A healthcare worker giving Polio drops and vaccination in an Anganwadi centre in Ghaziabad, Uttar Pradesh.  Photo: Vikas Choudhary/CSE
Health

World Immunisation Week: Immunising the last-mile child is key to India’s stride to inclusive growth

Reaching every last-mile child with life-saving vaccines is way beyond just a health goal; it’s a national investment in building an inclusive, resilient India

Puja Marwaha

In India, immunisation is more than a routine health service—it is a foundational pillar of public health. Over the seven and a half decades since independence, the country has made steady progress toward the goal of “Health for All.” Public health policies have evolved to place greater emphasis on inclusive infrastructure, with a focus on the needs of women and children. Immunisation, in particular, remained central to these efforts, offering protection to children from a range of vaccine-preventable diseases.

Every child in India—whether newly born or still in the womb—has the right to be safeguarded against life-threatening diseases. This vision began to take shape with the launch of the Expanded Programme on Immunisation in 1978, later rechristened as the Universal Immunisation Programme (UIP) in 1985. Today, as the World Health Organization (WHO) celebrates World Immunisation Week across the globe, the UIP ranks among the world’s largest public health undertakings.

At its core, India’s immunisation drive is anchored in two broad principles: universal access to vaccination and health equity. From the eradication of polio in 2014 to the nationwide rollout of the measles-rubella campaign, the country’s efforts reflect a sustained focus on public health outreach. While challenges such as socio-economic disparities and cultural resistance still persist, they have also shaped adaptive strategies to address both current and emerging health threats including those linked to climate change and pandemics.

From commitment to action

A quick look at India’s immunisation story underscores the quantum of progress that has been made in the past few years. There has been significant improvement in full basic immunisation (including BCG, three doses of each of DPT and polio vaccine, and one dose of measles) of children within the age-group of 12 to 23 months, as a comparative analysis of the Fourth (2015-16) and the Fifth (2019-21) rounds of National Family Health Survey (NFHS) Report reveals. The proportion of fully immunised children in this age-group increased from 62 per cent to 76.4 per cent, showcasing an impressive growth of 14.4 percentage points.

Over the same time-period, the percentage of children within the same age-group who had not received any vaccination dropped from 2.4 per cent to 1.5 per cent, indicating enhanced outreach, especially in remote and underserved areas. Another trend to be noted is the gradual narrowing of the rural-urban gap in vaccination, implying better rural penetration of immunisation campaigns and a significant improvement in supply and cold chain logistics management.

While the increase in full immunisation is a strong indicator of better access, awareness, and trust in public health services and the gains reflect better coordination, monitoring, data tracking, and effective mobilisation of frontline health workers; continued investment in routine immunisation, especially in tribal, remote, and conflict-affected areas remains essential to achieve universal coverage.

The economic case for vaccinating the last-mile child

Beyond the health rationale, immunisation also offers significant economic gains. Research conducted by Johns Hopkins Bloomberg School of Public Health revealed that for every dollar invested in immunisation in low- and middle-income countries, up to $44 is saved when the broader economic and social benefits are factored in. This is not merely a health investment — it is a boost to sustainable human capital development and high return on investment, so tax revenues could be repurposed in infrastructure, innovation and poverty alleviation for long-term human capital development.

That India is getting satisfactory return on investment in public health policies is evident from several important national health indicators. According to the Sample Registration System (SRS) 2020, the infant mortality rate (IMR) dropped from 39 per 1,000 live births in 2014 to 28 in 2020. The neonatal mortality rate (NMR) declined from 26 to 20 (per 1,000 live births), while the Under-5 Mortality Rate (U5MR) fell from 45 to 32 (per 1,000 live births) during the same period. These gains signal an overall improvement in child survival and well-being.

To catalyse the positive trend, since December 2014, Mission Indradhanush (IM) and subsequently the Intensified Mission Indradhanush (IMI) have been launched as special vaccination drives conducted in collaboration with states having a high burden of unvaccinated mothers and children. Till 2023, 54.6 million children and 13.2 million pregnant women have been vaccinated during the 12 phases of such drives.

COVID-19: Valuable lessons learnt the hard way

The COVID-19 pandemic posed significant challenges to routine immunisation services in India. Nationwide lockdowns, restrictions on movement, and physical distancing induced by the widespread fear of infection led to a temporary slowdown in outreach activities, particularly in hard-to-reach and underserved areas. Health workers were redirected toward COVID response duties, further straining the delivery of child health services.

According to a UNICEF report, millions of children globally missed scheduled vaccinations during this period, and India was no exception. While catch-up campaigns like Mission Indradhanush 3.0 and initiatives such as Har Ghar Dastak underscored the importance of digital infrastructure in health delivery and helped mitigate the setback. On the whole, the pandemic underscored the need for crises preparedness and stronger health system resilience to sustain routine immunisation during public health emergencies.

To sum up, the COVID-19 pandemic taught India vital lessons about health crises preparedness, particularly in the context of immunisation. It underscored gaps in last-mile delivery, cold chain management systems, and digital tracking, but also spurred innovations like Co-WIN and intensified vaccine literacy efforts. It showed that preparedness isn’t just about emergency response—it’s about resilient health systems, trained frontline workers, and trust-building in communities. COVID-19 reinforced that timely, equitable immunisation is India’s first line of defence, especially to protect its most vulnerable children.

Building forward

In a country as socio-economically and culturally diverse as India, universal immunisation is not just a policy goal—it is a social imperative. Therefore, India’s future immunisation efforts must be meticulously strategised to ensure coverage among last-mile children, especially in slums, tribal belts, and conflict-prone zones, with the lens of equity, empathy and innovation. Comprehensive policy layout for more interdepartmental handholding, clear and customised communication campaign by considering socio-economic and cultural factors. Utilising Digital platforms like U-WIN and creating a scope for scale up with added features of cutting-edge data analytics for more intelligent decisions. Global cooperation with UN agencies, research organisations, quality infrastructure and logistics, and a strong intent would strengthen India’s commitment towards universal health access to ‘Health for All’.

Reimagining India’s immunisation future

When a child receives a vaccine, it’s not just a shot toward better physical immunity—it’s about getting a level playing field. It is a promise of equal opportunity, dignity, and the right to a healthy life. Looking from this perspective, ensuring equitable access to immunisation at the blooming phase of their life is also about giving them an access to social justice.

Puja Marwaha is CEO, CRY – Child Rights and You

Views are author's own and do not necessarily reflect those of Down To Earth