Why India’s children’s vaccination stats depend on which report you read

At a time when the slow pace of Covid-19 vaccination drive at around 1.3 million doses a day compared to the at least 10 million a day that some experts have been seeking, Prime Minister Narendra Modi’s much awaited address to the nation on Monday, June 7th evening threw up some important points to ponder on India’s immunization plans.

The prime minister, referring to the pre-covid days, gave his government credit for taking up child immunisation in a mission mode and making a huge impact. He said the country had just around 60 per cent child immunization coverage in 2014, when his government was voted to power. But then, through varied initiatives like Mission Indradhanush (MI) and Intensified Mission Indradhanush (IMI) the coverage was expanded and extended to reach over 90 per cent and was all set to go beyond when Covid-19 walloped India.

But look closely at India’s child immunization journey and it seems replete with numbers and a definition conundrum. But then, it is hard to ignore, not just because of the precious group of population one is dealing with but also because of the absolute numbers. Afterall, nearly 27 million new-borns need immunization each year in India.

First the definition of full immunization: The World Health Organisation (WHO) defines it as the percentage of one-year-olds who have received one dose of Bacille Calmette-Guérin (BCG) vaccine, three doses of polio vaccine, three doses of the combined diphtheria, tetanus toxoid and pertussis (DTP3) vaccine, and one dose of measles vaccine. Numerator: Number of children aged 12–23 months receiving one dose of BCG vaccine, three doses of polio vaccine, three doses of DTP3 vaccine, and one dose of measles vaccine. Denominator: Total number of children aged 12–23 months surveyed.

The National Family Health Survey (NFHS) brought out by the ministry of health and family welfare is what most experts turn to. The NFHS-5 (2019-20), the latest in the series, released in December 2020, follows the WHO definition of children who are in the age bracket of 12 to 23 months. But the Niti Aayog SDG (Sustainable Development Goals) India Index 2020-21 released on June 3, 2021, gives data based on percentage of children fully immunised but in the age group of 9-11 months.

Here are some examples of what the two definitions do to numbers for same states:

– For Maharashtra, the Niti Aayog index definition puts the coverage at 100 per cent while the NFHS-5 data puts it at 81.7 per cent.

– Similarly, for Bihar, the numbers are 94 per cent and 82.7 per cent respectively.

– For Assam, 85 per cent and 71.8 per cent.

– For Himachal Pradesh, 86 per cent and 96.4 per cent.

– For Kerala, it is 92 per cent and 85.2 per cent respectively.

By Niti Aayog SDG India index, the national figure is 91 per cent but then the NFHS-5 is not yet complete with the data out only for just about half the Indian states.

To get a more clearer picture on the progress made thus far, there is the Roadmap document for achieving 90 per cent full immunization brought out again by the ministry of health and family welfare in January 2019. It talks of immunization coverage among children aged 12-23 months in the country increasing at a very slow pace of around 1 per cent each year and rising from 35 per cent in 1992-93 to 62 per cent in 2015-16. On the status as on January 2019, this document points to the following:

– 91 districts in India have had less then 50 per cent FIC (full immunization coverage). – 555 districts have had between 50 and 90 per cent FIC. – 54 districts have had over 90 per cent FIC.

Taken together, it does convey the deep inter-state differences that we still have as also the long distance that is yet to be covered. What has

complicated the process is the pandemic hitting the country in 2020 which many experts believe would have impacted the immunization drive though the numbers again need to looked at closely across states and different regions. If this is not all, then there is one more data point that adds to the immunization conundrum: A report from Gavi – Meeting of the Strategic Advisory Group of Experts on Immunization put out in October 2015 lists India along with 15 other countries that had reached 80 to 89 per cent coverage in 2014. This is for “Routine immunisation coverage in Gavi countries.” But then, we are leaving that aside for the moment and the definitions used therein.