'Communities with high no. of zero-dose kids are often epicentre of infectious disease outbreaks'

From serving as an IAS officer in the fields of health, education, nutrition and finance as well as former deputy CEO of Gavi in Geneva, to now working as President at the Sabin Institute in Washington DC, Anuradha Gupta has not only added many feathers to her cap, but also brought a remarkable change in the health sector, focusing on importance of immunization.
In an interview with TOI's Sheezan Nezami, Gupta explains the term zero dose children she had coined and initiatives which needs to be taken to cover up the loss as many children missed their important vaccines during Covid-19.
1) You coined the term 'zero-dose children' and according to one of the new reports, it has been ranked among the nine global buzz words. Can you explain the term?
I pioneered the concept of zero dose children to shine a spotlight on those millions of children who have not received even a single dose of a basic vaccine to protect against Diphtheria, Whooping cough and Tetanus. They are the most marginalised population and many of them die because of diseases that can be so easily prevented with vaccines. Communities with a substantial accumulation of zero dose children are often the epicentre of highly infectious disease outbreaks such as measles, polio and cholera.
2) During the Covid-19 pandemic, the number of such zero dose children is said to have further increased, that is several more skipped the important vaccines. What was the reason?
The Covid-19 pandemic was an unprecedented catastrophe in our time. Health systems were completely overwhelmed in every part of the world. People were also afraid to seek non-urgent health care and services. As a result, all essential health services, including immunisation, saw a worrying decline. In the early part of 2020 when lockdowns were imposed, vaccination for children fell steeply. It did bounce back somewhat but could not fully recover because of the added pressure of delivering Covid-19 vaccines to billions of people.
The poorest population bore the brunt of the decline, as shown in the 37% increase in the number of zero dose children during the pandemic. This means millions more children have not received primary vaccines against Diphtheria, Whooping Cough, Tetanus, Measles, Polio, Diarrhoea and Pneumonia.
3) What was the percentage of such children in our country before pandemic and post pandemic?
With steady improvements in immunisation rates, the number of zero-dose children came down to less than 25 lakh in 2019. However, the pandemic reversed some of the progress and is estimated to have led to an additional 5 lakh zero-dose children.
4) What about such zero-dose children in Bihar, Jharkhand and Odisha?
Odisha has shown very impressive progress on immunisation, with nearly 95% children getting vaccinated. Jharkhand and Bihar have improved as well, compared to their previous coverage rates, but are still missing nearly 15% of children. They would need to be laser-focused on mapping and reaching their zero-dose children to prevent the reemergence and spread of infectious diseases and child deaths.
5) There is a certain age group when a particular vaccine has to be administered. Can those children, who have missed their vaccines, be given later too?
The effort should be to get children vaccinated on time so that they are protected as early as possible. However, if for some reason they have missed their vaccines, they should still be vaccinated.
6) What strategies should the central and state governments should adopt to combat the loss?
The first important thing is political will. Wherever the political leadership has made immunisation a priority, improvements and access have moved incredibly fast. This includes countries with protracted challenges.
In India, Covid-19 vaccination is a brilliant example of decisive leadership. This political commitment must be followed by rigorous use of data to identify areas, populations and communities that still lack access to basic health services such as immunisation.
That would enable the states to design service delivery models which work for marginalised populations. For example, in urban slums, something as simple as providing immunisation services late in the evening when mothers are back from work has proven to be very effective in improving vaccination rates in other countries.