Zero is the only acceptable number when it comes to children who go unimmunised. Zero children left behind, zero missed doses, zero preventable deaths. Yet, across the world, millions of children still miss out on life-saving vaccines—often with tragic consequences.
Every seven seconds, a newborn dies somewhere in the world. More than two million newborns die in their first month of life with another two million stillborn. A heartbreaking number of these deaths are preventable—with immunisation playing a critical role.
In the last three decades, India has slashed its under-five mortality rate from 126 to 32 per 1,000 live births—a stunning achievement that speaks to the power of public health programmes, particularly the Universal Immunisation Programme, which now reaches 29 million pregnant women and 27 million newborns annually.
Today, India’s national immunisation coverage stands at an impressive 93%. But in public health, it’s often the last mile that is the toughest. The remaining 7%—those not yet covered—represent the most vulnerable and hardest to reach. And each one of them deserves our attention.
State governments play a crucial role in expanding immunisation coverage, particularly in regions where populations are sparsely distributed, and terrain is challenging. For example, Arunachal Pradesh has made remarkable progress despite having 26 hard to reach districts. In some areas, health care workers have even used elephants to reach remote villages—demonstrating extraordinary commitment to ensuring no one is left behind.
Who are the children being missed—and why? The reasons are varied, complex, and heartbreakingly human.
Unlike in many parts of the world where supply-side issues dominate, India’s challenges lie elsewhere. Political will and vaccine availability are not the problems. What stand in the way are social myths, lack of awareness, mobility, and misinformation.
In some communities, lingering myths persist. One disturbing belief is that vaccines cause infertility in boys—leading some families to immunise daughters while leaving sons at risk. In others, the gap is simply a lack of awareness. Many parents don’t know that a full immunization schedule involves nearly 30 doses over 16 years. Without them, the risk of preventable disease remains dangerously high.
For migrant families, it’s often a case of access and record-keeping. They may not know that vaccines are available across India, or they may lose track of their child’s vaccine history as they move from place to place.
To fix this, solutions must be local, inclusive—and smart.
In Arunachal Pradesh, community leaders have played a vital role in mobilising zero-dose children in remote districts. In the state’s Longding district, pastors have organized awareness camps during Sunday mass prayers, while Buddhist Bhantes (monks) in Namsai, Tawang, and West Kameng have boosted vaccination coverage through strong community advocacy.
Maharashtra too is thinking out of the box. There, health workers partnered with members of the transgender community—who are traditionally invited to bless newborns—to spread immunisation messages in peri-urban slums in Thane district. It’s an approach rooted in culture and trust, where the messenger is just as important as the message.
These efforts are backed by robust national programmes. Mission Indradhanush and its intensified variant are bringing vaccines to underserved communities, particularly in hard to reach and vaccine-hesitant populations. Complementing these is the Community of Practice for Demand (CoP-D)—an initiative of the ministry of health and family welfare with support from UNDP.
CoP-D brings together ASHAs, ANMs, community leaders, influencers, and civil society groups to work closely with vulnerable communities to co-create strategies tailored to local realities. It enables strategic planning at state and national levels, encourages community-led innovations, and draws from global best practices to develop solutions that are truly made for India.
But community engagement alone isn’t enough. We need robust health care delivery systems.
This is where India’s digital prowess shines. The Electronic Vaccine Intelligence Network (eVIN) has revolutionised the way vaccines are tracked and stored—providing real-time data from over 30,000 cold chain points across the country.
Building on that success is U-WIN—India’s latest digital innovation, launched by Prime Minister Narendra Modi in 2024. U-WIN tracks vaccinations from pregnancy through childhood, registers doses, sends reminders, and ensures no child slips through the cracks. In just one year, it has registered over 23.5 million pregnant women, 67.7 million children, and tracked more than 375 million doses. A true game changer.
Together, eVIN and U-WIN are not just digitising health care—they’re democratising it. These platforms offer a blueprint for countries around the world, showcasing how technology can make health care more transparent, efficient, and equitable.
We’ve done it before—and we can do it again.
India was one of the first countries to eliminate polio. It carried out one of the largest Covid-19 vaccination campaigns on the planet. We know what it takes: innovation, collaboration, and unwavering commitment.
As we move beyond World Immunisation Week, the message remains urgent: every child deserves a fair start in life—regardless of gender, geography, or income. Because every child missed is a story left unfinished. And zero is not just a goal. It’s a promise.
This article is authored by Angela Lusigi, resident representative, UNDP India and Biyuram Wahge, minister for health & family welfare, Arunachal Pradesh.
