Study highlights inequalities in early childhood vaccination in India

February 13, 2023—Despite progress made toward widespread early childhood vaccination in India, northeastern parts of the country and certain states account for most of the children who aren’t getting routine shots, according to a new study co-authored by researchers from Harvard T.H. Chan School of Public Health.

The study was published in JAMA Network Open on February 11. Co-authors included S.V. Subramanian, professor of population health and geography at Harvard Chan School; Rockli Kim, visiting scientist in the Harvard Center for Population and Development Studies; and Sunil Rajpal, research fellow in the Harvard Geographic Insights Lab.

Researchers examined data from 1993 to 2021 from India’s National Family Health Survey, looking at the vaccine status of 125,619 children ages 12 to 23 months. Vaccination status was defined as having received the first dose of the diphtheria-tetanus-pertussis (DTP) vaccine.

The study found that the prevalence of young children who did not receive routine vaccines sharply decreased nationally—but remained high or even resurged in certain parts of the country. For example, by 2021, 53% of children who hadn’t received the first dose of the DTP vaccine resided in the populous states of Uttar Pradesh, Bihar, and Maharashtra.

The findings highlight the toll the COVID-19 pandemic took on otherwise successful government efforts to vaccinate India’s youth, and suggest the importance of continued vaccination programs, particularly those targeting high-burden areas—some of which were low-burden until as recently as 2016.

“Children who do not receive any routine vaccinations are at elevated risk of death, morbidity, and socioeconomic vulnerabilities that limit their development over the life course,” the researchers wrote. “India has the world’s highest number of [unvaccinated children]; analysis of national and subnational patterns is the first important step to addressing this problem.”

Read the study: Patterns in the Prevalence of Unvaccinated Children Across 36 States and Union Territories in India, 1993-2021