In a milestone that places India as a world leader in child health and immunisation, India has achieved a historic fall in the proportion of zero-dose children, children who have not received even a single dose of a vaccine. According to the recent statistics, the ratio of zero-dose children to the overall population has declined from 0.11 per cent in 2023 to 0.06 per cent in 2024, demonstrating the Government of India’s tireless efforts to augment its Universal Immunisation Programme (UIP) and leave no child behind.
The achievement has been globally acknowledged, with India’s remarkable progress recognised by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) 2024 report. India has also been awarded the high-profile Measles and Rubella Champion Award by the Measles and Rubella Partnership, which comprises international health behemoths such as the American Red Cross, WHO, UNICEF, and GAVI.
Historic Decline in Child Mortality
Aside from immunisation, India’s record in decreasing child and maternal mortality has attracted international acclaim. India has recorded a staggering 78 per cent decline in its Under-Five Mortality Rate (U5MR) from 1990 to 2023, significantly surpassing the 61 per cent global average decline, the UN IGME 2024 report states. India’s Neonatal Mortality Rate (NMR) has also decreased by 70 per cent between 1990 and 2023, against the world’s 54 per cent decline.
India’s improvement in maternal health is just as impressive. The Maternal Mortality Ratio (MMR) declined from 130 per lakh live births during 2014-16 to 88 per lakh live births during 2020-22, according to the latest Sample Registration System (SRS) data. The UN Maternal Mortality Estimation Inter-Agency Group (UN-MMEIG) report estimates India’s current MMR at 80 per lakh live births, representing an 86 per cent drop since 1990, well above the world’s 48 per cent decline.
Immunisation Network Protecting 2.6 Crore Babies Each Year
At the core of this outstanding turnaround is India’s large and broad Universal Immunisation Programme (UIP), which has expanded greatly over the last ten years. The UIP administers free vaccination services to around 2.9 crore pregnant women and 2.6 crore infants below the age of one year every year. This large-scale effort is backed by more than 1.3 crore immunisation sessions delivered by frontline health workers, such as ASHAs and ANMs, nationwide.
As of 2013, India’s UIP had just six vaccines. But since 2014, six more vaccines have been added, including Inactivated Polio-virus Vaccine (IPV), Rotavirus Vaccine (RVV), Pneumococcal Conjugate Vaccine (PCV), Measles-Rubella Vaccine, Adult Japanese Encephalitis Vaccine and Tetanus-Diphtheria Vaccine. The UIP now protects against 12 vaccine-preventable diseases, from tuberculosis to measles, rubella, hepatitis, and tetanus, making it one of the richest immunisation programs in the world.
Mission Indradhanush: Reaching the Unreached
Initiated in 2014 and accelerated in 2017, Mission Indradhanush has been a pillar of India’s immunisation achievement. The program has immunised 5.46 crore children and 1.32 crore pregnant women who were not previously covered or reached by immunisation programs, especially from far-flung, hard-to-reach, and disadvantaged areas.
The government’s focused strategy involves special campaigns for hard-to-reach, urban slums, migratory, and vaccine-hesitant communities. The new effort, the Zero Dose Implementation Plan 2024, is being implemented in 143 districts of 11 states that have been recognised as high-burden areas with a high number of unvaccinated children.
Supporting these initiatives, India has been polio-free since 2014 under National Immunisation Days (NIDs) and Sub-National Immunisation Days (SNIDs) under the legendary Pulse Polio Campaign.
Last-Mile Delivery and Technological Innovations
One of the standout aspects of India’s immunisation program is its last-mile delivery and technological approach to leaving no child behind. The U-WIN platform electronically monitors immunisation status, allowing real-time tracking and ensuring every child is covered.
Additionally, mass awareness campaigns by way of community radio, social media, mass media, and even street plays have been key to creating awareness among families about the advantages of vaccination. Door-to-door sensitisation by ASHAs and ANMs has also been helpful in breaking the vaccine hesitancy barrier.
Regularly, Village Health and Nutrition Days (VHNDs) are conducted to provide immunisation and other health interventions at the grassroots level, making them accessible even to the most isolated populations.
India Beats Global Averages in Immunisation Coverage
India’s success in immunisation is not a national achievement alone but an international benchmark. India’s antigen-wise immunisation coverage is higher than global averages in all antigens, the World Health Organisation’s WUENIC 2023 report states.
Particularly, India’s national immunisation coverage of major vaccines such as DTP-1 (Diphtheria, Tetanus, and Pertussis) and DTP-3 is among the highest in the world, even when benchmarked against high-income nations. For instance:
1) India’s coverage of DTP-1 is 93 per cent, which is the same as New Zealand and higher than Germany and Finland at 91 per cent.
2) The rate of drop from DTP-1 to DTP-3 has declined from 7 per cent in 2013 to a mere 2 per cent in 2023.
3) Measles vaccination coverage has increased from 83 per cent in 2013 to 93 per cent in 2023.
This is all the more significant given the large size and socio-geographical heterogeneity of India’s population. India gives over 2.6 crore infants a dose of vaccine each year, two or three times the combined population of nations such as New Zealand, Australia, Finland, and Switzerland.
India’s Global Standing in Meeting Zero-Dose Children
Zero-dose children, who have not yet received a single vaccine, are a critical focus of global child health. India’s current rate of zero-dose children, at a mere 0.06 per cent in 2024, is a record of unprecedented achievements.
By comparison, nations with high burden of zero-dose children per total population indicates that nations such as Yemen (1.68 per cent), Sudan (1.45 per cent), Angola (1.1 per cent), Afghanistan (1.1 per cent), Nigeria (0.98 per cent), DR Congo (0.82 per cent), Ethiopia (0.72 per cent), Indonesia (0.23 per cent), and Pakistan (0.16 per cent) have much higher rates of zero-dose children than India, which was as low as 0.11 per cent in 2023, based on the most recent WUENIC report.
India’s success is in stark contrast to such nations, especially when one takes into account the sheer size of the nation’s population and logistical hurdles.
Eradicating Lethal Diseases
India’s health success goes beyond immunisation. The nation eradicated polio in 2014 and tetanus among newborns and mothers in 2015. The recent introduction of the Measles-Rubella Elimination Campaign 2025 further attests to the fact that India wants to eradicate vaccine-preventable diseases and have every child healthy.
The effect of higher vaccine coverage is seen in a decline in child morbidity and mortality from illness such as diarrhoea, pneumonia, meningitis, and encephalitis. The government asserts that continued immunisation activism, together with strong health infrastructure and community support, is essential to protecting child health.
Challenges and Roadmap Ahead
Though the milestones have been met, there are still challenges like vaccine hesitancy, migrant populations, and difficult-to-reach areas. Yet the multi-layered approach of the government, state, district, and block-level task forces evokes synergy and fruitful implementation of vaccination campaigns.
Maintenance of Regular Information, Education, and Communication (IEC) campaigns is designed to counter misinformation and generate confidence in vaccines. Additionally, exploitation of technology through U-WIN and improved last-mile delivery mechanisms are at the core of the government’s plan.
A Global Exemplar in Child Health
India’s child health and immunisation success story is a reflection of the nation’s unflinching commitment to public health. Through far-reaching policy measures, ground-breaking technology, and the efforts of millions of healthcare providers, India has become a global exemplar in child health and immunisation coverage.
As the country moves forward in its vision to eradicate fatal diseases and provide universal immunisation, such success not only guarantees the future of India’s kids but also serves as an inspiring source of motivation to other nations waging a similar war against health issues.
The Ministry of Health and Family Welfare has reaffirmed that the government remains committed to keeping immunisation and last-mile healthcare delivery high on the agenda to create a healthier, stronger India for generations to come.
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