Universal vaccination became part of government policy in 1978. A quarter of a century since, progress has been fitful. In some parts of the country -- the south especially -- progress has been impressive, but in two of the most populous states -- Bihar and Uttar Pradesh -- very little headway has been made. As of now, just about half the children in the country are vaccinated against the six most common diseases -- diphtheria, measles, whooping cough, polio, tetanus and tuberculosis -- that are included in the government's universal immunisation programme (uip). Currently, the annual budget for the programme is Rs 2,221 crore approximately. Global agencies are supposed to help developing countries meet their targets as well as the un's millennium development goal, which is to reduce under-five mortality by two-thirds by 2015. This target will be deemed to have been met if two-thirds of children under one are vaccinated against measles by that date. But on the ground, the role of global agencies is actually making the task of meeting targets even more difficult, by insidiously changing programme priorities in the developing world. Hepatitis b is a case in point. The Global Alliance for Vaccines and Immunisation (gavi) nudged India towards including the disease in the uip. It funded a pilot project after which the Indian government included hepatitis b in the universal programme. The unfortunate part of the story is that gavi just funded the pilot project and the government is now saddled with an expensive vaccine in its programme. This is changing the design of the country's vaccination programme. Traditionally, India, and other developing countries, have spent more on their delivery systems than vaccines themselves, because that is needed for deeper penetration levels. This has been possible because vaccines for the six uip diseases are cheap. But as expensive vaccines are coming into play, more money is being spent on vaccines and the delivery system could suffer. Vibha varshney reports on India's vaccination regime, its global context and the new technologies that are emerging from Western laboratories.