Immunization and Child Health
One of the most cost-effective ways to protect children’s lives and futures.
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Immunization—a key to child survival is one of the most cost-effective ways to protect children's lives and their future. India's immunization programme, UIP (Universal Immunization Programme), is one of the world's most extensive public health programmes.
Every year, nearly 26 million newborns and 34 million pregnant women are targeted for immunization, and over 13 million immunization sessions are held nationwide to vaccinate children and pregnant women.
Over the last two decades, India has significantly improved health outcomes, particularly child health and immunization. The country was certified polio-free in 2014 and eliminated maternal and neonatal tetanus in 2015.
New vaccines, including the Measles-Rubella, Pneumococcal Conjugate Vaccine (PCV) and Rotavirus Vaccine (RVV), have been introduced and expanded nationwide.
Even then, challenges remain. In 2022, 14.3 million infants did not receive the first DPT vaccine globally, pointing to a lack of access to immunization and other health services. An additional 6.2 million are partially vaccinated.
Of the 20.5 million who are either not vaccinated or partially vaccinated, nearly 60 per cent of children live in 10 countries, including India. The others are Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, Indonesia, Mozambique, Nigeria, Pakistan and the Philippines.
In India, infectious diseases continue to contribute to a significant proportion of child mortality and morbidity. Nearly one million children die before their fifth birthday. Many of these deaths are preventable and can be averted by interventions such as breastfeeding, immunization and access to treatment.
The Indian government is dedicated to reducing the morbidity and mortality of children and pregnant women and protecting communities from diseases that vaccines can prevent. According to NFHS-5, 2019-21, the country's full immunization coverage stands at 76.1 per cent, which means that one out of every four children is missing out on essential vaccines.
However, according to the web-based Health Management Information System (HMIS) portal, the full immunization coverage for 2021-22 was 89 per cent.
Also, as per the latest WUENIC (WHO-UNICEF Estimates National Immunization Coverage) estimates, India has successfully reduced the number of zero-dose (ZD) children to 1.1 million in 2022 from 2.7 million in 2021, covering an additional 1.6 million children with life-saving vaccination.
While India is making excellent progress towards reaching the zero-dose goal outlined in the Immunization Agenda 2030, there are millions of children still waiting to be vaccinated. Sixty-three per cent of ZD children live in the five states of Bihar, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh.
Together, this makes up nearly 55 per cent of the birth cohort. A high proportion of zero-dose children are also in the following states – 17.8 per cent in Meghalaya, 15.8 per cent in Nagaland, 14.5 per cent in Mizoram and 13.4 per cent in Arunachal Pradesh.
Bringing down the number of zero-dose children can be attributed to multiple rounds of Intensified Mission Indradhanush (IMI), which aimed at bridging the immunization gap in select districts and urban areas.
To recover from the COVID-19 backslide, another IMI campaign, 4.0, was conducted in February 2022 to vaccinate unvaccinated and partially vaccinated children. Identified states with outbreaks and conducted measles and rubella catch-up campaigns along the MR elimination roadmap.
In yet another nationwide coverage improvement drive, IMI 5.0 was conducted in August- September/October 2023. The focus of this drive was extended to children up to five years of age to specifically reach and vaccinate two- to five-year-old children who may have missed MR doses, thus preparing the country for MR elimination.
Other factors that helped improve the coverage are increased focus on marginalized and vulnerable populations (Tribal/Urban/ high risk and hard-to-reach) through targeted strategies, advocacy, focused communication interventions and community-based interventions with CSO/CBOs.
UNICEF’s role
Over the last 70 years, immunization has been at the heart of UNICEF's work. UNICEF is a technical partner of the Government of India's immunization programme and stands committed to supporting it, ensuring that no child suffers from diseases that can be prevented through vaccination.
UNICEF partners with the Ministry of Health and Family Welfare (MoHFW) and other stakeholders in the areas of coverage and equity, data monitoring and research, demand generation and advocacy and cold chain strengthening further to reach the zero-dose and under-immunized children in the country and leverage immunization for PHC integrated services, community engagement and multisectoral actions.
UNICEF is an active member of many technical groups, including the National Technical Advisory Group on Immunization, the Immunization Action Group, the India Expert Advisory Group for Polio and Measles, and the Technical Group for HPV Introduction for Technical and Policy Guidance.
Expanding access to immunization is crucial to achieving the Sustainable Development Goals (SDGs). Diseases such as polio and smallpox that once killed thousands of children have been eliminated, and others are close to extinction– primarily due to safe and effective vaccines.
By improving routine immunization, UNICEF ensures that its commitment to child rights is matched with action for every boy and girl everywhere. It works with partners and other stakeholders to narrow the immunization gaps among the poor, marginalized, and less educated groups in all geographical locations, rural and urban.
Doing so ensures that every child who comes for vaccination is not turned away and receives the required and appropriate vaccine and doses. It ensures every level has the resources necessary – vaccinators, supplies, skills, motivation and community involvement.
UNICEF played a pivotal role in strengthening national resource centres, NCCVMRC and NCCRC, institutionalizing them within the government system. These centres serve as nodal points for immunization supply chain research, training, planning and policy initiatives in India.
UNICEF is a lead partner in cold chain strengthening, demand generation and advocacy. Over the past few years (2018-2022), using clean and green technology has been crucial in supporting and fortifying the country's cold chain system.
As part of this, capacity building of more than 1100 cold chain technicians and managers was done. In addition, 20 EVM assessments (Effective Vaccine Management) and monitoring over 180,000 sessions through the Supportive Supervision application were also done. UNICEF also plays a vital role in strengthening the cold chain with the supply of cold chain equipment.
In terms of procurement, 56 walk-in coolers, 2999 ILRs, 480 SDDs, 33,479 cold boxes, 379,480 freeze-free vaccine carriers, 202,641 vaccine carriers, 8300 voltage stabilizers, 350 toolkits, 28 WIF, 620 DF, and 48,700 freeze tags were procured to strengthen the cold chain systems and improve access for vaccination.
While India became polio-free in 2014, UNICEF continues to support the Government of India as the lead communication partner in the fight against polio and sustain the gains through communication and social mobilization strategies. It supports the health ministry in the observance of Polio National Immunization Days and Sub-national Immunization Days.
Ensuring the people's trust is essential to sustaining a programme's gains. In this context, to sustain the confidence in vaccines and health systems. UNICEF facilitates partnerships with media, especially radio, faith-based organizations and other community leaders and influencers, to share factual information on the benefits of immunization to achieve this objective.
It is also vital to make parents and caregivers aware of the importance of immunization and the immunization cycle. They should know when and where to bring their children for vaccination, the duration between the doses and the importance of attending a visit. UNICEF plays an essential role in spreading awareness about this as well.
India's commitment to improving access to vaccines has been a critical intervention in reducing child mortality and morbidity, and immunization remains a priority amongst decision-makers at the highest levels of government.
Immunization is an entry point for the delivery of primary health care services, and UNICEF's commitment to India in running a regular and effective immunization programme may be able to eradicate many preventable diseases affecting children across the country.