Mission Indradhanush: Immunizing India’s Missed Children

Start with the problem. Then see how the mission answered it.

1. What is Mission Indradhanush, and when did it begin?

Mission Indradhanush is a special catch-up drive for immunisation. The Ministry of Health and Family Welfare launched it on 25 December 2014. It aimed at children who had missed their vaccines. It also aimed at pregnant women.

The ministry’s guidelines set a clear target. Full immunisation coverage stood at about 65 per cent in 2014. The mission aimed to lift it to at least 90 per cent. A later government summary says the 90 per cent target was first set for 2020. It was then brought forward to 2018.

2. Which seven diseases did the mission cover?

The mission offered the vaccines of India’s Universal Immunisation Programme. That programme protects against seven life-threatening diseases:

• Diphtheria
• Whooping cough (pertussis)
• Tetanus
• Polio
• Tuberculosis
• Measles
• Hepatitis B

Two more vaccines were given only in selected districts. They were the Hib vaccine and the Japanese Encephalitis vaccine.

Later the vaccine basket grew. A 2023 government explainer says it now covers 12 diseases. New vaccines include rotavirus, pneumococcal and measles-rubella.

3. Why did so many children miss their vaccines?

India’s immunisation programme began in 1985. Yet by 2014 only about 65 in every 100 children received all vaccines in their first year. The guidelines estimate that more than 89 lakh children missed some vaccines every year. That was the highest number in any country.

The risk was real. Unimmunised and partly immunised children face a three to six times higher risk of death than fully immunised children.

The guidelines name three main reasons for missed vaccines:

• Parents did not know the benefits of vaccination.
• Parents feared side effects after the injection.
• Vaccines or vaccinators were not available at the session.

4. Who did the mission target?

The mission targeted children under two years of age and pregnant women. The guidelines also made a kind rule. A child above two years who came for a vaccine at a session was not turned away.

The national schedule in the guidelines lists tetanus toxoid doses for pregnant women.

Now follow the drive from the district map down to the village session.

5. Which were the 201 high-focus districts?

The government picked 201 high-focus districts for the mission. These districts held nearly half of all unvaccinated or partly vaccinated children in India.

Four states stood out. Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh held 82 of the 201 districts. Together they held nearly a quarter of India’s missed children.

The mission was still a nationwide drive. The 201 districts only got the greatest attention.

6. Which places did the drive reach first?

The guidelines list the places that needed extra sessions:

• Areas with a vacant sub-centre, where no nurse had been posted for over three months.
• Villages that had missed three or more routine sessions in a row.
• High-risk areas known from the polio programme, such as urban slums, brick kilns and construction sites.
• Hard-to-reach places such as forest, tribal and hilly areas.
• Areas with measles outbreaks or cases of diphtheria and neonatal tetanus in the past two years.

The idea was simple. Go where the routine system had failed.

7. How were the rounds organised?

The guidelines planned four rounds. Each round began on a Monday. Each lasted up to seven days, depending on need.

Sessions ran from 9 am to 4 pm. Each nurse, called an ANM, planned her own roster. She spent one or two days in her own sub-centre area. She spent the other days in nearby blocks or urban areas.

After a round, the sessions were folded into regular routine immunisation. This kept the gains alive.

8. Who ran a vaccination session?

A session team had one vaccinator and up to two mobilisers. At least one mobiliser came from the local neighbourhood. A second vaccinator joined when the expected number of injections passed about 60 to 70.

Sessions were held at health posts, primary health centres and district hospitals. In urban slums, family welfare centres and local leaders’ premises also served. In villages, anganwadi centres and primary schools were used.

Where only a few children lived, mobile sessions reached them. These suited scattered slums, brick kilns and construction sites.

Numbers matter here. Each figure below comes from a government document.

9. What had four phases delivered by 2018?

A government summary from the fourth year of the NDA government gives the first results. Four phases had covered 528 districts. In those phases:

• 2.55 crore children were vaccinated.
• 66.57 lakh children were fully immunised.
• 68.78 lakh pregnant women were immunised.
• 73.49 lakh doses of vitamin A were given.
• 68.57 lakh ORS packets were handed out.

The drive carried more than vaccines. It also carried vitamin A, ORS and zinc.

10. What do the 2023 figures show?

A government explainer of March 2023 gives the larger picture. Eleven phases of Mission Indradhanush had been completed. They covered 701 districts.

By February 2023, 4.45 crore children and 1.2 crore pregnant women had been vaccinated. The first two phases alone raised full immunisation coverage by 6.7 per cent in a year.

Compare this with the past. Before the mission, coverage had grown only about 1 per cent a year between 2009 and 2013.

11. What was the coverage target, and how did it shift?

The target was 90 per cent full immunisation. The ministry’s scheme slide says it was meant for 2020 and was then brought forward to 2018.

Remember the three numbers together:

• 65 per cent: coverage in 2014.
• 90 per cent: the target.
• 2018: the revised year in the scheme slide.

The mission did not end with the target. It grew into a more intense drive. That is the next story.

The first mission worked. The government then pushed harder.

12. What was the first Intensified Mission Indradhanush?

The Prime Minister launched the Intensified Mission Indradhanush (IMI) on 8 October 2017 at Vadnagar, Gujarat. It covered 190 districts and urban areas across 24 states. These were 121 districts, 17 urban areas and 52 districts in the north-east.

IMI built on the first mission. It brought in departments outside health. It tried to turn routine immunisation into a people’s movement.

A coverage survey afterwards found an average rise of 18.5 per cent in full immunisation, compared with the earlier NFHS-4 survey of 2015-16.

13. What were IMI 2.0 and IMI 3.0?

IMI 2.0 ran from December 2019 to March 2020. The government explainer says it focused on 380 districts in 29 states. It vaccinated 37.09 lakh children and 7.41 lakh women.

IMI 3.0 came after the Covid-19 disruption. It aimed at children and pregnant women who had missed doses during the pandemic. It had two rounds of 15 days each, in February and March 2021. It covered 250 districts in 29 states and Union Territories.

Under IMI 3.0 about 9.58 lakh children and 2.24 lakh pregnant women were vaccinated.

14. What was IMI 4.0?

The government launched IMI 4.0 on 7 February 2022. It was another catch-up drive after the pandemic broke routine services.

It ran in 416 districts across 33 states and Union Territories. That count included 75 districts chosen for the Azadi ka Amrit Mahotsav. Districts were picked using NFHS-5 coverage data, HMIS data and the burden of vaccine-preventable diseases.

It had three rounds between February and May 2022. About 59.99 lakh children and 15.31 lakh pregnant women were vaccinated.

Both questions below were short fact checks. Learn the target group and the aim.

15. How did UPSC and CDS test Mission Indradhanush?

UPSC CSP 2016, General Studies Paper I, Q32 (Series A). The question asked what Mission Indradhanush pertains to.

UPSC’s official answer key gives (a) for item 32. The mission is about immunisation. The other three options name unrelated ideas.

CDS I 2021, General Knowledge, Q16 (Series A). The question asked what the mission aims at.

The correct answer is (d) full immunisation of children. The ministry’s guidelines state the aim as full immunisation of children and pregnant women. No other option matches any aim in the guidelines.

16. What should I revise at a glance?

Use this list before the exam:

• Launch: 25 December 2014, by the Ministry of Health and Family Welfare.
• Aim: full immunisation of children under two and pregnant women. The target was 90 per cent coverage.
• Seven diseases: diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B.
• First focus: 201 high-focus districts. They held nearly half of India’s missed children.
• Intensified Mission Indradhanush: launched on 8 October 2017 at Vadnagar, Gujarat.
• Later versions: IMI 2.0, 3.0 and 4.0 followed the Covid-19 gaps, up to February 2022.

Revise the list line by line.