Immunisation in India

Number of children in India who were unvaccinated or missed their first dose of diphtheria-tetanus-pertussis (DTP) combined vaccine doubled. This was revealed by the official data published by the WHO and UNICEF.

Key Highlights –

• Decline in childhood vaccinations —
  • The data published by WHO and UNICEF recorded the largest sustained decline in childhood vaccinations in approximately 30 years.
  • The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) fell 5 percentage points between 2019 and 2021 to 81 per cent.
    • DTP acts a marker for immunisation coverage within and across countries.
  • As a result, 25 million children missed out on one or more doses of DTP through routine immunisation services in 2021 alone.
• Factors responsible for this decline —
  • The decline was due to many factors. This includes –
    • an increased number of children living in conflict and fragile settings where immunisation access is often challenging;
    • increased misinformation;
    • COVID-19 related issues such as service and supply chain disruptions, resource diversion to response efforts and containment measures that limited immunisation service access and availability.

India specific observations –

• Rise in the number of unvaccinated children —
  • The number of children in India who were unvaccinated or missed their first dose of diphtheria-tetanus-pertussis (DTP) combined vaccine doubled.
    • The number has increased from 1.4 million in 2019 to 2.7 million in 2021.
  • This is the first time ever that there has been a decline in evaluated coverage in immunisation for India as a whole.
• India was able to arrest the declining trend between 2020 and 2021 —
  • Though immunisation coverage continues to decline the world over, India was able to arrest the trend between 2020 and 2021.
  • The number of children with zero dose rose sharply to three million in 2020.
  • But a further backsliding was prevented and the number dropped to 2.7 million in 2021.
    • This was due to catchup programmes such as the third Intensified Mission Indradhanush (IMI).

Background –

• Immunisation Programme in India was introduced in 1978 as ‘Expanded Programme of Immunisation’ (EPI).
• In 1985, the programme was modified as ‘Universal Immunisation Programme’ (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90.
• Despite being operational for many years, UIP has been able to fully immunise only 65% children in the first year of their life.

Mission Indradhanush –

• Mission Indradhanush was launched in December 2014.
• The ultimate goal of Mission Indradhanush is to ensure full immunisation with all available vaccines for children up to two years of age and pregnant women.
• Earlier the increase in full immunisation coverage was 1% per year which has increased to 6.7% per year through the first two phases of Mission Indradhanush.
• Four phases of Mission Indradhanush was conducted till August 2017 and more than 2.53 crore children and 68 lakh pregnant women have been vaccinated.

Intensified Mission Indradhanush (IMI) –

• IMI was launched in October 2017 to further intensify the immunisation programme.
• The aim is to reach every child up to two years of age and all those pregnant women who have been left uncovered under the routine immunisation programme/UIP.
• The focus of special drive was to improve immunisation coverage in select districts and cities to ensure full immunisation to more than 90% by December 2018.
• In February 2022, Govt launched Intensified Mission Indradhanush (IMI) 4.0.
  • IMI 3.0 was launched in 2021 with a focus to cover all the children and pregnant women who had missed their vaccine doses during the Covid-19 pandemic.

Achievements –

• Till date, ten phases of Mission Indradhanush have been completed covering 701 districts across the country.
• As of April 2021, during the various phases of Mission Indradhanush, a total of 3.86 crore children and 96.8 lakh pregnant women have been vaccinated.
• The first two phases of Mission Indradhanush resulted in 6.7% increase in full immunisation coverage in a year.
• However, the recent survey shows 18.5% points increase in full immunisation coverage as compared to NFHS-4.
• Coverage increased from 43% during the National Family Health Survey (NFHS) -3 (2005-2006), to 62% in the NFHS-4 (2015 – 2016).
• In NFHS-5, more than three-fourths (77%) children age 12-23 months were fully immunised, compared with 62 percent in NFHS-4.