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The rise in unvaccinated children in India

  • Published
    16th Jul, 2022

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


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.


  • 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.
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