Despite claims by India regarding its economic growth, poverty has increased, the health sector faces deterioration, and especially child immunization is a challenge.
The gains made in improving childhood immunization rates in India in 2022 had been undone to an extent in 2023, according to the latest WHO-Unicef report.
The rates had dropped sharply during the COVID-19 pandemic in 2020 and the effect was seen also in 2o21. Some reversal of this adverse trend happened in 2022.
According to the report, what’s also concerning is that India is one of the highest contributors as far as the number of children who received zero doses against two diseases at least is concerned.
Declining immunization rates can lead to higher mortality and morbidity in children. For almost all vaccines, India improved its vaccination rates in 2022. But the trend reversed in 2023.
The key vaccines for which immunization rates declined in 2023 as compared to 2022 were BCG, DTP (first and second doses), hepatitis vaccines, measles (fist dose), polio, and rotavirus (diarrhea) among others. The rates remained constant for the second dose of measles. The coverage of most of these vaccines is yet to return to pre-pandemic levels of 2019.
The following table gives a snapshot of the coverage of vaccines among children.
For some of these diseases, there has also been evidence of increases in morbidity. Measles is a case in point. Like many other countries, India also witnessed an uptick in cases.
From October 2023 to March 2024, India registered 15,590 measles cases – the fourth highest in the world.
“Over the last five years, measles outbreaks hit 103 countries – home to roughly three-quarters of the world’s infants. Low vaccine coverage (80% or less) was a major factor,” the report said.
“In contrast, 91 countries with strong measles vaccine coverage did not experience outbreaks. Besides declining immunization rates, what’s also worrying is a high number of children who received zero doses of vaccines,” the report added, highlighting the consequences of low coverage of measles vaccines among children.
Zero-dose children
The other matter of concern is the number of children who could not receive even one dose of vaccine – known as zero-dose children.
According to the WHO-Unicef report, at least 16 lakh children in India had not received even one dose of the DTP (diphtheria, tetanus, and pertussis) vaccine and measles vaccine in 2023. In 2022, the number of zero-dose children was 11 lakh.
As far as DTP (first dose) is concerned, India has missed the second-highest number of children despite immunizing 93% of kids. In terms of absolute number of children, only Nigeria had a higher number of zero-dose children than India. The other countries in this cohort included Ethiopia, the Democratic Republic of Congo, Sudan, Indonesia, Yemen, Afghanistan, Angola and Pakistan. These 10 countries accounted for 59% of children globally who couldn’t even get the first dose of DTP.
“The countries with the most zero-dose children are a mix of those with large birth cohorts, weak health systems, or both. New in this list in 2023 are countries afflicted by conflict, like Sudan, Yemen, and Afghanistan,” the report said.
Similarly, in the case of measles, India accounted for 16 lakh zero-dose children (despite vaccinating 93% of children), the third highest in the world. Only Nigeria and the Democratic Republic of Congo were ahead of India. The other countries in this group, which accounted for 55% of children globally missing this vaccine, are Ethiopia, Pakistan, Sudan, Indonesia, Yemen, Angola and Afghanistan.
“A key goal of the Immunization Agenda 2030 (IA2030) is to reduce the number of zero-dose children by half by 2030,” says the report.
[However] actual achievements show that the 2023 estimate of zero-dose children is still above 2019 levels. I.e. global coverage has not fully recovered from pandemic disruptions and is not yet on track to achieve the IA2030 target,” the report says highlighting how a high number of zero-dose children in a few counties could adversely affect the achievement of global targets also.
Reference Link:- https://thewire.in/health/childhood-immunisation-rates-indias-post-pandemic-recovery-slows-in-2023-says-who-unicef-reports