India’s Growing Vaccination Crisis

Context

A recent global study published in The Lancet has brought to light a critical public health concern in India: over 1.44 million children remain “zero-dose,” meaning they have not received even the first dose of the essential diphtheria, tetanus, and pertussis (DTP) vaccine in 2023. India ranks second globally after Nigeria in the number of such unvaccinated children, underscoring persistent immunisation inequities despite decades of progress.

What Does “Zero-Dose” Mean?

A “zero-dose” child is defined as a child who has not received any routine vaccinations, and has missed all vaccines such as DTP, which is a key measure of access to immunisation services. These children remain at risk from preventable and continue to face risks from preventable but potentially fatal illnesses, for example diphtheria, tetanus, pertussis, measles, polio, and tuberculosis.

Scale and Significance of the Problem

• Global: In 2022, there were about 15.7 million zero-dose children globally, with more than half of zero-dose children living in eight countries. With DTP coverage from 2019-2023, the eight countries include India, Nigeria, Democratic Republic of Congo, Ethiopia, Somalia, Sudan, Indonesia and Brazil.
• India: India is home to 1.44 million zero-dose children, the second largest share globally, and makes a substantial contribution to the global vaccination gap. 
• COVID-19: The COVID-19 pandemic disrupted routine immunisation services. Since 2020, vaccine coverage has seen a sharp decline and areas that previously recorded some loss of zero-dose children have all returned to record levels of zero-dose children. Prior to COVID-19, we estimated that there were an additional 12.8 million new zero-dose children in India between 2020 and 2023, a substantial number of which were estimated during the pandemic.

Causes Behind the Vaccination Gap in India

• Disadvantaged and Remote Communities: Zero-dose children are often from low income, rural, tribal and/or remote communities that lack the ability to access health services.
• Health Delivery System Deficiencies: Inadequate health delivery systems, lack of trained health staff, and issues related to vaccine supply chains inhibit coverage in certain areas.
• Vaccine Misinformation and Hesitancy: Growing vaccine misinformation, hesitancy and vaccine awareness inhibits immunisation efforts.
• Socio-political Variables: Displacement, social unrest, economic uncertainty, and adverse climate impacts may aggravate inequities in vaccine access.

Consequences of the Vaccination Gap

• Increased Disease Burden: Unvaccinated children are at high-risk of catching and transmitting vaccine preventable diseases. These children and young people carry a much heavier burden of morbidity and mortality.
• Threat to Public Health Targets: The lack of progress represents a threat both to India’s and the wider world’s ability to reach the immunisation 2030 targets set by WHO and other global health institutions.
• Expanding Health Inequities: Health inequities continue to persist and ultimately worsen as gaps in service delivery further impact defined groups that are already under-valued or marginalised and will therefore carry further impacts from the ongoing inequity

Government Initiatives and Challenges

India’s Universal Immunisation Programme (UIP) offers free vaccination against 12 diseases, yet gaps persist due to implementation challenges in reaching all children. The COVID-19 pandemic highlighted the fragility of routine immunisation services and the need for resilient health systems.

Conclusion

The Lancet study’s revelation of 1.44 million zero-dose children in India is a stark reminder that despite significant advances, large immunisation gaps remain. Urgent, focused, and equitable action is needed to ensure every child receives life-saving vaccines, protecting them from preventable diseases and contributing to India’s broader public health and development goals.

Source: The Hindu

UPSC Mains Practice Question

Q. Critically examine the causes behind declining immunisation rates in India and suggest policy measures to improve vaccine coverage, especially among vulnerable groups.

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