Childhood immunisations in India during the COVID-19 pandemic

The national immunisation programme run by the Government of India is one of the largest in the world, with an annual reach of over 26 million children and 29 million pregnant women.4 Mission Indradhanush was launched in 2014 to extend this reach and achieve full immunisation for 90% of children, and the programme was further intensified in 2019.4 5 While remarkable progress has been made, there is evidence of existing inequalities in coverage.6 Early in the pandemic, soon after the lockdown was announced, there were major disruptions in health services, especially in women and children’s services. The National Health Mission’s health management and information system reported a substantial decrease in routine immunisation services relative to the previous year, indicating that in March 2020 at least 100 000 and 200 000 children missed their BCG and pentavalent (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b) vaccines, respectively.7 8 Researchers modelled different scenarios and used the Lives Saved Tool (LiST, a mathematical modelling tool to estimate the impact of programme coverage of maternal, newborn and child health on mortality at a country level9) to demonstrate that widespread disruption to health systems could lead to substantial increases in maternal and child deaths.10 In India they estimated that an additional 49 000 child deaths and 2300 maternal deaths in a month could be attributable to severely disrupted services.10 Applying the current population demographic data in India, estimates suggested that eventually over 27 million children will miss out on diphtheria tetanus pertussis vaccines and other health services, resulting in a 40% increase in child mortality over the next year.11 If vaccination services are not restored and barriers to access are not addressed, disparities will become more pronounced and the number of zero-dose children will likely increase. Analyses from the West African Ebola outbreak in 2014–2015 suggest that the increased number of deaths caused by other infections such as measles, HIV and tuberculosis attributable to health system failures exceeded deaths from Ebola.2 13 A sustained period of disrupted immunisation can result in the accumulation of susceptible individuals, which in turn can lead to disease outbreaks.14 Given the disruptions and the realisation of the dire consequences, the Government of India declared immunisation an essential health service in April 2020 and issued g