Editorial 2: Vaccinating India

Context

A large number of zero-dose children are still found in poor families.

Introduction

Between 1980 and 2023, global vaccination coverage significantly improved, especially against diseases like measles, polio, and tuberculosis. A major success has been the global reduction in zero-dose children, a crucial indicator of health equity. However, despite progress, India still accounts for a large number of these children, highlighting persistent regional and socio-economic disparities in immunisation access.

Global and Indian Vaccination Trends (1980–2023)

Global Progress in Vaccination

• Between 1980 and 2023, global vaccine coverage doubled for six major diseases:
  measles, polio, tuberculosis, diphtheria, tetanus, and pertussis.
• Significant drop in zero-dose children (children not receiving the first dose of DTP vaccine).
  • Global zero-dose rate now at 75% reduction.
  • Zero-dose children are a key indicator of healthcare access and inequality.

Zero-Dose Children: Indian Scenario

• India ranks second globally in the number of zero-dose children (as per The Lancet).
• India is among the 8 countries that together account for over 50% of global zero-dose children (~16 million).
• India’s zero-dose percentage in 2023 = 6.2%, relatively lower due to its large birth cohort.

Key Factors Affecting Immunisation in India

Geographical Concentration: High number of zero-dose children in:

• • Large states: Uttar Pradesh, Bihar, Maharashtra, Rajasthan, Madhya Pradesh, Gujarat.
  • Northeast states: Meghalaya, Nagaland, Mizoram, Arunachal Pradesh.

•  Sociodemographic Disparities

• Location-Based Challenges
  • Hard-to-reach tribal areas
  • Urban slums with migrant populations
  • Areas with vaccine hesitancy, particularly among Muslim families

Meeting WHO’s IA2030 Target

• India must reduce zero-dose children to ~0.7 million by 2030.
• Requires sustained, targeted interventions in:
  • Low-performing states
  • Underserved communities
  • Awareness & trust-building programs

Conclusion

India has made commendable progress in reducing zero-dose children, yet the current figures reflect a need for targeted strategies. To meet the WHO’s Immunization Agenda 2030, India must focus on vulnerable regions, combat vaccine hesitancy, and improve health infrastructure. Sustained efforts are essential to achieve universal immunisation and ensure healthcare equity for every child, regardless of geography or background.