Title : The last mile: Addressing India's immunization gap with zero-dose insights from WUENIC estimates
Abstract:
Reaching zero-dose children remains one of the greatest challenges in global health, directly influencing under-five mortality and health equity. The Immunization Agenda 2030, endorsed by the World Health Assembly, calls for targeted action to ensure that no child is left unprotected. In 2023, 14.5 million children worldwide missed basic vaccines, including 1.6 million in India alone, underscoring the fragility of immunization systems when confronted with socioeconomic inequalities, environmental disruptions, workforce fatigue, and digital divides. This narrative review synthesizes WUENIC and NFHS data to explore trends, determinants, and innovations in addressing zero-dose burdens, with implications that extend beyond national borders. India’s progress illustrates both vulnerability and resilience: between 1992 and 2021, zero-dose prevalence declined by 27%, though WUENIC estimates indicated a temporary 2% setback in 2023. Encouragingly, 2024 data reported a 43% recovery, demonstrating how robust policies and adaptive systems can reverse disruptions. Crucial to this recovery were interventions that moved beyond traditional catch-up drives such as equity-focused microplanning, climate-resilient infrastructure, empowered frontline workers, and interoperable digital health systems. These approaches provide globally relevant lessons for shaping sustainable, inclusive immunization strategies. As the burden of zero-dose children accounts for nearly half of vaccine-preventable deaths in low- and middle-income countries, tackling this challenge is not only a matter of disease prevention but a pathway to equity, resilience, and stronger health security worldwide. Integrating digital innovations, climate adaptation, and people-centered strategies into immunization programs represents a transformative opportunity to reduce disparities and strengthen global health systems; ultimately shaping a future where access to life-saving vaccines is universal, equitable, and sustainable.
Keywords: Zero-dose children, Immunization, Equity, Digital health, Global health resilience
