Population level assessments of immunization-when more complex is better

Abstract

It is estimated that more than 10 million children in India do not receive BCG, 3 doses of OPV and DTP, and measles vaccine during their first year of life and more than 3 million of these do not receive any immunizations[1]. The complexity and diversity of India means that the distribution of unvaccinated and partially vaccinated children is not equal either between or within states. How immunization performance gaps are bridged is of interest to all stakeholders – Union and State governments and immunization partners. Bihar, India’s second more populous state historically competed for the inauspicious distinction of having the lowest immunization coverage rates in the country. To be certain, times have changed and Bihar’s progress to improve vaccination coverage over the past several years has been considerable. For these reasons, the assessment by Goel and colleagues of Bihar’s Muskaan Ek Abhiyan campaign [2] is timely and welcome.