed under the following domains:
• Program structure and governance
• Antigen composition and scheduling
• Coverage and equity indicators
• Public health outcomes and challenges
Findings were organized in tables and charts to illustrate differences in schedules, timelines, and coverage.
Strategies and priorities
Kyrgyzstan:
Priority: Maintain high coverage rates and address vaccine hesitancy.
Strategy: Health systems strengthening, community engagement, and targeted outreach to high-risk groups to build trust in vaccines.
India:
Priority: Achieve and maintain high coverage for a large population, and address nutritional deficiencies through vaccine delivery.
Strategy: A universal immunization program leveraging a vast network of community health workers (ASHAs and ANMs) to administer vaccines and supplements across the country.
Results
1. Antigen Selection
• Kyrgyzstan’s Schedule: Includes BCG, OPV/IPV, DTP-HepB-Hib (Pentavalent), PCV, Rotavirus, and MMR.
• India’s Schedule: Includes BCG, OPV/IPV, Pentavalent, Rotavirus, PCV, MR, JE (in endemic states), HPV (in pilot states), and Td/TT boosters.
India’s broader antigen inclusion reflects a larger disease burden and population heterogeneity.
2. Coverage Rates
• Kyrgyzstan: DTP3 coverage ≈ 95–97%; MMR coverage ≈ 94–96%.
• India: DTP3 coverage ≈ 90–92%; MMR/MR coverage ≈ 89–91%.
Kyrgyzstan achieves more uniform coverage due to smaller geography and centralized health systems, while India faces challenges of regional disparity.
3. Implementation Strategies
• Kyrgyzstan integrates immunization through family medicine centers, with strong WHO support.
• India relies on Anganwadi workers, Accredited Social Health Activists (ASHAs), and large-scale campaigns such as Mission Indradhanush for outreach.
4. Vaccine Logistics and Cold Chain
• Kyrgyzstan: Managed under EPI with WHO-supplied cold chain equipment.
• India: Expanded cold chain network with over 30,000 cold storage points and electronic Vaccine Intelligence Network (eVIN) for monitoring.
5. Public Health Outcomes
• Both countries show decline in vaccine-preventable diseases:
• Kyrgyzstan eliminated polio and controlled diphtheria outbreaks.
• India eradicated polio (2014) and significantly reduced neonatal tetanus and measles cases.
Discussion
The findings highlight how national priorities, economic resources, and healthcare infrastructure influence immunization strategies.
Kyrgyzstan demonstrates success in maintaining high coverage through an efficient, centralized, and donor-supported program. However, it is limited in introducing newer vaccines due to financial constraints.
India, with its vast and diverse population, prioritizes expansion and inclusion of new vaccines, but faces challenges in ensuring equitable coverage, especially in rural and underserved regions.
The analysis also underscores the role of global partnerships (Gavi, WHO, UNICEF) in supporting low- and middle-income countries. In Kyrgyzstan, external support sustains the program; in India, domestic manufacturing capacity and policy initiatives drive expansion.
Policy Implications:
• Kyrgyzstan could explore phased introduction of newer vaccines (e.g., HPV) through Gavi support.
• India should continue strengthening last-mile delivery, surveillance, and digital tracking systems.
• Both countries can benefit from sharing experiences in community engagement, cold chain management, and vaccine confidence-building.
References
1. World Health Organization. WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), 2024.
2. Ministry of Health of the Kyrgyz Republic. National Immunization Programme Report, 2023.
3. Ministry of Health and Family Welfare, Government of India. Universal Immunization Programme: National Immunization Schedule, 2024.
4. Gavi, the Vaccine Alliance. Country Profiles: Kyrgyzstan and India.
5. UNICEF Data Portal. Immunization Coverage Statistics.
6. Lahariya C. (2021). “Strengthening India’s Immunization Program: Lessons from UIP Expansion.” Indian Journal of Public Health.
7. WHO Regional Office for Europe. Kyrgyzstan Immunization Review Report, 2023.
8. World Bank. Immunization Financing and Health System Strengthening in Central Asia, 2022.
9. WHO. Global Vaccine Action Plan 2011–2020: Review and Recommendations.
10. International Vaccine Access Center (IVAC). Vaccine Introduction Status Reports for Asia, 2023.
