Exploring means to overcome programmatic barriers in maximizing zero dose vaccination in India

Abstract This article examines the critical issue of Zero Dose children in India children who have not received even the first dose of the Diphtheria, Pertussis, and Tetanus (DPT)-containing vaccine. In India specifically, Zero Dose children are defined as those who have not received the first dose of the pentavalent vaccine by their first birthday, as the pentavalent vaccine (which contains DPT) replaced the standalone DPT vaccine in the national immunization schedule. The paper identifies major programmatic barriers to ensuring the Zero Dose Children in India, such as challenges in health system strengthening, access barriers, socio-cultural and behavioral barriers, supply chain management issues and data gaps and monitoring gaps. Zero Dose children in most of the cases are seen to be in underserved and hard to access communities, slum areas of cities, and conflict zones. In order to tackle these complicated issues, the document proposes various measures that are related to, enhancing the infrastructure of Primary Healthcare through the construction of additional healthcare centers, recruitment of more qualified specialists, and better management of cold chains points. In the case of capitalizing on digital interventions, digital health application like U-WIN, e-VIN and Co-Win is being used for registration, tracking beneficiaries as well as real time monitoring of vaccine stock & temperature of cold chain equipment with ease and simplicity. In the case of Models of innovative service delivery, it is advised to use a flexible approach, such as mobile vaccination teams and integrated visits to cover those people in the hard-to-reach areas and in regard to policy and funding enhancements, concentrate on equitable and fair financing, improved policy and intersectoral collaboration. The paper concludes that addressing the Zero Dose challenge in India requires an integrated, urgent, and multi-pronged approach that strengthens health systems, deepens community engagement, and harnesses digital technologies to close gaps in vaccine access and accelerate immunization coverage. It emphasizes the importance of building programme resilience against disruptions and implementing targeted actions specifically designed to reach Zero Dose children, with special attention to urban informal settlements.