Child vaccine coverage falling short in India, says Lancet study

Despite making progress in vaccinating children against preventable diseases, a new Lancet study has revealed that there are several gaps in vaccine coverage at the local level in India.

This means that while millions of children are getting vaccinated, small regions within districts are still struggling. This is leaving several children vulnerable to diseases like measles and polio.

The research was conducted by experts from Harvard University, Flame University, and the University of Montreal that analysed data from over 87,000 children between the ages of one and three, representing a population of approximately 46 million children across 36 states and union territories.

The study tried to understand where vaccine coverage is falling short, using data from the most recent National Family Health Survey 2019-21 (NFHS-5).

The findings highlight a troubling trend: small areas within districts show stark differences in vaccination rates. These "low-coverage clusters" are often hidden within states that appear to perform well overall.

This uneven distribution is a major barrier to achieving India's immunisation goals.

KEY FINDINGS FROM THE STUDY

Researchers found that over 50% of the variations in vaccination rates occur within small local areas rather than across districts or states. This means that while one village might have high vaccination rates, a neighbouring village could have very low coverage.

The northeastern states and Uttar Pradesh were found to have the highest rates of under-vaccination for vaccines administered during the first year of life.

However, pockets of low vaccination were identified across most states, even in regions known that have robust healthcare systems.

Districts with more children missing vaccines often had greater inequalities within their borders. This suggests that certain communities or areas within these districts face more barriers to accessing vaccines.

Despite India's overall high vaccination rates, gaps in coverage leave many areas susceptible to outbreaks of diseases like measles, diphtheria,



pertussis, and polio.

For example, while official estimates show that over 90% of children received their polio and measles vaccines, the study found that only a few states, such as Odisha and Tamil Nadu, have vaccination rates high enough to prevent outbreaks.

The study has found several reasons for these disparities:

. Remote and hard-to-reach areas often face logistical issues in delivering vaccines.

. In some communities, a lack of knowledge about the importance of vaccines leads to low acceptance.

. Lack of proper infrastructure and staff shortages in certain regions further amplify the problem.

In light of these findings, the authors suggest a different perspective to address these gaps.

They said that instead of focussing on entire districts, health programs should target specific low-coverage regions within districts to expand and penetrate immunisation for children.

Addressing issues at the grassroots, resources can be used more effectively to ensure all children are protected, the authors wrote.

"India's recently created 'Ayushman Arogya Mandirs' (Health and Wellness Centres), with a territorial responsibility to deliver primary health care, may provide a natural niche for localised approaches," the authors suggested.

The study shows that aggregate numbers can be misleading. While the country appears to be on track nationally, local inequalities reveal a different story.

The study authors stated that in India children missing vaccinations happens because of several reasons, which include supply (with not enough vaccine available) and demand (parents not bringing children for vaccination).

Besides this, other challenges like poverty, and lack of resources might be causing child under-vaccination in India. To understand the complexity of resources and geographical areas, the researchers suggested the need to study social scientific research to better understand these issues.

These gaps are not just statistics, they represent children who remain at risk of deadly but preventable diseases.