Zero‑Dose Children: A Global Emergency and the Path Forward

-

Zero‑dose children are those who have not received even the first dose of the diphtheria, tetanus, and pertussis (DTP) vaccine by their first birthday. This marks them as completely unprotected from serious childhood illnesses and indicates a failure to provide basic health services, a powerful marker of inequity and exclusion in health systems 

Global Trends: Progress Lost

A. Historic Gains and Recent Reversals

  • From 1980 to 2019, the number of zero‑dose children dropped from ~59 million to ~14.7 million, a ~75% decline.

  • However, coverage gains slowed drastically since 2010. Between 2010–2019, measles vaccination declined in 100 countries, and 21 of 36 high-income countries saw drops in DTP, measles, polio, or TB immunisation.

  • The COVID-19 pandemic worsened matters: zero‑dose children surged to 18.6 million in 2021, then modestly recovered to 15.7 million by 2023.

B. Vulnerable Regions & Countries

  • Over 50% of zero‑dose children live in just eight countries Nigeria, India, DR Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil.

  • The most affected regions are Sub-Saharan Africa (~53%) and South Asia (~13%).

C. Emerging Threats

  • Even high-income countries are seeing resurgences in measles and polio due to rising vaccine hesitancy.

The Immunisation Cascade: How Vaccination Progresses

A major multi-country study across 92 LMICs found:

  • Zero‑dose prevalence is ~7.7%, while 76.8% of children who received any vaccine followed through with all four basic vaccines (BCG, polio, DTP, measles).

  • Drop-out rates are high: 4% drop between BCG → DTP1, 14% from DTP1 → DTP3, and 9% from DTP3 → measles vaccine .

Key insight: reaching children for their first routine vaccine significantly increases the chances of full immunization.

India in Focus: Second‑Highest Zero‑Dose Numbers

  • India had ~1.44 million zero-dose children in 2023, second only to Nigeria (~2.48 million).

  • This cohort represents ~13% of global zero‑dose children and ~23% of South Asia's total..

  • While absolute numbers are large, this equates to ~6% of India’s birth cohort—a decline from ~2.7 million in 2021 .

Geographic and Demographic Disparities

  • High-prevalence areas include large states Uttar Pradesh, Bihar, Maharashtra, Rajasthan, MP, Gujarat and tribal regions in the Northeast .

  • Disadvantaged groups: poor households, mothers with low education, Scheduled Tribes, and Muslims are disproportionately affected .

Impact of COVID-19

  • Routine immunization dropped sharply during lockdowns and hospital disruptions. Some recovery has occurred, but pre-pandemic coverage levels haven’t fully bounced back.

The COVID Disruption-a Setback and Partial Recovery

  • 2019: ~1.4 million zero-dose children

  • 2021: surged to 2.7 million amid COVID-19 disruptions

  • 2022: decreased to ~1.1 million

  • 2023: climbed again to 1.44 million 

The data highlights both resilience and fragility in India’s immunization systems.

Why Zero‑Dose Children Matter

  • They are most at risk for vaccine-preventable diseases and often lack broader health services.

  • They serve as barometers of health system strength and equity finding them reveals where essential health services are failing.

  • In India, bridging this gap supports Universal Health Coverage goals and helps prevent outbreaks in marginalized communities .

Why Nigeria Tops the List

A. Geographic & Demographic Disparities

  • Northern Nigeria, especially rural areas, holds the most zero‑dose children, states like Sokoto, Bauchi, Kano, Borno, and Yobe are hotspots.

  • Residents include nomadic Fulani and remote rural communities with very limited access to healthcare infrastructure .

B. Conflict, Insecurity & Climate

  • Ongoing violence, armed banditry, and climate-driven displacement in the North hinder safe and regular access to health services .

C. Weak Health Systems

  • Frequent vaccine stock-outs and broken cold chains make parents less likely to return after a failed attempt.

  • Nigeria has around 1–2 doctors per 10,000 people, far below WHO recommendations; many centers rely on unpaid volunteers.

  • The COVID‑19 pandemic strained the system further, disrupting routine immunization.

D. Poverty, Education & Poverty

  • Zero‑dose children disproportionately come from the poorest, rural households, often earning less than $1.90/day, with uneducated mothers and no prenatal care.

E. Vaccine Hesitancy & Misinformation

  • Persistent rumors and mistrust, especially in predominantly Muslim communities in the North include fears of infertility, disease, or Western plots.

  • Around 42–50% of caregivers either distrust healthcare workers or question vaccine safety.

F. Systemic Inequities & Governance

  • Pronounced sub‑national inequality, e.g. DPT‑1 coverage ranges from 5% in Sokoto to 91% in Surulere, Lagos.

  • Weak data systems, poor planning, and insufficient funding at local levels further leave many kids unreached. 

What’s Being Done

Nigeria, with support from WHO, UNICEF, Gavi, Global Fund, World Bank, and others, has launched integrated campaigns, like “Big Catch-up” plans, mobile outreach, community health workers (CHIPS) targeting the ~2.1–2.3 million zero‑dose children.
Efforts focus on:

  • Upgrading cold‑chain and supply,

  • Leveraging religious and community leaders to counter misinformation

  • Incentivizing vaccinations in hard‑to‑reach zones (e.g. New Incentives’ CCT programs

Vaccine Hesitancy Among Muslims

A. Concerns Over Halal Status

  • Some vaccines contain porcine-derived products (e.g., gelatin), which are considered haram (forbidden) in Islam. Religious authorities in regions like Aceh, Indonesia, have labeled certain vaccines haram, causing coverage to drop drastically sometimes to below 10%.

  • Even when halal alternatives exist, lack of clear labeling leads to confusion and mistrust .

B. Divine Fate (Qadar) and Religious Fatalism

  • A belief that health outcomes are preordained by Allah leads some Muslims to reject vaccines as interfering with divine will.

  • In Guinea, 46% believed vaccination during Ramadan was forbidden; in Malaysia, similar beliefs prevail.

C. Distrust Fueled by Rumors and Historical Events

  • Conspiracy theories (e.g., vaccines causing sterility, containing HIV, or being Western ploys to weaken Muslim populations) became rampant in Pakistan, Nigeria, and North India, sometimes endorsed by some local imams.

  • The CIA’s fake vaccination drive in Pakistan (intended to locate Osama bin Laden) worsened public trust, contributing to attacks on vaccinators.

D. Social & Cultural Barriers

  • In South Asia, conservative customs like purdah, impede women’s mobility, making it harder for female caregivers or girls to access vaccination services.

  • Religious leaders and local community influencers often shape opinions, contributing substantial weight to hesitancy or acceptance.

Solutions: How to Eliminate Zero‑Dose Gaps

A. Strengthen Primary Health Systems

  • Global & Indian initiatives like Gavi’s 2030 goal and Mission Indradhanush aim to reduce zero-dose cases dramatically.

  • Investment in frontline services, midwives, outreach teams, and cold-chain infrastructure is essential.

B. Locate & Target High-Need Communities

  • Use GIS tools, registry data, and household surveys to identify hotspots e.g., 143 priority districts in India’s latest implementation plan .

C. Community Engagement & Trust-Building

  • Leverage community leaders, faith-based outreach, and culturally sensitive communication to counter hesitancy and misinformation.

D. Make Vaccination Accessible

  • Deploy mobile clinics, integrated health camps in remote and slum areas, and combine immunization with maternal and child health services .

E. Monitor Continuously & Follow Up

  • Ensure zero‑dose children who receive one vaccine complete their schedules by integrating campaign efforts with routine health systems.

F. Combat Misinformation

  • Transparent messaging, digital tools, and local influencers can mitigate false narratives especially vital in countries like India and Australia where hesitancy is rising.

Effective Approaches to Reduce Vaccine Hesitancy Among Muslims

A. Halal Certification & Transparency: Clearly labeling vaccines as halal-approved and ensuring ingredients align with Islamic values.

B. Engaging Religious Leaders (Ulama and Imams): Trusted clerics issuing fatwas endorsing vaccination and offering guidance during Friday sermons have been effective (e.g., Pakistan’s polio campaign).

C. Cultural Sensitivity in Messaging: Tailoring communication to respect practices like Ramadan fasting and female privacy (e.g., using female vaccinators).

D. Building Trust Post-Flunks: Address historical mistrust by acknowledging past harms (e.g., CIA operation), reinforcing health infrastructure, and establishing transparent systems.

E. Localized Outreach & Education: Engage communities directly with religious leaders, women’s groups, and healthcare workers to explain vaccines, dismantle myths, and highlight community protection.

Real-World Successes

  • Polio eradication in Pakistan & Nigeria: Fatwas, community engagement, and religious leader advocacy brought about a 99.9% reduction in polio cases.

  • Malaysia’s COVID-19 campaign: Religious clarifications ensuring the vaccine’s halal status minimized hesitancy.

The Road to 2030 and Beyond

  • The Immunization Agenda 2030 aims to halve zero-dose children compared to 2019 a target only 18 of 204 countries have met thus far.

  • Success requires equity-first approaches, bold investment, resilience in health systems, and community solidarity.

Zero‑dose children are not just a vaccination shortfall, they signal systemic neglect and deep inequities. While the COVID-19 era has disrupted progress globally, it also emphasizes the urgency of action.

India’s decline from 2.7 million to 1.44 million zero-dose children shows promise but sustaining and accelerating this requires targeted, community-centred strategies. Globally, prioritizing the first vaccine touchpoint will pave the way for stronger health systems, reduced inequity, and healthier generations ahead.

Location: India
Welcome to EcoVisionary. I'm Dr. Anitha V, an environmentalist passionate about exploring and sharing insights on the intricate relationship between humans and the natural world. Having successfully completed my Ph.D. in Environmental Sciences, my goal is to raise awareness of pressing environmental issues and inspire actionable solutions for a healthier planet. Through engaging articles, in-depth research, and thought-provoking discussions, I aim to empower readers to embrace sustainable practices and become stewards of the environment. Join me on this journey to create a more sustainable future, where every small step can lead to significant change.

Comments

Post a Comment

Popular posts from this blog

Cloudbursts in India

-
Image
A  cloudburst  is an extremely intense rainfall event typically  100 mm (≈4 inches) or more in under one hour , localized in a small area. It is not literally a cloud “bursting,” but results when moisture-laden cumulonimbus clouds suddenly release their stored precipitation over mountainous regions. When upward air currents weaken abruptly, enormous volumes of water rapidly descend as heavy rainfall. Why Do Cloudbursts Happen? Orographic Uplift : Moist air pushed up mountain slopes cools and condenses quickly. Thunderstorm Dynamics : Strong convection builds up water-heavy cumulonimbus formations. Atmospheric Instability : Sudden weakening of upward currents allows rapid fall of accumulated moisture. Topography & Land Use : Steep slopes, deforestation, unstable terrain amplify water run-off speeds. Climate Change Effects : Increasingly frequent and intense events linked to global warming trends, glacier melt, and changing monsoon patterns. Impacts of Cloudbursts ...
Read more

Electric Toothbrushes: Balancing Personal Care and Environmental Impact

-
Image
An electric toothbrush is a battery-powered device that uses rapid bristle motions either back-and-forth or rotating-oscillating to clean teeth effectively. The bristle movements are driven by a motor for sonic speeds or by a piezoelectric crystal for ultrasonic motions. These brushes are typically rechargeable, using inductive charging while resting on a charging base. Electric toothbrushes are categorized by their movement frequency: power brushes operate below the audible range, sonic brushes within the audible range (20–20,000 Hz), and ultrasonic brushes above the audible range, with up to 2,400,000 movements per minute. History The first electric toothbrush, the Motodent, was created by Tomlinson Moseley in 1937. In 1954, Dr. Philippe Guy Woog invented the Broxodent in Switzerland, designed for patients with limited motor skills and orthodontic needs, which entered the U.S. market in 1960 through E.R. Squibb and Sons. In the early 1960s, General Electric introduced a cordless, re...
Read more

Neurocysticercosis: A Pressing Public Health Concern in India During the 2025 Monsoon

-
Image
Neurocysticercosis (NCC) , a parasitic infection of the central nervous system caused by the larval stage ( cysticercus cellulosae ) of the pork tapeworm Taenia solium , has emerged as a pressing public health concern in India during the 2025 monsoon season . Recent reports, particularly from major cities such as Mumbai , highlight a disturbing rise in cases. The surge is attributed to monsoon-related flooding, sewage contamination, and compromised sanitation , which facilitate the fecal oral transmission of tapeworm eggs. Even individuals who do not consume pork remain at risk due to contaminated water and food. Epidemiology and Global Context NCC is the most common parasitic infection of the human nervous system and is a leading cause of acquired epilepsy worldwide. The World Health Organization (WHO) recognizes NCC as one of the leading causes of preventable epilepsy , especially in low- and middle-income countries. Globally, an estimated 2.5–8 million people are affect...
Read more

Addressing Antibiotic Pollution: WHO's First-Ever Guidance and its Global Implications

-
Image
In a groundbreaking move, the World Health Organization (WHO) has released its first-ever guidance aimed at reducing antibiotic pollution from pharmaceutical manufacturing processes. This guidance comes at a crucial time, as the world battles the rising threat of antimicrobial resistance (AMR), a phenomenon where bacteria evolve to resist the drugs designed to kill them, making infections increasingly difficult to treat. The Growing Threat of Antibiotic Pollution and AMR Antimicrobial resistance is one of the most significant public health challenges today. While overuse and misuse of antibiotics in healthcare and agriculture are primary drivers of AMR, another major contributor is the pollution caused by antibiotic production facilities. When antibiotic residues from manufacturing plants are released into the environment-especially in wastewater and solid waste-they can promote the growth of resistant bacteria. These resistant strains can spread globally through air, water, and human ...
Read more

Environmental and Health Effects of Sanitary Napkins and Pads

-
Image
Sanitary napkins and pads are widely used feminine hygiene products that offer convenience and accessibility. However, their environmental and health impacts have become a growing concern. Chemicals in Sanitary Napkins and Pads: Composition  and Effects Conventional sanitary pads are composed of layers of synthetic materials, adhesives, and superabsorbent polymers. These include: Polyethylene and Polypropylene Plastics : Used in the top and bottom layers to prevent leakage. These materials are non-biodegradable, contributing to long-term environmental pollution. Superabsorbent Polymers (SAPs) : Derived from petroleum, SAPs enhance absorbency but are linked to skin irritation and allergic reactions. Dioxins and Furans :  Byproducts of the bleaching process used to whiten the cotton and rayon components. Exposure to dioxins can disrupt the endocrine system and is associated with cancer and reproductive issues. Phthalates :  Used in some pads to improve flexibility, phthala...
Read more

The Growing Crisis of E-Waste: Environmental Impact, Consumerization, and Strategies for Reduction

-
Image
In our modern, technology-driven world, electronic devices have become an integral part of everyday life. From smartphones and laptops to household appliances and wearables, these gadgets provide convenience, connectivity, and efficiency. However, the rapid technological advancements and consumer demand for the latest products have created a mounting global challenge: electronic waste ( e-waste ). E-waste is one of the fastest-growing waste streams worldwide, and its improper disposal poses significant environmental and health risks.  E-Waste E-waste refers to discarded electrical or electronic devices that are no longer in use or functional. These items include everything from outdated mobile phones, computers, and televisions to refrigerators, washing machines, and even electronic toys. According to the Global E-waste Monitor 2020, the world generated over 53.6 million metric tonnes of e-waste in 2019, with predictions estimating that this figure could reach 74 million metric ...
Read more

Medical Waste Management: An Overview

-
Medical waste, also known as biomedical waste, refers to any waste generated during the diagnosis, treatment, or immunization of humans or animals, or in research activities related to these processes. Effective management of medical waste is crucial to prevent environmental pollution, health hazards, and the spread of diseases. Types of Medical Waste Medical waste can be broadly classified into the following categories: Infectious Waste : Waste contaminated with blood, bodily fluids, or other infectious materials. Examples: Bandages, surgical gloves, and laboratory cultures. Pathological Waste : Includes human tissues, organs, body parts, and fluids. Examples: Biopsies and autopsy materials. Sharps Waste : Objects capable of puncturing or cutting. Examples: Needles, scalpels, and broken glass. Chemical Waste : Consists of discarded chemicals from laboratories or medical procedures. Examples: Disinfectants, heavy metals, and solvents. Pharmaceutical Waste : Expired, unused, or contamin...
Read more

Trifluoroacetic Acid (TFA): A Rising Global Environmental Threat

-
Image
Trifluoroacetic Acid (TFA) , once primarily restricted to laboratory applications, has now emerged as one of the most widespread and persistent contaminants in the global environment. As an ultra-short-chain perfluoroalkyl acid (PFAA) and member of the broader PFAS “ forever chemical ” family, TFA is now increasingly detected in rainwater, rivers, groundwater, crops, and even in consumer products such as bottled water, tea, beer, and wine. Its highly stable molecular structure, anchored by strong carbon–fluorine bonds, renders it nearly impossible to degrade naturally, making it extremely persistent and mobile across ecosystems. Compounding this concern, TFA is not only directly released but also forms as a terminal degradation product of numerous modern industrial compounds, including refrigerants (e.g., HFO-1234yf), fluorinated agrochemicals, and pharmaceuticals. This diversity of sources, combined with its resistance to conventional water treatment methods and lack of global regulat...
Read more

The Hidden Water Footprint of Virtual Products: A Closer Look at Digital Consumption

-
Image
In the modern world, where the internet governs nearly every aspect of our lives, the digital landscape is often perceived as an intangible space. We stream videos, send emails, play games, and engage in social media activities that seem to have no physical substance. However, behind every digital product or service, there lies a significant environmental impact, particularly in terms of water use. The concept of a water footprint the total volume of freshwater used to produce goods and services-has traditionally been applied to physical products like food and clothing. But with the rise of digital products and services, a new dimension of water consumption emerges, often invisible to the average consumer: the hidden water footprint of virtual products. What Is a Water Footprint? The water footprint of a product refers to the amount of water consumed throughout its lifecycle, from raw material extraction through production, use, and disposal. The water footprint is broken down into thr...
Read more

The Impact of Climate Change on Education

-
Climate change, a pressing global challenge, is increasingly influencing various facets of human life, including education. As extreme weather events become more frequent and severe, their impact on educational outcomes is becoming more apparent. This blog explores the multifaceted ways climate change affects education and what policymakers can do to mitigate these impacts, ensuring that education remains a catalyst for economic development and social cohesion. Climate Change and Education: An Overview The World Bank report highlights that climate change is intensifying the frequency and severity of extreme weather events such as cyclones, floods, droughts, heatwaves, and wildfires. These events disrupt schooling, leading to significant learning losses, increased dropout rates, and long-term educational and economic consequences. A 10-year-old today will experience multiple times more climate-related events over their lifetime compared to a 10-year-old in 1970, underscoring the urgent ...
Read more