Decoded: Who are zero-dose children and what does the Unicef report mean?

Acc to the latest World Health Organisation (WHO) and Unicef immunisation report, India follows Nigeria in having the highest number of unvaccinated children, with 1.6 million zero-dose kids in 2023

A recent report claiming that India is grappling with the challenge of ensuring that every child receives the essential vaccinations needed to protect against deadly diseases has raised concerns.

According to the recent WHO and Unicef report, India ranks second only to Nigeria in the number of children who received no vaccines in 2023. This stark reality highlights the gaps in the country’s immunisation coverage and the efforts required to bridge them.

The Unicef report revealed that India had the second-highest number of children who did not receive any vaccines in 2023, with 1.6 million "zero-dose" children, following Nigeria's 2.1 million. The report noted a two-percentage point decrease in diphtheria, pertussis, and tetanus (DPT) vaccine coverage, from 95 per cent in 2022 to 93 per cent in 2023. This vaccine serves as a proxy for the number of zero-dose children.

 

Nigeria topped the list with 2.1 million unvaccinated children in 2023. However, India’s neighbourhood has shown a somewhat better trend. Pakistan recorded around 396,000 unvaccinated children, while Afghanistan had 467,000 in the category during the period.

India lagging behind in measles vaccine too

India also had the third-highest number of children who did not receive the measles vaccine, with 1.6 million "measles zero-dose children." Nigeria topped the list with 2.8 million, followed by the Democratic Republic of Congo with 2 million. India was among ten countries that accounted for 55 per cent of children without measles vaccines globally.

The 2023 WHO and Unicef estimates of national immunisation coverage (WUENIC) were based on data reported by member states to WHO and Unicef up to July 1, 2024, as well as the 2024 World Bank Development Indicators Online and the United Nations Population Division's 2024 revision.

The report noted a slight increase in the number of zero-dose children from the previous year, with a rise of 600,000 from 13.9 million to 14.5 million. It also highlighted that the total number of un- and under-immunised children reached 21 million in 2023, which is 2.7 million more than the baseline value.

Who are zero-dose children?

Zero-dose children are those who have not received any routine immunisation services, as defined by the WHO. These children are operationally identified as those who did not receive their first dose of the DPT vaccine. This metric helps highlight immunisation gaps and drives efforts to address them. The calculation involves the difference between the estimated surviving infants and the number of children who received the first DPT dose.
 

Are Indian children at increased risk?

Zero-dose children in India are those who have not received the first DPT dose, typically given at six weeks. However, many zero-dose children might still receive other vaccines administered at birth, as per a Times of India report. The latest National Family Health Survey (2019-21) shows that 88.6 per cent of births occur in health facilities.

Moreover, 95 per cent of children under two received the birth dose of the Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis, indicating that even children born outside health facilities accessed immunisation services.

According to a recent United Nations estimate, India had 1.6 million zero-dose children in 2023, up from 1.1 million in 2022. With approximately 23 million births annually, this suggests that 6.9 per cent of surviving infants in 2023 were zero-dose children.

Indian govt rebuts WHO and Unicef report

Indian officials have disputed the Unicef report, arguing that the country's large population was not adequately considered when comparing vaccination data with 19 other countries in the latest WHO and Unicef national immunisation coverage estimates. "Even though India has the second-highest number of zero-dose children globally, it represents only 0.11 per cent of the country's total population," stated sources from the Union Health Ministry.

Study on zero-dose immunisation in India

However, a study supported by the Gates Foundation, published in the Journal of the American Medical Association (JAMA) in February 2023, examined zero-dose immunisation trends over 29 years (1993 to 2021) using anonymised data from all five rounds of India's National Family Health Survey (NFHS). The study found a significant decrease in the proportion of zero-dose babies, from 33.4 per cent in 1993 to 6.6 per cent in 2021.