A new analysis published in The Lancet journal has revealed sobering data showing that more than 1.44 million children in India remained unvaccinated in 2023. This figure places India among eight countries that accounted for over half of the world’s 15.7 million zero-dose children last year. The findings underscore how the COVID-19 pandemic severely disrupted childhood immunisation and reversed decades of steady progress.
The study used comprehensive data from the Global Burden of Disease 2023 project. It covered vaccination trends across 204 countries from 1980 to 2023. Researchers focused on 11 critical vaccines recommended by the World Health Organisation (WHO). These vaccines include those protecting children against diphtheria, measles, and polio. They also protect against tuberculosis, pneumonia, and rotavirus.
The report has sounded the alarm on the rising number of children who did not receive even a single dose of life-saving vaccines in their first year of life. This group, commonly referred to as “zero-dose” children, is especially vulnerable to preventable diseases and complications that can be fatal.
THE DECLINE AND REVERSAL OF PROGRESS IN VACCINATION
The WHO first launched the Essential Programme on Immunisation in 1974. It has since saved an estimated 154 million lives worldwide. From 1980 to 2019, there were notable improvements, as the number of zero-dose children fell by a dramatic 75 percent. According to the study, the figure dropped from nearly 59 million in 1980 to just 14.7 million by 2019.
Yet, the global health crisis triggered by the COVID-19 pandemic reversed much of this hard-won progress. In 2021, the number of zero-dose children climbed again to 18.6 million, mainly due to the disruption of routine health services. In India, immunisation programmes suffered setbacks when lockdowns and public health emergencies forced the suspension of vaccination campaigns. Many families also hesitated to visit healthcare facilities out of fear of exposure to COVID-19.
While vaccination rates began to recover after the acute phase of the pandemic, the lingering gaps remain significant. The Lancet study shows that in 2023, India still had 1.44 million unvaccinated children. The issue affected both low-income and high-income countries. Several high-income nations also recorded declines in routine immunisation during the pandemic years.
UNVACCINATED; SUB-SAHARAN AFRICA AND SOUTH ASIA DISPROPORTIONATELY AFFECTED
Globally, more than half of all zero-dose children were found in just eight countries. Sub-Saharan Africa accounted for approximately 53 percent of the unvaccinated children, reflecting structural weaknesses in health systems and challenges posed by conflict, poverty, and poor infrastructure. South Asia contributed about 13 percent of these cases, underscoring that large populations and inequitable access continue to fuel disparities.
The top eight countries with the highest numbers of unvaccinated children in 2023 were:
- Nigeria with 2.48 million
- India with 1.44 million
- Democratic Republic of Congo with 882,000
- Ethiopia with 782,000
- Somalia with 710,000
- Sudan with 627,000
- Indonesia with 538,000
- Brazil with 452,000
These figures highlight how concentrated the problem has become, calling for targeted solutions in these nations to prevent further backsliding.
UNVACCINATED‘; CHANGING PRIORITIES DURING THE PANDEMIC
The study noted that during the pandemic, healthcare priorities shifted toward addressing respiratory illnesses caused by COVID-19. Vaccines such as pneumococcal and rotavirus received more attention. Meanwhile, coverage for core vaccines like diphtheria-tetanus-pertussis (DTP), measles, and polio declined. This shift inadvertently created immunity gaps among young children.
The authors argue that while pandemic preparedness is essential, it should never come at the cost of routine immunisation. The decline in coverage increases the risk of outbreaks of diseases that were previously well-controlled or nearly eradicated.
BARRIERS HINDERING IMMUNISATION EFFORTS
Several factors continue to hinder vaccination efforts in India and similar settings. Rural areas often lack adequate healthcare infrastructure, making it difficult to transport vaccines and maintain the cold chain. Vaccine misinformation and hesitancy, fueled by social media, further discourage parents from bringing children for immunisations.
The study also highlighted that conflict-affected areas face additional barriers. Displacement, insecurity, and the destruction of clinics make it nearly impossible for health workers to reach vulnerable populations.
MEETING THE IMMUNISATION AGENDA 2030 GOALS
The WHO’s Immunisation Agenda 2030 has set ambitious targets to halve the number of zero-dose children by 2030 compared to 2019 levels. The aim is to achieve 90 percent coverage for all childhood vaccines globally. Achieving this will require a renewed focus on equity, resilience, and community trust in vaccines.
According to the study, the following strategies can help bridge current gaps:
- Strengthening Primary Healthcare Systems
Countries must invest in robust primary healthcare infrastructure. This includes training health workers, ensuring the availability of essential vaccines, and improving supply chains to reach remote regions. - Increasing Public Awareness and Combating Misinformation
Public education campaigns should clearly explain the benefits and safety of vaccines. Partnerships with community leaders and local organisations can help build trust and dispel myths that undermine immunisation. - Prioritising Conflict Zones and Fragile Settings
Health authorities must develop strategies tailored to conflict-affected regions. Mobile clinics, local partnerships, and dedicated funding can ensure that children in these areas are not left behind. - Supporting Global Campaigns
The WHO’s ‘Big Catch-Up’ campaign was launched in the aftermath of COVID-19. It is an example of a large-scale initiative. This initiative aimed at restoring vaccination coverage. Continued support and funding for such campaigns are critical to reaching zero-dose children.
THE WAY FORWARD FOR INDIA AND OTHER HIGH-BURDEN COUNTRIES
For India, achieving better vaccination coverage will require both renewed investment and innovative solutions. The government has already introduced digital tools. One such tool is the Electronic Vaccine Intelligence Network (eVIN). This network helps monitor vaccine stocks and improve distribution. However, experts note that digital tools must be complemented by community outreach and targeted interventions for vulnerable populations.
India’s experiences during the pandemic also highlight the importance of flexibility and adaptability in immunisation strategies. For instance, combining COVID-19 vaccination drives with routine childhood vaccinations can help make healthcare delivery more efficient.
UNVACCINATED; A CRITICAL WINDOW OF OPPORTUNITY
The Lancet study shows that despite decades of progress, childhood immunisation remains fragile and uneven. The pandemic has exposed and widened gaps that threaten children’s health and survival in countries like India, Nigeria, and Ethiopia.
With only five years left to achieve the Immunisation Agenda 2030 goals, policymakers must act quickly to strengthen health systems, rebuild community trust, and close immunity gaps. Failure to act now could undo decades of progress and leave millions of children vulnerable to preventable diseases.
Sustained political commitment, adequate funding, and international cooperation will be key to ensuring that every child, regardless of where they live, receives the protection they need to survive and thrive.
