Zero-Dose Decline Marks India’s Health Progress
New Delhi: India reduced the percentage of zero-dose children—those who have not received any vaccines—from 0.11% of its 1.4 billion population to 0.06% in 2024, a decline highlighted by the United Nations Inter-agency Group for Child Mortality Estimation in its 2024 report as evidence of India’s progress in child health.
On June 28, 2025, the Ministry of Health and Family Welfare announced that India’s immunisation programmes have lowered mortality rates and expanded vaccination coverage across diverse communities. The Universal Immunisation Programme, which provides free vaccinations to 2.9 crore pregnant women and 2.6 crore infants annually, now protects against 12 vaccine-preventable diseases, up from six in 2013, aligning with vaccines recommended by the World Health Organization (WHO)
Since 2014, new additions have included Inactivated Poliovirus Vaccine, Rotavirus Vaccine, Pneumococcal Conjugate Vaccine, Measles-Rubella Vaccine, Adult Japanese Encephalitis Vaccine, and Tetanus-Diphtheria Vaccine, resulting in a reduction in deaths and illnesses from diarrhoea, pneumonia, meningitis, and encephalitis. These programmes have driven an 86% decline in the Maternal Mortality Ratio to 80 per lakh live births since 1990, compared to a global reduction of 48%, as per the United Nations Maternal Mortality Estimation Inter-Agency Group’s 2000–2023 report. The Sample Registration System data shows a further drop from 130 to 88 per lakh live births between 2014–16 and 2020–22. The United Nations Inter-agency Group for Child Mortality Estimation’s 2024 report also notes a 78% decline in India’s Under-Five Mortality Rate and a 70% decline in the Neonatal Mortality Rate from 1990 to 2023, surpassing global declines of 61% and 54%, respectively, reflecting the impact of vaccination as a cost-effective public health intervention.
Across India’s villages, towns, and cities, immunization campaigns, including Mission Indradhanush and the Zero Dose Implementation Plan 2024, have extended vaccination to communities previously beyond the health system’s reach—such as urban slums, peri-urban areas, migratory populations, and remote regions—as reported by the Ministry of Health and Family Welfare.
National Immunisation Days and Sub-National Immunisation Days have sustained India’s polio-free status since 2014 through coordinated vaccination drives. Mission Indradhanush, launched in 2014 and expanded in 2017 with state government collaboration, has vaccinated 5.46 crore children and 1.32 crore pregnant women previously unreached or under-vaccinated, bridging gaps in marginalised areas.
The Zero Dose Implementation Plan 2024, covering 143 districts in 11 states with high numbers of unvaccinated children, targets barriers in underserved communities and those with vaccine hesitancy, supporting India’s goal to eliminate Measles and Rubella by 2025.
India’s antigen-wise coverage exceeds global averages, with 93% of infants receiving the Diphtheria, Tetanus, and Pertussis first dose (Penta-1), covering 2.47 crore of 2.65 crore infants in 2023, compared to Nigeria’s 70%, as per the World Health Organization and United Nations Children’s Fund National Immunization Coverage report for 2023. The dropout rate from Diphtheria, Tetanus, and Pertussis first dose to third dose fell from 7% in 2013 to 2% in 2023, and measles coverage rose from 83% to 93%, aligning with countries like New Zealand (93% DTP-1), Germany (91% DTP-3), Finland (91% DTP-3), Sweden (93% MCV-1), Luxembourg (90% MCV-2), Ireland (83% PCV-3), and the United Kingdom (90% Rotavirus C).
India’s prioritisation of the Universal Immunisation Programme is supported by the U-WIN digital platform, which tracks immunisation status to ensure comprehensive coverage, and public awareness campaigns using mass media, community radio, social media, and street plays to inform families about vaccination benefits and address hesitancy. Over 1.3 crore immunisation sessions are conducted annually by Accredited Social Health Activists and Auxiliary Nurse Midwives, who visit households to vaccinate and educate, supported by Village Health and Nutrition Days for community access.
Task forces at the state (State Task Force for Immunisation), district (District Task Force for Immunisation), and block (Block Task Force for Immunisation) levels coordinate implementation, while Information, Education, and Communication campaigns promote awareness and counter misinformation.
With a 2.6 crore annual birth cohort—larger than the populations of New Zealand, Australia, Finland, or Switzerland—India’s progress stands out compared to countries with higher zero-dose percentages, such as Yemen (1.68%), Sudan (1.45%), Angola (1.1%), Afghanistan (1.1%), Nigeria (0.98%), Democratic Republic of Congo (0.82%), Ethiopia (0.72%), Indonesia (0.23%), and Pakistan (0.16%) in 2023, with India at 0.11% in 2023. Milestones include polio elimination in 2014, maternal and neonatal tetanus elimination in 2015, and the launch of the Measles and Rubella campaign in 2025. On March 6, 2024, The Measles and Rubella Partnership—comprising the American Red Cross, Bill & Melinda Gates Foundation, GAVI, United States Centers for Disease Control and Prevention, United Nations Foundation, United Nations Children’s Fund, and World Health Organization—awarded India the Measles and Rubella Champion Award at the American Red Cross Headquarters in Washington, DC, recognizing its vaccination programs.
Through a focus on last-mile delivery, India continues to reduce deaths from vaccine-preventable diseases, advancing public health for its children.
– global bihari bureau
