Building trust to reach zero-dose children in India
One of the world’s largest immunization initiatives is protecting children left behind during the pandemic
Shalu Vishal Kale and her family live under an overpass in the bustling community of Bandra, in Mumbai. She sells flowers at traffic stops, earning about $5 USD a day.
Shalu has three children, aged between 2 months old and 4 years old. Until recently, they were all zero-dose children, meaning they hadn’t received any routine vaccinations that would protect them from preventable diseases like measles and polio. For Shalu, taking her children to a vaccination center to get the vaccines they needed would mean losing her daily earnings, which her family relies on. But thanks to the launch of an immunization programme in India, known as Intensified Mission Indradhanush (IMI), her children are now fully protected.
As part of the initiative, health workers travel to reach families like Shalu’s. The programme is making sure that children in India get the important vaccines they missed during the COVID-19 pandemic.
Currently about 25 per cent of children under 2 and pregnant mothers missed out on routine vaccinations
The IMI initiative, launched in 2018, is part of India’s Universal Immunization Programme (UIP), which is one of the world’s largest public health efforts. IMI’s objective is to reach all children under the age of 2 and pregnant women who have missed out on routine vaccinations. The aim is to achieve 90 per cent vaccination coverage cross the country, with the current rate currently at about 75 per cent.
UNICEF is a key partner in this effort and is working directly with the government of Maharashtra, which is the state that Mumbai is the capital of. UNICEF spearheads social mobilization efforts, social and behaviour change projects, and oversees cold chain logistics.
“We still have one child out of four who is not getting every vaccine. This one child resides in communities which are the urban poor, migrant communities or marginalized communities. They’re in scattered geographical areas that are hard to reach and where access to immunization is difficult.”
As Chandrasekar notes, there are several factors that contribute to the significant number of zero-dose children in India. These children are predominantly from low-income families, where caregivers are faced with financial and time constraints. They often can’t afford to lose their daily wages or travel to health facilities.
Furthermore, misinformation is a contributing factor, with some caregivers fearful that their child might experience a bad reaction.
“Sometimes fever or swelling post vaccination makes the community wary of getting their child vaccinated. However, few families are aware of the benefits of immunization and get their children vaccinated.”
UNICEF has been working directly with the Brihanmumbai Municipal Corporation, which is the governing civic body of Mumbai, to promote trust and spread awareness. A team of experts, including doctors, social health activists, midwives and community health volunteers have been traveling to the homes of families. It’s there that they can directly address any questions and reassure caregivers that have any concerns.
It’s crucial that more families like Shalu’s are reached, as the urban slum communities they live in are among those with the highest rate of zero-dose children. Significant progress has been made, but the COVID-19 pandemic disrupted those advances.
Before the pandemic, the number of zero-dose children in India stood at around 1.3 million. In 2021, the figure alarmingly went up to 2.7 million.
Outbreaks of preventable diseases like measles have been seen in cities like Mumbai. If a child is not vaccinated against measles and contracts the disease, they’re at a much greater risk of experiencing complications that can potentially be fatal.
Some families also migrated during the pandemic and that’s proven to be a contributing factor to the fall in immunization rates. This campaign, supported by UNICEF, is committed to reaching those families, with mobile health teams deployed to bus terminals and railway stations.
Among the children they’re trying to reach is Sugra who is 13 months old. Her father, Abdul is a bag maker and hails from Basti, in the state of Uttar Pradesh, which is about 1,000 miles away. The family has delayed getting Sugra vaccinated because they keep travelling back to their native village. Abdul adds that Sugra has been unwell, and that’s an additional reason she remains unvaccinated.
Another community that’s previously been difficult to reach is a nomadic tribe in the city of Aurangabad, east of Mumbai. The tribe has historically kept their children unvaccinated, believing that a thread that’s blessed by the local religious leader and tied around arms will protect them from ailments. Furthermore, misinformation that vaccines lead to sterility and impotence has spread. The absence of vaccines, combined with often poor sanitation and low nutrition levels, place children here at high risk of preventable diseases.
In an effort to reach tribal communities, UNICEF is partnering with civil society partners to mobilize community leaders and influencers. Religious leaders are also involved in the process. They’ll engage with the community, advocating for good sanitation, nutrition and health, which includes getting vaccines. Their efforts have begun to have a significant impact in both urban and rural areas.
For Rajeshwari Chandrasekar, UNICEF’s field chief in the region, it’s clear that the Intensified Mission Indradhanush initiative is having a positive impact.
“Immunization is a shared responsibility that involves communities, service providers and policy makers alike. Health workers are working relentlessly to narrow the gap in immunization coverage in urban slums and vulnerable communities by going door-to-door. They’re ensuring that children get an opportunity to go to school and grow up healthy.”
