If you are a medical doctor or a health professional, you may want to skip the long write up below. For you and other readers, I have a pleasant news to share.

According to a very recent survey, of the States in India which scored very high in their performance in Adverse Events Following Immunization (AEFI) management for the year 2019-20, Bihar and Uttar Pradesh scored very high. Bihar was excellent with a score above 80% and UP close to 80%.

When I had begun Public health practice in India not so long back, we were taught an acronym. I found the acronym almost obnoxious, but it was a reality then. BIMARU, the Hindi of “sick”, States. It talked of Bihar (BI), Madhya Pradesh (MP), Rajasthan (R) and Uttar Pradesh (UP). The four BIMARU states of India with lowest public health indicators.

Today these States are marching rapidly and are nearing close to States that have traditionally been advanced in public health. And it is not happening by magic or divine blessings. It is happening because of the hard work, meticulous planning, dedication and determination demonstrated by health workers, physicians and public health managers in the State. To ensure that the State’s population receive the best of health care.

BIMARU in 2020, my foot!!


Vaccines are precious commodities given primarily to precious people: children and mothers. With a hope and trust that in long run vaccines will protect them from infectious diseases. Infectious diseases that have the chance to kill and handicap healthy life.

Vaccines are given to precious human and animal lives. Therefore, they must themselves not cause harm to the body. They must have the highest standards of safety. While science and technology may not guarantee a full proof protection from an infectious disease after a vaccine against it is administered, it must ensure that no harm comes to these precious lives after the administration of the vaccine.

How effectively the vaccine will work in human body will depend on multiple factors. The four most important factors being the nutritional status of the recipient. The status of sanitation and hygiene. Any underlying disease condition that affects the immunity of the recipient. And finally, the condition of the particular vaccine administered.

Vaccines are generally very safe. Every vaccine passes through a rigorous phase of multiple clinical trials in animals and human body to understand human body’s reactions, response to the vaccine. How well does the body tolerate a vaccine administered externally to internal human systems? The results of these trials are meticulously studied by regulatory bodies at global and national levels before they are scientifically approved for use in human body.

But yes. Vaccines are biological and chemical agents. Developed to elicit a response in human body. They must provoke the body’s immune system and the agents that protect the body naturally to effectively fight and overcome any harmful infectious agent from outside. And they are administered by humans, health workers. Therefore, there are chances of errors in administration and chances that the external agent is not well tolerated by a particular body system. Therefore, at times, after a vaccine administration there are reactions within a normal human body that are averse to the normal human body system. These reactions manifest commonly in mild forms: mild fever of short duration; headache; swelling at injection site. In very (very) rare cases, serious events happen. Shock and if not managed effectively, death. Rare, very rare. Chances of severe reactions leading to major events like shock and death are so rare that they are almost negligible. For example, it may be expected that only 1 in 1 million (10 lakh) children administered with Measles vaccine will develop any adverse event according to WHO’s statistics. https://vaccine-safety-training.org/rates-of-adverse-vaccine-reactions.html

But every life, even a single life in the 26 million lives born in India every year is precious. And must be protected by every means at science’s disposal to predict and protect the rarest of rarest adverse event that may happen to a life following vaccine administration.

And what does this protection from adverse events following immunization (AEFI) mean? It means four things. To be carried out by trained medical professionals. Health workers, doctors, nurses, medical administrators. 1) every AEFI case must be identified early by trained eyes. 2) every case must be immediately managed following standard procedures. 3) every case based on its severity must be reported to the designated authority. And finally, 4) every case must be investigated thoroughly to find any association with the vaccine administered to the body. Based on the result of this investigation, countries will decide whether to continue with the use of the vaccine in its land for its people.

A strong AEFI management system is critical and essential component of an immunization program of a country.

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