WHO defines under-vaccinated children as those who do not have access to routine immunization services or are never reached by routine immunization services. They are operationally measured as those who have not received their first dose of the DPT vaccine (diphtheria, pertussis and tetanus). It is primarily used to communicate about vaccination gaps and to urge collective efforts to close them. It is calculated as the difference between the estimated number of surviving infants and the estimated number of children who received their first dose of DPT.
Not necessarily. Since zero-dose means that babies have not received the first dose of DPT – which in India is given at six weeks – it is possible that most zero-dose children have received most or all of the vaccines given at birth. The latest National Family Health Survey (2019-21) suggests that 88.6% of births are institutional, or occur in a health facility. However, the percentage of children under two years of age who received the birth dose of the BCG vaccine against TB is 95%. This suggests that even children not born in a health facility had access to immunization services. According to the latest UN estimate, there will be 1.6 million zero-dose children in India in 2023, up from 1.1 million in 2022. With an estimated 23 million births per year, this would mean that 6.9% of surviving babies in 2023 will be zero-dose children.
Vaccines given at or shortly after birth include BCG (given at birth or as early as possible up to one year of age), hepatitis B vaccine (given at birth or as early as possible within 24 hours), and oral polio vaccine (OPV; given at birth or as early as possible within the first 15 days). At six weeks, the baby receives a single dose of fractional inactivated polio vaccine (IPV), another dose of OPV (oral rotavirus vaccine), the first of two doses of pneumococcal conjugate vaccine, and the first of three doses of pentavalent vaccine, which is a combination of diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus Influenzae type B (Hib) vaccines. Therefore, if a baby misses the first dose of DPT, it is assumed that he or she has probably missed all the other doses due at six weeks. According to WHO/UN estimates, not receiving the first dose of the DPT-containing vaccine indicates a lack of access to routine immunization in general, which may not necessarily be the case.
A Gates Foundation-backed study published in the Journal of the American Medical Association (JAMA) in February 2023 looked at zero-dose immunization over 29 years (1993 to 2021; see chart) using anonymized data from all five rounds of India’s National Family Health Survey (NFHS). It found that the percentage of babies with zero doses dropped from a total of 33.4% to 6.6% between 1993 and 2021.
In absolute numbers, there was a huge decline in the number of children receiving zero doses over the 10-year period from 2006 to 2016. From around 85 lakh children receiving zero doses in 2006, it dropped to just over 16 lakh in 2016. However, the annual relative decline was highest in the five-year period between 2016 and 2021 at 7.4% per annum. This was after the launch of Mission Indradhanush in 2014, which aimed to cover all unvaccinated or partially vaccinated children. After the setback the immunisation programme suffered during Covid, when the number of children receiving zero doses shot up to 27 lakh, India managed to bring it down to 11 lakh by 2022, according to Unicef estimates. However, by 2023, the number will have risen to 16 lakh, according to Unicef.
Not necessarily. Since zero-dose means that babies have not received the first dose of DPT – which in India is given at six weeks – it is possible that most zero-dose children have received most or all of the vaccines given at birth. The latest National Family Health Survey (2019-21) suggests that 88.6% of births are institutional, or occur in a health facility. However, the percentage of children under two years of age who received the birth dose of the BCG vaccine against TB is 95%. This suggests that even children not born in a health facility had access to immunization services. According to the latest UN estimate, there will be 1.6 million zero-dose children in India in 2023, up from 1.1 million in 2022. With an estimated 23 million births per year, this would mean that 6.9% of surviving babies in 2023 will be zero-dose children.
Vaccines given at or shortly after birth include BCG (given at birth or as early as possible up to one year of age), hepatitis B vaccine (given at birth or as early as possible within 24 hours), and oral polio vaccine (OPV; given at birth or as early as possible within the first 15 days). At six weeks, the baby receives a single dose of fractional inactivated polio vaccine (IPV), another dose of OPV (oral rotavirus vaccine), the first of two doses of pneumococcal conjugate vaccine, and the first of three doses of pentavalent vaccine, which is a combination of diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus Influenzae type B (Hib) vaccines. Therefore, if a baby misses the first dose of DPT, it is assumed that he or she has probably missed all the other doses due at six weeks. According to WHO/UN estimates, not receiving the first dose of the DPT-containing vaccine indicates a lack of access to routine immunization in general, which may not necessarily be the case.
A Gates Foundation-backed study published in the Journal of the American Medical Association (JAMA) in February 2023 looked at zero-dose immunization over 29 years (1993 to 2021; see chart) using anonymized data from all five rounds of India’s National Family Health Survey (NFHS). It found that the percentage of babies with zero doses dropped from a total of 33.4% to 6.6% between 1993 and 2021.
In absolute numbers, there was a huge decline in the number of children receiving zero doses over the 10-year period from 2006 to 2016. From around 85 lakh children receiving zero doses in 2006, it dropped to just over 16 lakh in 2016. However, the annual relative decline was highest in the five-year period between 2016 and 2021 at 7.4% per annum. This was after the launch of Mission Indradhanush in 2014, which aimed to cover all unvaccinated or partially vaccinated children. After the setback the immunisation programme suffered during Covid, when the number of children receiving zero doses shot up to 27 lakh, India managed to bring it down to 11 lakh by 2022, according to Unicef estimates. However, by 2023, the number will have risen to 16 lakh, according to Unicef.