The rise in unvaccinated children in India

Published
16th Jul, 2022

Context

The number of children who were unvaccinated or missed the first dose of the diphtheria-tetanus-pertussis vaccine doubled due to the pandemic, UNICEF.

About

Key-highlights of the observation

Observation in the official data published by the WHO and UNICEF:

Pandemic effect: Due to the pandemic, the number of children who were unvaccinated or missed their first dose of the diphtheria-tetanus-pertussis (DTP) combined vaccine has doubled.
- India was hit particularly hard as it had the highest number of such unprotected children at nearly 3.5 million, an increase of 1.4 million from 2019.
This is the largest sustained decline in childhood vaccinations in approximately 30 years.
Zero dose children: For the first time there has been a decline in evaluated coverage in immunisation for India as a whole due increase in zero doses, or those who missed their first diphtheria-tetanus-pertussis, between 2019 and 2021.
More than 3 million of these 'zero-dose children' in 2020 lived in India.
Measles too remains a concern, as well as outbreaks of diseases like diphtheria which can spread quickly where people are unvaccinated.

Positives: A further backsliding was prevented and the number dropped to 2.7 million in 2021 due to catchup programmes such as the third Intensified Mission Indradhanush (IMI).

Immunization Programs in India:

Universal Immunization Programme:

The Immunization Programme in India was introduced in 1978 as ‘The Expanded Programme of Immunization (EPI) by the Ministry of Health and Family Welfare.’
In 1985, the Programme was modified as the ‘Universal Immunization Programme (UIP)’. UIP prevents mortality and morbidity in children and pregnant women against 12 vaccine-preventable diseases.

Vaccines against preventable disease

Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases:

Nationally against 9 diseases - Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B
Sub-nationally against 3 diseases - Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis; of which Rotavirus vaccine and Pneumococcal Conjugate vaccine are in process of expansion while JE vaccine is provided only in endemic districts.

Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close to 2.67 crore newborns and 2.9 crore pregnant women annually.
It is one of the most cost-effective public health interventions and is largely responsible for the reduction of vaccine-preventable under-5 mortality rate.
To accelerate the coverage, Mission Indradhanush was envisaged and implemented in 2015 to rapidly increase the full immunization coverage to 90%.

New vaccines

Inactivated Polio Vaccine (IPV): IPV has been introduced in UIP as part of Global Polio end-game strategy, to mitigate the risk associated with tOPV to bOPV switch.
Rotavirus vaccine (RVV): RVV has been introduced to reduce mortality and morbidity caused by Rotavirus diarrhoea in March 2016.
Measles Rubella (MR) vaccine: India is committed to the goal of measles elimination and rubella control and to achieve the goal MR vaccine was introduced in the country through a campaign mode in a phased manner in 2017.
Pneumococcal Conjugate Vaccine (PCV): PCV has been launched in May 2017 for reducing Infant mortality and morbidity caused by pneumococcal pneumonia.
Tetanus and adult diphtheria (Td) vaccine: TT vaccine has been replaced with Td vaccine in UIP to limit the waning immunity against diphtheria in older age groups.

Intensified Mission Indradhanush 4.0:

The aim is to fully immunize children who were either unvaccinated or partially vaccinated under UIP.
It will ensure that Routine Immunization (RI) services reach unvaccinated and partially vaccinated children and pregnant women. Children up to two years will be covered in this drive.
Until the pandemic, India steadily improved immunization coverage from 43% during the National Family Health Survey (NFHS) -3 (2005-2006), to 62% in the (NFHS) -4 between 2015 and 2016 and the (NFHS)-5 between 2019 and 2021.
IMI 4.0 will immensely contribute to filling the gaps and making lasting gains toward universal immunisation.

Concerns:

This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunisation in a generation.
The fall in immunisation coverage is worrying as it is being accompanied by a rapidly rising rate of severe acute malnutrition due to a fall in income levels during the pandemic.
A malnourished child already has weakened immunity and missed vaccinations make him vulnerable to common childhood illnesses.