India had 1.44 million children in the ‘zero dose’ category in 2023, most of whom are poor, illiterate, tribal, Muslim, and migrant communities. Geographic barriers, social hesitancy, disorganised governance in urban slums, and lack of monitoring are the major challenges. Schemes like Mission Indradhanush have had limited effectiveness. Solutions require community-based engagement, technology-based tracking, trained health workers, and social behaviour change communication. Unless we link policy to the rights of the last person, universal vaccination will remain a dream. Only a just health policy can lay the foundation for the future.
In a country like India with a huge population, universal vaccination is not just a health campaign but an important step towards social justice. But when we see that millions of children are still in a ‘zero dose’ situation, that is, they did not get a single vaccine after birth, it is natural to ask where we are missing? Is our health policy based only on statistics or is it actually benefiting the most deprived sections of society?
According to a Lancet (2024) report, in 2023, there were 1.44 million children in India who did not receive any vaccine. This number is not just a statistic but the untold suffering of families whose children were denied health services. The highest number of zero-dose children is seen in states where there is a strong combination of poverty, illiteracy, ethnic or religious marginalization, and administrative apathy. States like Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Gujarat, and Maharashtra are prime examples of this, where socio-economic disparities limit access to vaccination.
Poverty and maternal education level are among the biggest factors hindering vaccination. For a daily wage laborer, who works from morning to evening in the struggle for livelihood, taking the child to a government hospital becomes a ‘losing’ decision. If the wages are not earned that day, then the stomach is not filled. In such a situation, access to health facilities becomes a luxury. Along with this, if the mother is uneducated, then she is not fully aware of the need, process, and benefits of vaccination. This lack of information deprives children of the right to health.
Another important aspect is the situation of tribal, Muslim, and migrant communities. Vaccination rates within these communities are extremely low, and mistrust, cultural apprehensions, and suspicion of the government run deep. Religious misconceptions and rumours, especially in Muslim-dominated areas, lead to perceptions of vaccination as ‘haram’ or a conspiracy against the body. Misinformation spread during COVID-19 also reinforced this mistrust. People saw no clear communication at vaccination camps, only government pressure. This further increased fear among them.
Talking about urban slums and remote areas, the condition of health services there is even more pathetic. In the states of Northeast India like Nagaland, Meghalaya, and Arunachal Pradesh, difficult geography, limited health workers, and lack of infrastructure are the biggest obstacles to the success of the vaccination program. In these areas, neither the vaccine reaches on time, nor the trained personnel, nor are there frontline workers to provide information to the mothers.
Now let’s talk about governance and program failures. Mission Indradhanush was an ambitious scheme that aimed to achieve 90% full vaccination coverage. But according to the National Family Health Survey-5 (2019–21), this figure could reach only 76%. In many districts, it is even less. The reasons behind this are – administrative apathy, shortage of health workers, and failure of monitoring at the ground level. The division of health responsibilities in urban areas is so entangled between the state government, municipal corporation, and other institutions that accountability is nowhere to be seen. There is no clear determination of who will take responsibility for vaccination in a slum.
Also, the lack of monitoring mechanisms is a big problem. We do have systems like the Electronic Vaccine Intelligence Network (eVIN) that do the logistical tracking of vaccines, but this system does not ensure follow-up at the child level. It is not known which child took which vaccine and which one was missed. The COVID-19 pandemic shook this entire system. When all resources were diverted to Covid vaccination, programmes like routine immunisation went into the background, due to which the vaccination of lakhs of children stopped.
These problems cannot be solved by mere announcements or technical fixes. This requires policy changes that are based on the values of social justice. First of all, vaccination plans will have to be run under community-specific and area-specific strategies. Under Mission Indradhanush 5.0, micro planning and social behavior change communication (SBCC) will have to be given priority in high-burden districts. Just delivering the vaccine is not enough; trust and participation will have to be created among the people.
For this, our grassroots health workers – like ASHA, ANM, and Anganwadi workers – will have to be empowered. They should not only be provided with training and mobility, but also be given respectable incentives. Only when health workers work with confidence in their area will families trust them. Along with this, the National Urban Health Mission will have to be implemented strongly, so that millions of children living in slums also get the facility of regular vaccination.
The use of technology is meaningful only when it is in the public interest and reaches the last person. Vaccination records linked to Aadhaar, mobile-based vaccination vans, and artificial intelligence (AI)-based dashboards all need to be implemented so that every child has a digital record and missed children can be identified immediately. But a human touch is necessary along with technology. Vaccination is not just an injection; it is a relationship of trust – this needs to be understood.
The importance of community participation has increased even more today. Self-help groups, religious leaders, teachers and social workers will have to be included in the campaign so that the message reaches every household that vaccination is a right of children, not an unnecessary risk. Countries like Bangladesh have proved that if vaccination is done door-to-door, both reach and acceptance increase. In an African country like Rwanda, mobile health clinics have given miraculous results in remote areas. India will have to take inspiration from them and create its own model.
The government should not focus only on achieving the target, but it should also see who is being left out and why. Policies should be made keeping the socially excluded sections in mind. Otherwise, we will keep bringing new schemes every year, keep showing an increase in the figures, and the childhood of millions of children in the country will continue to grow up without protection and at risk.
India’s universal immunization goal will only be realised if there is integrity at all three levels of policy, intention, and execution. The biggest measure of the progress of any society is its health status, and the health of children is paramount in that. If we are not able to ensure that every child gets his or her first vaccine on time, we must ask ourselves — are we really building an equitable and inclusive nation?
In short, India should not leave the problem of zero-dose children as the concern of the Ministry of Health. It is a national challenge in which all departments, communities, and citizens have a role to play. It is not just a matter of children’s health, but also a question of the future of the country’s future generations. If we all come together can make vaccination not just a government responsibility but a social movement, then perhaps in the years to come, the dream of ‘zero deprivation’ instead of ‘zero dose’ will be realised. This dream is the foundation of a true democracy and social justice.
