Immunisation in India- Explained Pointwise

Immunisation has been one of the greatest triumphs in public health in India. Immunisation has helped in the eradication of diseases like smallpox and polio in India, by drastically reducing their devastating impact. Despite these successes in immunisation, the persistence of gaps in vaccination coverage poses future health and economic challenges.

What is immunisation? What is the status of immunisation in India?

Immunisation is a process by which a person becomes protected against a disease through vaccination. This term is often used interchangeably with vaccination or inoculation.

Increased Coverage- According to the National Family Health Survey (NFHS-5, 2019–2021) over 76% of children aged 12–23 months were fully immunized. This has increased from 62% in NFHS-4 (2015–2016).

Polio and Smallpox Eradication- Polio and smallpox have been eradicated by the successful implementation of the immunisation programme.

COVID-19 Vaccination/Immunisation Drive- India conducted one of the world’s largest COVID-19 vaccination drives, administering over 2 billion doses by 2023.

India’s immunisation programmes

What are the advantages of immunisation in India?

1. Protection from Life-threatening Diseases- Immunization prevents deadly diseases such as polio, measles, diphtheria, tetanus, hepatitis B, and rotavirus diarrhea. For Ex- The eradication of smallpox in 1977 and polio in 2014 in India are landmark achievements of vaccination campaigns.

2. Reduction of infant mortality- Immunization is one of the most cost-effective ways to protect children’s lives and significantly reduce the number of deaths from vaccine-preventable diseases in children under five.

3. Cost-Effectiveness- Preventing diseases through vaccines is far less expensive than treating them. For ex-The Rotavirus vaccine, introduced in India, prevents severe diarrhea in children, which otherwise leads to costly hospitalizations and loss of productivity for families.

4. Promotion of Herd Immunity- When a large portion of the population is vaccinated, the spread of infectious diseases slows down. This helps in the protection of unvaccinated population.

5. Economic and Social Benefits- Healthier populations contribute more to economic growth and reduce the financial strain on families. For Ex- India’s Mission Indradhanush, targeting of unvaccinated children, has improved productivity by reducing the long-term health impacts of diseases.

6. Control of Emerging Diseases- Immunization is a key tool for controlling outbreaks of new or re-emerging diseases. For Ex- During the COVID-19 pandemic, India’s vaccination drive with Covishield and Covaxin curbed severe cases and fatalities.

7. Strengthened Global Health Security- Immunization programs help India participate in global health security efforts by controlling outbreaks and contributing to research and production. For ex- India, as the world’s largest vaccine producer (e.g., through Serum Institute of India), supplies vaccines to developing countries, enhancing global immunization efforts.

8. Encouragement of Scientific Innovation- Robust immunization programs encourage investment in vaccine research and development. For ex- India’s development of indigenous vaccines, such as Covaxin, showcases its growing capacity for innovation.

9. Addressing Anti Microbial Resistance (AMR)- Wider vaccine adoption is expected to reduce antibiotic consumption, helping reduce the challenge of AMR.

What are the challenges with the immunisation programmes of India?

1. Geographical disparities in immunisation coverage- Immunization coverage varies significantly across states and regions due to infrastructure gaps, inaccessibility, and socio-economic differences. For ex- States like Kerala and Tamil Nadu have over 90% full immunization coverage, while Uttar Pradesh and Bihar struggle, with coverage below 60% in certain areas (NFHS-5, 2019–21).

2. Vaccine Hesitancy- Cultural beliefs, misinformation, and fear of side effects contribute to vaccine hesitancy. This often results in low immunisation coverage. For ex- A survey by WHO in 2021 highlighted that over 15% of respondents in some communities showed reluctance toward newer vaccines like the COVID-19 vaccine.

3. Inadequate Health Infrastructure- Rural and hard-to-reach areas often lack sufficient cold chain infrastructure, healthcare workers, and vaccine supplies. According to the National Cold Chain Assessment, only 60% of Primary Health Centers (PHCs) have fully functional cold chain equipment.

4. Migrant Populations- Migrant populations and urban slum residents are often missed by routine immunization drives due to mobility and lack of documentation. In cities like Mumbai and Delhi, immunization coverage is lower in slum areas compared to the overall urban population.

5. Insufficient Awareness and Education- Lack of awareness about the benefits of vaccines leads to lower participation. According to a UNICEF study, over 25% of families in rural areas were unaware of new vaccines like the rotavirus vaccine.

6. Funding and Resource Allocation- Immunization programs often face inadequate funding for outreach, logistics, and healthcare personnel. India spends approximately $9 per child on immunization, far less than the global average of $58 per child in middle-income countries.

7. Vaccine Wastage- Vaccine wastage occurs due to improper storage, distribution delays, or underuse of multidose vials. WHO estimates India’s vaccine wastage rates for routine immunizations to range from 15% to 30%.

8. Workforce Shortages- A shortage of trained healthcare workers, especially in rural areas, hampers vaccine delivery. India has a shortfall of 30% in ANMs at the sub-center level, as per the Rural Health Statistics (2021–22).

9. Emerging Diseases and Pandemic Strain- he emergence of diseases like COVID-19 and the diversion of resources to pandemic management disrupts routine immunization services. UNICEF reported a 12% reduction in DPT3 vaccination coverage during the pandemic.

What are the other initiatives of immunisation being undertaken in India?

What should be the Way Forward?

1. Strengthen Healthcare Infrastructure- The focus must be on enhancing the cold chain systems and healthcare facilities, especially in underserved regions, to ensure the safe storage and administration of vaccines.

2. Focused Interventions for High-Risk Areas- We must focus on implementing targeted strategies for areas with low coverage rates. This will address the immunisation gaps in challenging regions and among vulnerable populations​​.

3. Enhancement of Data Systems- Developing robust health information management systems will help to improve data accuracy and facilitate real-time monitoring and decision-making​​.

4. Community Engagement and Education- We must focus on strengthening community outreach and education programs to increase awareness about the benefits of immunization and address vaccine hesitancy.

5. Integrating Immunization with one health approach- The immunization programs must be linked with other health and welfare schemes to broaden the scope of health services and ensure a holistic approach to public health.