Why in the News?

India has made significant progress in expanding vaccine coverage, with a dramatic drop in the percentage of zero-dose children from 33.4% in 1992 to 6.2% in 2023. But even though India is not affected by war or extreme poverty like some other countries, it still has the second-highest number of children without any vaccination in the world.

What are zero-dose children?

• Zero-dose children are those who have not received the first dose of the diphtheria, tetanus, and pertussis (DTP) vaccine.
• They are a crucial performance marker of a country’s immunisation system and indicate inequities in vaccine coverage.

Why are they important for assessing vaccination?

• Reflects health system coverage and equity: A high number of zero-dose children shows that vaccination programmes are not reaching all segments of the population. NFHS-5 (2019–21) Data also showed that full immunisation coverage among children aged 12–23 months was significantly lower in rural and tribal regions compared to urban areas (e.g., Nagaland: 57.8%, compared to Tamil Nadu: 89.8%).
• Indicates social and economic exclusion: The presence of zero-dose children highlights barriers like poverty, low maternal education, and marginalisation. Eg: Urban slums with high migrant populations tend to have more zero-dose children due to lack of awareness and access.
• Warns of vulnerability to disease outbreaks: Areas with many zero-dose children are more likely to face outbreaks of vaccine-preventable diseases. Eg: Measles outbreaks are more common in districts with poor immunisation coverage.

Why does India still have a high number of zero-dose children despite adequate resources?

• High birth rate increases absolute numbers: India has the highest number of annual births globally. In 2023, India had around 23 million births, making even a small percentage of zero-dose children translate into a large number.
• Geographical and logistical challenges: Remote tribal areas, urban slums, and migrant populations are harder to reach due to terrain, mobility, and poor infrastructure. E.g., children in parts of Meghalaya or urban Delhi, slums often miss vaccinations due to lack of access and follow-up.
• Socio-cultural barriers and vaccine hesitancy: Low maternal education, religious beliefs, and misinformation lead to vaccine hesitancy in certain communities. Eg: In some Muslim households or among Scheduled Tribes, distrust or misinformation about vaccines limits uptake.

How has India’s zero-dose child rate changed over time, especially post-COVID?

• Steady decline before the pandemic: Between 1992 and 2016, India reduced the percentage of zero-dose children from 33.4% to 10.1%, showing consistent improvement in immunisation outreach.
• Sharp rise during the COVID-19 pandemic: Disruptions in health services led to a surge in zero-dose children, increasing from 1.4 million in 2019 to 2.7 million in 2021, reversing years of progress.
• Partial recovery after the pandemic: The number dropped to 1.1 million in 2022 but rose again to 1.44 million in 2023, indicating ongoing challenges in sustaining immunisation coverage.

Where are zero-dose children mainly located in India?

• High-burden states in northern and central India: Large numbers of zero-dose children are concentrated in Uttar Pradesh, Bihar, Maharashtra, Rajasthan, Madhya Pradesh, and Gujarat, which have large populations and gaps in last-mile immunisation delivery.
• Northeastern and underserved regions: A relatively high proportion is also found in Meghalaya, Nagaland, Mizoram, and Arunachal Pradesh, where geographic inaccessibility, scattered populations, and weaker health infrastructure pose challenges.

What actions are needed for India to meet the WHO’s 2030 immunisation target?

• Expand and intensify targeted immunisation drives: Strengthen last-mile delivery through regular and focused vaccination campaigns in underserved regions. Eg: Mission Indradhanush and its intensified versions could increase immunisation coverage in low-performing districts.
• Strengthen community-level engagement and awareness: Promote behavioural change and reduce vaccine hesitancy through culturally tailored IEC (Information, Education, and Communication) activities. Eg: Janani Suraksha Yojana (JSY) encourages institutional deliveries and postnatal care, which can be used to ensure timely vaccination of newborns.
• Integrate immunisation with digital health monitoring systems: Use technology for real-time tracking of vaccine coverage and follow-up in high-birth and high-risk areas. Eg: eVIN (Electronic Vaccine Intelligence Network) monitors vaccine stocks and cold chain availability, improving efficiency and reducing wastage.

Conclusion: India’s immunisation journey shows a mixed reality, while the country is a global leader in vaccine development, it still struggles to ensure all its children receive basic immunisation. Closing this gap is important not just for public health but also for social fairness and overall development. The need is even more urgent because India has the highest number of newborns in the world. The Immunisation Agenda 2030 should be treated as a national priority.

Mains PYQ:

[UPSC 2022] How do vaccines work? What approaches were adopted by the Indian vaccine manufacturers to produce COVID-19 vaccines?

Linkage: It explicitly deals with “vaccines” and “Indian vaccine manufacturers”. While it focuses on COVID-19 vaccines, the discussion around vaccine functionality and production capacity is fundamentally linked to the broader challenge of “Vaccinating India” and reaching “zero-dose children” for various preventable diseases.

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