Answer

Introduction

Zero-dose children, who have not received their first DTP (diphtheria, tetanus, and pertussis) vaccine, represent a critical gap in primary healthcare. Despite progress, India had 1.44 million such children in 2023, the second-highest globally, posing a significant challenge to its universal immunization goals.

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Persistence of Zero-Dose Children and Healthcare Delivery Gaps

• Inadequate Reach: Poor infrastructure in remote areas hinders vaccine delivery, leaving vulnerable populations uncovered.
  Eg. As per NFHS-5, tribal and rural regions in states like Nagaland have significantly lower full immunization coverage (57.8%) compared to urbanized states like Tamil Nadu (89.8%).
• Pandemic-Induced Disruptions: The COVID-19 pandemic diverted healthcare focus and resources, reversing years of progress.
  Eg. Zero-dose numbers in India surged from 1.4 million in 2019 to 2.7 million in 2021 due to pandemic-related lockdowns and public fear.

Deeper Socio-Economic and Behavioural Inequalities

Socio-Economic Inequalities

• Poverty and Awareness: Poverty acts as a major barrier, with low-income families facing opportunity costs and lacking awareness.
• Maternal Education: Lower maternal education levels strongly correlate with under-vaccination, as mothers may have limited access to health information.
  Eg. According to NFHS-5, 6.2% of children whose mothers have no schooling are zero-dose, compared to 2.7% for children of mothers with higher education.
• Social Marginalisation: Marginalised groups, like Scheduled Tribes in remote areas, face systemic exclusion from healthcare.

Behavioural Inequalities

• Misinformation and Rumours: Widespread misinformation fuels fear and distrust, leading to refusal.
  Eg. False WhatsApp videos linking vaccines to infertility severely impacted uptake in the Nuh-Mewat region of Haryana.
• Lack of Trust: A deficit of trust in the public health system, rooted in historical experiences or cultural beliefs, drives vaccine hesitancy.
• Low Perceived Risk: As diseases become rare, parental complacency rises, leading to de-prioritisation of vaccines.
  Eg. The major measles outbreaks in Mumbai and Malappuram (Kerala) during 2022-23 were directly linked to low vaccination coverage in preceding years.

Challenges in Increasing Vaccine Access

• Last-Mile Delivery: Reaching the ‘last mile’ in geographically challenging terrains remains a persistent logistical hurdle.
• Unplanned Urbanisation: Rapid urbanisation creates dense slums where tracking transient populations for a full immunisation schedule is extremely difficult.
  Eg. Health workers in Dharavi, Mumbai, struggle to maintain consistent records for its highly mobile population, leading to missed vaccinations.
• Overburdened Health Workers: Frontline health workers are stretched thin, affecting counselling and mobilization quality.
  Eg. In states like Bihar, an ASHA worker often serves over 2,000 people, double the 1,000-person norm.
• Data Management Gaps: Despite digital initiatives like U-WIN, maintaining real-time data on immunisation for migrant children remains a challenge.

Way Forward

• Targeted Micro-Planning: Use data from U-WIN and surveys to identify and target zero-dose hotspots with tailored strategies.
  Eg. Launching focused immunisation drives like Intensified Mission Indradhanush (IMI) 5.0, targeting  left-out children and pregnant women in underperforming districts.
• Behavioral Communication: Implement targeted communication using local influencers and community leaders to counter misinformation and build trust.
  Eg. Use of local Korku language videos with trusted doctors in Melghat, Maharashtra, to counter vaccine skepticism among adivasi mothers.
• Inter-Sectoral Convergence: Foster strong collaboration between Health, Women & Child Development, and Panchayati Raj departments for a holistic approach.
• Strengthen Primary Healthcare: Enhance infrastructure by ensuring consistent vaccine supply, cold chain integrity, and sufficient trained personnel.
  Eg. Establishing more Health and Wellness Centres in remote North-East and tribal regions to serve as accessible vaccination points.

Conclusion

To meet the Immunization Agenda 2030 goal of halving zero-dose children, India must intensify its efforts. A sustained, equitable approach that addresses both systemic delivery gaps and the deep-seated social determinants driving exclusion is crucial for protecting every child and ensuring lasting progress.

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