Immunisation coverage in India remains too low, study finds

BMJ 2013; 347 doi: (Published 12 September 2013) Cite this as: BMJ 2013;347:f5573
  1. Cheryl Travasso
  1. 1Mumbai

The proportion of Indian children between 12 months and 23 months who have had all their vaccinations has increased only moderately in 15 years from 35% in 1992 to 44% in 2006, an analysis has reported.

About half of eligible children in nine states across India did not receive complete immunisation, it found.

India has the highest death rate among under 5s in the world and immunisation is considered to be an effective lifesaver. According to World Health Organization guidelines, full immunisation coverage refers to three doses each of the diphtheria, whooping cough, and tetanus (DPT), and the polio vaccines; one dose of the measles vaccine; and the BCG vaccine (against tuberculosis) by 12 months of age.

For the study, reported in PLoS One, author Prashant Singh analysed data from the 1992-93, 1998-99, and 2005-06 rounds of the nationally representative National Family Health Survey (NFHS).1

In the states of Goa and Tamil Nadu, more than 80% of the children received their full immunisation compared with less than 25% in Uttar Pradesh. Except for Assam and Tamil Nadu, all states had better immunisation in the urban areas than in rural regions in 2006. Between 1992 and 2006 Assam, Bihar, and Rajasthan reduced the inequality between urban and rural regions, while a number of other states, including Maharashtra and Madhya Pradesh, showed an increase.

Bihar, Andhra Pradesh, and Punjab had the highest gender inequality ratio, with full vaccination coverage favouring male children, while Delhi and Tamil Nadu had no or almost no gender differential. However, Singh wondered whether an absolute decline in child sex ratio in certain states had contributed to the seeming gender inequality in those regions.

Singh told the BMJ that he was surprised at the low coverage given that immunisation is free at government health facilities. He also stressed the importance of periodic evaluation of how the health system is performing.

Chandrakant Lahariya, WHO’s representative on routine immunisation and new vaccines in India, told the BMJ that figures from 2005-06 were out of date and many surveys performed since then had reported improved coverage levels, even in the lowest performing states of Uttar Pradesh and Bihar.

However, he added, “The fact is, full immunisation in India is still suboptimal. Even the best performing states in India have less than 90% coverage. Contrast that with our neighbours like Bangladesh and Sri Lanka, which, in similar circumstances, have successfully achieved and sustained more than 95% full immunisation status. We definitely need to take vaccination coverage to the next level.”


Cite this as: BMJ 2013;347:f5573