Guwahati: India has made significant strides in child immunisation, but a new study published in The Lancet Regional Health – Southeast Asia (2025) reveals that the northeastern states are falling behind. Data from the 2019-2021 National Family Health Survey (NFHS-5) shows alarmingly high rates of under-vaccination, raising concerns about public health vulnerabilities and inequities in the region.
The study, titled Small-area variation in child under-vaccination in India: a multilevel analysis of cross-sectional data, analysed vaccination patterns across 36 states, 707 districts, and 22,349 small-area clusters. The findings underscore the need to address regional disparities to achieve India’s goal of fully vaccinating every child, as part of the global Immunisation Agenda 2030.
“India has made exceptional progress in immunisation in recent decades, but subnational inequities in vaccination persist,” the study said adding that to address these challenges and achieve India’s aim to fully vaccinate every child, insights into the subnational patterning of vaccination coverage are required,” the study says. Like many countries, due to immunisation gaps exacerbated by the global COVID-19 pandemic, India recently experienced vaccine-preventable disease outbreaks, including flare-ups of measles and diphtheria.
“For vaccines administered in the first year of life, the northeastern states and Uttar Pradesh had the highest median under-vaccination” the study found.
Although India has made exceptional progress in immunisation, the study highlights that subnational inequities persist. Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, and Tripura lag significantly behind national averages in key vaccination metrics.
Key findings from the study include:
- Zero-Dose Prevalence: States like Nagaland (15.14%), Meghalaya (15.83%), Mizoram (14.25%), and Arunachal Pradesh (13.01%) have far higher rates of children not receiving even a single dose of the DTP vaccine, compared to the national average of 6.1%.
- Basic Immunisation Incomplete: Nagaland has a rate of 42.12% for children missing essential vaccines like BCG, DTP, and measles-rubella—nearly double the national average of 23.4%. Arunachal Pradesh follows closely with a rate of 35.09%.
- Measles-Rubella Vulnerability: The study also reveals troubling statistics for measles-rubella vaccines. Meghalaya (27.52%), Nagaland (26.20%), and Manipur (23.41%) have high rates of children missing the first dose, with second-dose non-coverage rates reaching shockingly high levels, particularly in Meghalaya (74.07%) and Manipur (74.19%).
A call for strategic shifts in vaccination focus
The study suggests that the largest variations in vaccination coverage are now occurring at the small-area level, indicating a need for a strategic shift from a district-wide approach to one that targets sub-areas within districts. While many districts have achieved high vaccination coverage, significant disparities persist, fueling localised outbreaks, even when national coverage rates are high.
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