What would it cost to raise childhood vaccination coverage to at least 90% in every district in India?

A study presenting updated estimates of the budgetary impact of India’s routine childhood vaccination program has been published by researchers from One Health Trust (formerly CDDEP) and other organizations in Health Policy and Planning.

India’s Universal Immunization Programme (UIP) is among the largest routine childhood vaccination programmes in the world. However, only an estimated 65% of Indian children under the age 2 years were fully vaccinated in 2019. This study estimated the cost of raising childhood vaccination coverage to a minimum of 90% in each district in India.

Vaccine price data were obtained from India’s comprehensive multi-year strategic plan for immunization. Cost of vaccine delivery by district was derived from a 2018 field study in 24 districts. Researchers used propensity score matching methods to match the remaining Indian districts with these 24, based on indicators from the National Family Health Survey (2015–16). It was assumed that the same unit cost of vaccine delivery in matched pair districts and estimated the total and incremental cost of providing routine vaccines to 90% of the current cohort of children in each district.

The estimated national cost of providing basic vaccinations—one dose each of Bacillus Calmette–Guerin (BCG) and measles vaccines, and three doses each of oral polio (OPV) and diphtheria, pertussis and tetanus vaccines—was $784.91 million (2020 US$). Considering all childhood vaccines included in UIP during 2018–22 (one dose each of BCG, hepatitis B and measles–rubella; four doses of OPV; two doses of inactivated polio; and three doses each of rotavirus, pneumococcal and pentavalent vaccines), the estimated national cost of vaccines and delivery to 90% of target children in each district was $1.73 billion.

The 2018 UIP budget for vaccinating children, pregnant women and adults was $1.17 billion (2020 US$). In comparison, $1.73 billion would be needed to vaccinate 90% of children in all Indian districts with the recommended schedule of routine childhood vaccines. Additional costs for infrastructural investments and communication activities, not incorporated in this study, may also be necessary.

Key messages

• While substantial progress toward universal child immunization in India has been made since the advent of the Universal Immunization Programme (UIP) in 1985, vaccination rates vary greatly among Indian districts. There is also heterogeneity in the cost of vaccination delivery between Indian districts and states.

• The estimated national cost of providing basic vaccinations was 784.91 million US$ in 2020. The estimated national cost of providing all vaccinations included in the Government of India’s schedule of routine childhood immunization was $1.73 billion US$.

• To achieve universal immunization, the budget for India’s UIP should be increased from its 2020 level of 1.58 billion US$. Variation in district- and state-level costs should be taken into consideration when considering expenditure needed to increase vaccination coverage in underserved areas