Not necessarily. Since zero dose means those babies who did not receive the first dose of DPT – which in India is given at six weeks – it’s possible that most zero-dose children have got most or all vaccines that are given at birth. The latest National Family Health Survey (2019-21) indicates that 88.6% births are institutional or those happening in a health facility. However, the proportion of children less than two years of age who received the birth dose of the BCG vaccine against TB is 95%. This indicates that even children who were not born at a health facility were accessing immunisation services. According to the latest UN estimate, there were 1.6 million zero-dose children in India in 2023, up from 1.1 million in 2022. With an estimated 23 million births every year, it would mean that 6.9% of surviving infants in 2023 were zero-dose children.
Vaccines given at or soon after birth include BCG (given at birth or as early as possible till one year of age), Hepatitis B vaccine (given at birth or as early as possible within 24 hours), and oral polio vaccine (OPV; at birth or as early as possible within the first 15 days). At six weeks, the baby gets a single dose fractional inactivated polio vaccine (IPV), another dose of OPV (oral rotavirus vaccine), first of two doses of pneumococcal conjugate vaccine and first of three doses of pentavalent vaccine, which is a combination of diphtheria, pertussis, tetanus, Hepatitis B and Haemophilus Influenzae type B (Hib) vaccines. Hence, if a baby has missed the first dose of DPT, it is assumed that they have likely missed all the others to be given at six weeks. In WHO/UN estimates, not receiving the first dose of DPT-containing vaccine is understood to signal a lack of access to routine immunisation as a whole, which might not be the case.
A study supported by the Gates Foundation published in the Journal of the American Medical Association (JAMA) in Feb 2023 looked at zero-dose immunisation over 29 years (from 1993 to 2021; see chart) using anonymised data from all five rounds of India’s National Family Health Survey (NFHS). It found that the proportion of zero-dose babies decreased from an overall 33.4% to 6.6% between 1993 and 2021.
In absolute numbers, there was a huge fall in the number of zero-dose children in 10 years from 2006 to 2016. From about 85 lakh zero-dose children in 2006, it fell to just over 16 lakh by 2016. However, the annual relative decrease was highest in the five-year period between 2016 and 2021 at 7.4% per year. This was after the launch in 2014 of Mission Indradhanush, which aimed to cover all unvaccinated or partially vaccinated children. After the setback that the immunisation programme suffered during Covid, when the number of zero-dose children went up to 27 lakh, India managed to bring it down to 11 lakh in 2022 according to Unicef estimates. However, in 2023 that number has gone up to 16 lakh, according to Unicef.