Abstract
Background: Vaccination, as an early childhood intervention is well-established as an efficacious intervention, and yet not all children, receive it. Children failing to receive vaccination are often poorer in socio-economic status and located in specific communities and in specific hotspots. India accounts for nearly 400,000 vaccine-preventable deaths that stem from full vaccine coverage among children at 65%.
Aim: Using a national program for expanding immunization coverage in India we seek to understand how more intensive vaccination strategies may address the deficits in immunization. The program sought to improve vaccination coverage among children, but targeting districts, communities and socio-economic profile where vaccine coverage had been low.
Method: Exploiting the staggered roll-out of the program, Mission Indradhanush, and the exogenous timing of when a national survey is carried out, we show that full immunization and partial immunization increase with more intensive vaccination drives.
Results: We find the districts where the program was rolled out with greater intensity tended to have larger impacts, and there were important gains for socio-economic groups that have historically had low outcomes.
Our result is robust to several robustness checks that include accounting for potential purposive program placement in a selection of districts, secular trends in district immunization rates, testing for parallel trends prior to roll-out, and a propensity score matching to account for selection of program roll-out on observable variables.
Conclusion: Our intention-to-treat difference-in-differences estimate also suggests that policy-relevant variables such as the access to health infrastructure, and intensity of vaccination drives can have a significant impact on early childhood protection from vaccine-preventable deaths.