Vaccinating India: On zero-dose children

The vaccine coverage globally, between 1980 and 2023, doubled for six diseases, including measles, polio and tuberculosis. Further, at 75% globally, there has been a sharp fall in the number of zero-dose children. However, according to The Lancet report, India still had the second largest number of zero-dose children, and is among the eight countries with over 50% of the nearly 16 million zero-dose children globally.

India’s vaccination landscape:

• Zero-dose children in India: Despite increased immunisation coverage over the decades, in 2023 India had 1.44 million zero-dose children. These are those who have not received even the first dose of the diphtheria, tetanus, and pertussis (DTP) vaccine.
• Linkages to high birth rates: Most of the zero-dose children globally are in countries that are conflict-affected or with limited resources for vaccination programmes; however, India has neither of these two problems, and zero-dose children can be linked to the prevalence of high birth rates.
• Impact of COVID-19 on vaccination: Before the COVID-19 pandemic, the number of zero-dose children was 1.4 million in 2019; however, this swelled to 2.7 million in 2021 and then dropped to 1.1 million in 2022 before increasing to 1.44 million in 2023.

Regional and demographic challenges:

• Geographic distribution: As in the 2021 study, a large percentage of zero-dose children are in Uttar Pradesh, Bihar, Maharashtra, Rajasthan, Madhya Pradesh, and Gujarat. There is also a relatively high proportion of them in Meghalaya, Nagaland, Mizoram and Arunachal Pradesh.
• Socio-demographic disparities: Over the years, the difference in zero-dose children based on gender, caste, and rural-urban status has reduced substantially. However, prevalence remains high among the poor, mothers with low education, Scheduled Tribes and Muslims.
• Barriers to immunisation: Vaccine hesitancy among Muslim households with newborn children and challenges in reaching migrants create barriers to access to immunisation.

Policy and future directions:

• India’s immunisation efforts: A study in 2021 found that India had sharply reduced the percentage of zero-dose children, from 33.4% in 1992 to 10.1% in 2016.
• Aligning with global goals: India has much work to do to align with the WHO’s Immunisation Agenda 2030 (IA2030) for halving zero-dose children.
• Strategies for Improvement: Focus is needed to immunise children in hard-to-reach tribal areas, urban slums where there is a huge migrant population, and in reducing vaccine hesitancy among Muslim households with newborn children.

Practice Question:

Q. Despite significant global progress in vaccination coverage, India continues to face challenges with a high number of zero-dose children. Analyse the factors contributing to the issue and evaluate the effectiveness of India's immunisation programs.