India is currently facing significant challenges in ensuring that every child receives the essential vaccinations needed to protect against deadly diseases, according to a recent report. The joint report by WHO and UNICEF places India second only to Nigeria in the number of children who received no vaccines in 2023, revealing critical gaps in the country’s immunisation coverage.
In 2023, India had 1.6 million “zero-dose” children—those who did not receive any vaccines—following Nigeria’s 2.1 million. This decrease in vaccine coverage is concerning, with the report noting a two-percentage-point drop in the coverage of the diphtheria, pertussis, and tetanus (DPT) vaccine, which serves as a proxy for the number of zero-dose children. India’s neighbors, including Pakistan and Afghanistan, showed better trends, with fewer unvaccinated children reported.
India also ranks third globally for the number of children missing the measles vaccine, with 1.6 million “measles zero-dose children.” This places India among the ten countries that account for 55% of children without measles vaccines worldwide. The 2023 WHO and UNICEF estimates of national immunisation coverage (WUENIC) were based on data from member states up to July 1, 2024.
The report highlighted an increase in the number of zero-dose children globally, rising from 13.9 million in 2022 to 14.5 million in 2023, with the total number of un- and under-immunised children reaching 21 million—2.7 million more than the previous year.
Who are Zero-Dose Children?
Zero-dose children are those who have not received any routine immunisation services, as defined by WHO. Specifically, they are identified as those who did not receive their first dose of the DPT vaccine. This metric is critical in highlighting immunisation gaps and guiding efforts to address them.
The Risk to Indian Children
In India, zero-dose children are those who have not received the first DPT dose, typically administered at six weeks of age. However, many of these children may still receive other vaccines given at birth. According to the latest National Family Health Survey (2019-21), 88.6% of births occur in health facilities, and 95% of children under two receive the birth dose of the Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis.
Despite this, the number of zero-dose children in India increased from 1.1 million in 2022 to 1.6 million in 2023. With approximately 23 million births annually, this indicates that 6.9% of surviving infants in 2023 were zero-dose children.
Government Response
Indian officials have contested the UNICEF report, arguing that the country’s large population was not adequately considered when comparing vaccination data with other countries. According to sources from the Union Health Ministry, although India has the second-highest number of zero-dose children globally, they represent only 0.11% of the total population. Official sources also emphasized that India’s population, which is many times larger than several of the other nations included in the comparison, was not taken into account in the analysis of vaccination data in the latest WHO and UNICEF estimates.
Study on Zero-Dose Immunisation in India
A study supported by the Gates Foundation, published in the Journal of the American Medical Association (JAMA) in February 2023, examined zero-dose immunisation trends in India over 29 years, using data from all five rounds of the National Family Health Survey (NFHS). The study found a significant reduction in the proportion of zero-dose children, from 33.4% in 1993 to 6.6% in 2021.
Key Facts and Figures
- Reduction in Zero-Dose Children: India saw a drop in zero-dose children from 27.3 lakh in 2021 to about 16 lakh in 2023.
- Global Ranking: Despite improvements, India ranked second globally in 2023 for zero-dose children, with Nigeria leading at 21 lakh.
- Immunization Agenda 2030: India is one of the 20 countries prioritized under this agenda, focusing on reducing zero-dose children.
WHO and UNICEF Report Highlights
- Measles Vaccination: India had the third-highest number of children missing the first dose of the measles vaccine in 2023, with nearly 16 lakh children.
- MCV1 Coverage: Coverage for the measles-containing vaccine (MCV1) in India was 93% in 2023, a slight decline from 95% in 2019 but still higher than the global average of 83%.
- MCV2 Coverage: Coverage for the second dose of the measles vaccine (MCV2) remained constant at 90%.
Urgent Call to Action
The World Health Organization (WHO) has called for increased efforts to identify and immunize unvaccinated and under-vaccinated children, especially with tailored approaches at sub-national levels. UNICEF’s Executive Director, Catherine Russell, also emphasized the need for global investment in primary healthcare to close the immunization gap.
Conclusion
The latest WHO and UNICEF estimates highlight both the progress India has made in reducing the number of zero-dose children and the challenges that remain. Continued efforts are essential to close the immunisation gap and protect every child from vaccine-preventable diseases.
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