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Source: India Today

India's large number of zero-dose children speaks to the urgent need to close persistent gaps in vaccine delivery.

About “Zero-Dose Children”

"Zero-Dose Children are those who have not received their first dose of the diphtheria, tetanus, and pertussis (DTP) vaccine.
Globally, vaccination efforts improved significantly between 1980 and 2023, particularly for six diseases: DTP, Measles, Polio, and Tuberculosis.
The number of zero-dose children worldwide has significantly decreased.
Currently, 75% of countries still have zero-dose children, while 25% have completely eliminated them.

Why are they important when evaluating vaccination?

Reflects health-care coverage and equity: The high number of zero-dose children demonstrates that vaccination programmes do not reach all segments of the population. NFHS-5 (2019-21) Data also revealed that full immunization coverage among children aged 12-23 months was significantly lower in rural and tribal regions than in urban areas (e.g., Nagaland: 57.8% vs. Tamil Nadu: 89.8%).
This indicates social and economic exclusion. The presence of zero-dose children highlights barriers such as poverty, limited maternal education, and marginalisation. For example, urban slums with large migrant populations have a higher proportion of zero-dose children due to a lack of awareness and access.
Warnings about disease outbreaks: Communities with a high number of zero-dose children are more likely to experience outbreaks of vaccine-preventable diseases. For example, measles outbreaks are more common in districts with low immunisation rates.

Despite decades of increased immunisation coverage, India had 1.44 million zero-dose children in 2023. These are people who have not even received their first dose of the diphtheria, tetanus, and pertussis (DTP) vaccine.
Linkages to high birth rates: The majority of zero-dose children worldwide live in countries with conflict or limited resources for vaccination programs; however, India does not have either of these two issues, and zero-dose children can be linked to the prevalence of high birth rates.
COVID-19's impact on vaccination: Prior to the pandemic, the number of zero-dose children was 1.4 million in 2019; however, this increased to 2.7 million in 2021, then dropped to 1.1 million in 2022, before increasing to 1.44 million in 2023.

In 2023, India accounted for 1.44 million (14.4 lakh) zero-dose children.
India ranks as the second-highest globally in absolute number of zero-dose children.
Among the eight countries where zero-dose children make up over 50% of total children, India is unique—it is neither in conflict nor lacking vaccine procurement funds.
This presents a paradox: despite peace and adequate funding, India has a high burden of zero-dose children.

In 2023, India had 23 million (2.3 crore) births, while China had 9.5 million (95 lakh).
Although India’s absolute number of zero-dose children is high, the percentage is only 6.2% of total births, considered “very low”.
The high birth rate inflates the absolute count, despite relatively better proportional performance.

In 1992, 33.4% of Indian children were zero-dose.
By 2016, this reduced to 10.1%.
In 2023, the figure improved further to 6.2%.
India has shown commendable progress in reducing zero-dose prevalence over decades.

It dropped to 1.1 million in 2022, but rose again to 1.44 million in 2023.
This trend reflects post-COVID setbacks, showing unsustained progress and the need to revisit strategies.

India's immunization efforts: According to a 2021 study, India's percentage of zero-dose children has decreased dramatically, from 33.4% in 1992 to 10.1% in 2016.
Aligning with global goals: India must do much more to meet the WHO's Immunisation Agenda 2030 (IA2030) goal of halving the number of zero-dose children.
Strategies for Improvement: Improving immunization rates in hard-to-reach tribal areas, urban slums with a large migrant population, and reducing vaccine hesitancy among Muslim households with newborn children.

Practice Question

Q. Analyse the factors contributing to the issue and evaluate the effectiveness of India's immunisation programs.