There have been some media reports stating that in comparison to other countries, India has a high number of ‘zero dose children’ – children who did not receive any vaccine, according to a recent UNICEF report. These reports depict an incomplete picture of the country’s immunization data, as they do not factor in the population base and immunization coverage of the countries compared.
The accurate and complete narrative of the Immunization efforts of the Government can be gauged through comprehensive understanding of the relative data and programmatic interventions.
Graph 1 shows in the blue line that percentage coverage for all antigens in India is higher than the global average. In India, for most of the antigens, the coverage is more than 90%, which is at par with other high-income countries e.g., New Zealand (DTP-1 93%), Germany & Finland (DPT-3 91%), Sweden (MCV-1 93%), Luxembourg (MCV-2 90%), Ireland (PCV-3 83%), United Kingdom of Great Britain and Northern Ireland (RotaC 90%).
Even if the India’s coverage of 83% is compared for Pneumococcal Conjugate Vaccine (PCV), which falls at the lowest bracket, it is much higher than the global figures of 65%.
Graph 1: Antigen wise comparison between India and Global coverage (%)
(WUENIC 2023)
The Graph 2 compares DTP-1 (Penta-1) & DTP-3 (Penta-3) coverage of India with other countries having high burden of zero dose and under-vaccinated children. The graph indicates that India with its large population has the highest number of vaccinated children. The target cohort of India is more than 3 times of the other nine countries compared in the graph. Among the compared countries, India is the only country having DTP-1 (Penta-1) coverage above 90% and dropout children i.e., those that receive a first but not the third dose of DTP (Penta), are 2%, whereas this gap is much wider in other compared countries. These figures are clearly reflective of focused programmatic interventions in the country within the folds of its wide socio-geographically diversity.
Graph 2: Comparison between India and other Countries with high number of zero dose children for DTP Containing Vaccine (%) (WUENIC 2023)
The Graph 3 shows that the number of zero dose children in India account for 0.11% of the country’s total population.
Graph 3: Zero dose children as a percentage of the total population
These statistics reflect the unwavering commitment of the Government to continuously increase the scope and reach of the immunization program of the nation. The country’s Universal Immunization Programme is the largest public health initiative, targeting a massive cohort of 2.6 crore children and 2.9 crore pregnant women annually through 1.2 crore vaccination sessions. The Full Immunization Coverage for FY 2023-24 stands at 93.23% nationally. With consistent efforts to reach and vaccinate all eligible children against vaccine preventable diseases, the country has been able to achieve a noteworthy reduction in the Under-5 Mortality Rate (U5MR) declining from 45 per 1000 live births in 2014 to 32 per 1000 live births (SRS 2020). In addition, India has widened the basket of vaccines with the introduction of six new vaccines under the UIP to increase breadth of protection since 2014.
To reach out to zero dose and under vaccinated children, India has implemented initiatives under Mission Indradhanush and Intensified Mission Indradhanush with the support of the States. This has resulted in the reduction in the number of zero dose children by 34% between 2014-2023. Since 2014, 12 phases of Mission Indradhanush have been conducted across all districts wherein 5.46 crore children and 1.32 crore pregnant women have been vaccinated across all phases.
India provides maximum number of WHO recommended vaccines under the UIP in comparison to most of the other countries. The mean coverage for India is 83.4%, which is more than 10 percentage point of the global coverage. With high level of coverage of OPV and IPV, India has successfully maintained 13 years of polio-free status since the last polio case was detected in 2011.
With 93% DTP-1 (Penta-1) vaccine 1st dose coverage and 93% Measles and Rubella vaccine 1st dose coverage, the drive in the country is to reduce zero-dose children and achieving Measles and Rubella elimination. In recognition of its tireless efforts to combat Measles and Rubella, India was bestowed with the prestigious Measles and Rubella Champion Award by The Measles and Rubella Partnership (American Red Cross, BMGF, GAVI, US CDC, UNF, UNICEF, and WHO) at the American Red Cross Headquarters in Washington DC, USA on March 6th, 2024.