Mission Indradhanush: India's Universal Immunisation Drive

Policy Update
Lubian Dua

Background

India, for a long time, has been facing a serious problem: children dying and suffering from diseases that could have easily been prevented by vaccines. The Universal Immunisation Programme, which was launched in 1985, was a potential solution, but it did not prove to be as efficient as expected. In the four years between 2009 and 2013, the increase in vaccine coverage was just 1% per year (Ministry of Health and Family Welfare, 2014). At this rate, it would have taken another 25 years to reach the goal of 90% full immunisation

To help avert this situation, Mission Indradhanush was launched on December 25, 2014, by Union Health Minister J.P. Nadda. The name “Indradhanush,” which means “rainbow” in Hindi, represents the variety of vaccines offered and the vast range of children it aims to protect. This programme aimed to achieve the ambitious goal of 90% full immunisation coverage by 2020. It especially prioritised children under 2 years of age and pregnant women.

The Ministry of Health and Family Welfare (MoHFW) runs the programme as part of the National Health Mission (NHM), which provides most of the funding and resources. Mission Indradhanush has rolled out in several phases. It started with its launch in 2014-15, followed by Intensified Mission Indradhanush (IMI) from 2017. Then came the IMI 2.0, 3.0, 4.0, and IMI 5.0 in 2023. Each phase aimed to reach more parts of the country, include wider age groups, and offer more vaccines.

Phase	Year	Features
Mission Indradhanush (MI)	December 2014	Launched targeting 201 high-focus districts across 28 states; focus on children under 2 years and pregnant women; 7 vaccines
Intensified Mission Indradhanush (IMI) 1.0	October 2017	Expanded to 190 districts; greater focus on urban areas and hard-to-reach populations; target of 90% coverage by December 2018
IMI 2.0	December 2019	Expanded to 272 districts across 27 states and UTs; included children up to 2 years and pregnant women
IMI 3.0	February 2021	Launched specifically to recover vaccination gaps caused by the COVID-19 pandemic; covered 250 districts
IMI 4.0	February 2022	Covered 416 districts across 33 states and UTs; included 75 Azadi ka Amrit Mahotsav districts
IMI 5.0	August 2023	First phase to cover all districts nationally; expanded age group to children up to 5 years; special focus on Measles and Rubella elimination

Source: Ministry of Health and Family Welfare, Government of India; National Health Mission (nhm.gov.in)

Functioning

Mission Indradhanush is not a replacement programme for regular immunisation. It focuses on targeting women and children who have otherwise been missed or dropped out of the regular vaccination programme by periodically increasing the regular vaccination schedule. It is an attempt to close the gap between vaccinated and unvaccinated people.

Each phase happens in rounds, with each one lasting for 7 to 10 days. These rounds happen every quarter. Health workers like ASHA workers, Anganwadi workers, and Auxiliary Nurse Midwives find children and pregnant women who have not been vaccinated through the help of household surveys. Then they set up vaccination sessions. These sessions happen at fixed places or at outreach points, while mobile teams go to the areas that are hard to reach.

Districts are selected based on three criteria: vaccination coverage data from the National Family Health Survey (NFHS), Health Management Information System (HMIS) data, and burden of vaccine-preventable diseases. High-focus districts with the highest proportion of unvaccinated children are prioritised.

The vaccine basket has expanded significantly over the years. The Universal Immunisation Programme currently provides vaccines to protect against 12 diseases, including Diphtheria, Pertussis, Tetanus, Polio, Tuberculosis, Hepatitis B, Measles, Rubella, Japanese Encephalitis, Rotavirus, Pneumococcal disease, and Typhoid. IMI 5.0 paid special attention to ensuring coverage of the Measles and Rubella vaccines, with the goal of eliminating these diseases.

U-WIN digital platform is a significant addition, announced in the Union Budget 2024-25. This digitises immunisation records in real time.

Thereby helping track individual children across their vaccination schedules and eliminating the problem of dropped-out children going undetected.

Two features distinguish the recent phases of Mission Indradhanush. First, IMI 5.0 marked the first time the campaign was conducted across every district in the country. It also expanded the target age group to children up to five years of age, a significant departure from the previous limit of two years. Second, IMI 5.0 actively engaged Janpratinidhis, elected community representatives, alongside social media influencers, to drive awareness and improve vaccination uptake at the community level. Each phase of Mission Indradhanush is implemented through multiple rounds, typically conducted on a quarterly basis. Fixed vaccination sessions are established at health facilities and outreach points, while mobile teams are deployed to serve geographically remote and hard-to-reach areas.

Performance

Today, India’s Immunisation Programme is the largest public health initiative globally, targeting a cohort of 2.6 crore children and 2.9 crore pregnant women annually through 1.2 crore vaccination sessions (Ministry of Health and Family Welfare, 2024). Under Mission Indradhanush, a total of 5.46 crore children and 1.32 crore pregnant women were vaccinated till 2023. India’s full immunisation coverage for 2023-24 stands at 93.23% (Press Information Bureau, 2024).

The trajectory of improvement is striking. NFHS-5 (2019-21) recorded full immunisation coverage at 76.4%, compared to 35.4% in NFHS-1 (1992-93), an increase of over 40 percentage points over three decades, with a significant acceleration after Mission Indradhanush’s launch.

The Intensified Mission Indradhanush phases have delivered measurable gains. Clarke-Deelder et al. (2024), in a peer-reviewed cost-effectiveness analysis published in Health Policy and Planning, found 27% higher rates of full immunisation among children living in districts where Mission Indradhanush was implemented, compared to other districts. The same study found that IMI increased vaccine delivery by an estimated 2.2 million doses over 12 months and averted an estimated 1,413 deaths.

Budgetary support has been channelled through the NHM. The NHM allocation in the Union Budget 2024-25 was Rs 31,967 crore, up from Rs 31,550.87 crore in 2023-24, with Mission Indradhanush as one of its core components. The overall health ministry allocation for 2024-25 was Rs 90,658.63 crore, a 12.59% hike over the previous year.

State-level performance remains uneven. States including Bihar, Chhattisgarh, Odisha, and Punjab faced delays in completing IMI 5.0 rounds due to logistical and administrative constraints. States in the northeastern region and aspirational districts continue to record coverage below the national average.

Impact

The impact of Mission Indradhanush goes beyond just the number of people vaccinated. Significant progress has been made in reducing the mortality rates, especially the Child mortality rates in the country, because of the various preventable diseases. The near-elimination of polio, officially certified polio-free in 2014, is the true proof of what sustained immunisation drives can achieve.

The programme has had a particular impact on equity. By design, Mission Indradhanush targets the hardest-to-reach populations: children in tribal areas, migrant families, urban slum communities, and families in conflict-affected or geographically remote regions. The rapid decline of zero-dose children observed between 2005 and 2015 can be attributed significantly to health system reforms and the launch of Mission Indradhanush.

The COVID-19 pandemic disrupted routine immunisation severely in 2020-21. India did two rounds of IMI 3.0 across 250 districts in February 2021, specifically to identify children and pregnant women who had missed their vaccines during the pandemic. This demonstrated the programme’s adaptability as a recovery mechanism during health system crises.

The programme’s gender dimension is worth noting. Pregnant women form one of the two primary target groups, receiving tetanus and diphtheria toxoid vaccines, directly contributing to reducing maternal and neonatal mortality. In communities where women’s access to healthcare is constrained by mobility and social norms, the door-to-door identification model and fixed-day sessions at local sites have partially circumvented these barriers.

Internationally, India’s Intensified Mission Indradhanush was listed as one of twelve global best practices in immunisation outreach, featured in a special issue of the British Medical Journal (BMJ) published on the occasion of the fourth Partners’ Forum conference of The Partnership for Maternal, Newborn and Child Health, held in New Delhi in December 2018 (Press Information Bureau, 2018).

Emerging Issues

1. Persisting zero-dose children. Despite remarkable headline coverage figures, India still accounts for a significant number of zero-dose children globally, children who have not received a single routine vaccine. The government has clarified that zero-dose children account for only 0.11% of India’s total population, which is proportionally small but, in absolute numbers, remains significant given India’s population size. Reaching these children requires going beyond campaign-mode thinking.

Suggestion: Strengthen household-level tracking through U-WIN digital records and mandate ASHA workers to maintain updated immunisation maps at the village level, with block-level accountability for zero-dose reduction targets.

2. Uneven state-level absorption and coverage gaps. States like Bihar, Jharkhand, Uttar Pradesh, and several northeastern states consistently lag in coverage. Campaign rounds in these states face delays, low session attendance, and supply chain disruptions.

Suggestion: Establish a state-level Mission Indradhanush performance dashboard with district-disaggregated data published quarterly, enabling evidence-based accountability and timely central intervention in underperforming districts.

3. Vaccine hesitancy and misinformation. Adverse Event Following Immunisation (AEFI) fears, religious objections, and circulating misinformation about vaccines, particularly on social media and private messaging platforms, continue to drive refusals in certain communities.

Suggestion: Institutionalise community-level dialogue through religious leaders, school teachers, and local influencers as a permanent feature of pre-campaign mobilisation, rather than a last-minute addition. Peer-to-peer communication models have shown stronger results than top-down awareness campaigns in hesitant communities.

4. Cold chain and supply chain gaps. Maintaining the cold chain for temperature-sensitive vaccines, especially in remote and tribal areas with unreliable electricity, remains a structural challenge. Last-mile delivery failures can result in wasted vaccine doses and missed vaccination opportunities.

Suggestion: Accelerate the deployment of solar-powered cold chain equipment and ice-lined refrigerators in sub-centres serving hard-to-reach populations, with central funding under the NHM capital expenditure head.

5. Post-campaign dropout rates. Mission Indradhanush is effective at initiating vaccination but less effective at ensuring children complete their full schedule. A child vaccinated in an MI round who then drops out of routine immunisation is counted as partially vaccinated, the same problem the campaign was designed to address.

Suggestion: Link MI campaign records directly to the U-WIN platform so that every child vaccinated during a campaign is automatically enrolled in routine immunisation tracking, with follow-up reminders sent to ASHA workers for incomplete schedules.

Way Forward

Mission Indradhanush has achieved something significant: it transformed India’s immunisation programme from a slow-moving routine exercise into a dynamic, adaptive campaign machine. The jump from 35.4% full immunisation coverage in 1992 to 93.23% in 2023-24 is one of the most dramatic public health improvements in India’s post-independence history.

But 93.23% is not 100%. And in a country of India’s size, the remaining gap represents millions of children. The programme’s next chapter cannot rely on the same campaign-mode approach that got it here. The children who remain unvaccinated in 2026 are not unreached because of lack of campaigns; they are unreached because of structural barriers: misinformation in their communities, cold chain failures in their districts, mobility constraints on their mothers, and distrust of health systems built up over years of poor service experiences.

A particularly overlooked group in this context is urban migrant populations. Internal migrants, construction workers, seasonal labourers, and their families frequently fall through the gaps of both their home state’s and destination state’s immunisation systems. Their children are neither counted in the source district’s records nor consistently tracked in the destination city’s outreach sessions. The U-WIN platform, if implemented with portability in mind, offers a meaningful opportunity to address this gap by enabling real-time tracking of a child’s vaccination status regardless of where the family has moved.

The honest challenge now is to shift Mission Indradhanush from a programme that excels at periodic intensification to one that builds permanent, community-rooted immunisation infrastructure. U-WIN digitisation, stronger ASHA accountability frameworks, solar cold chain investment, and genuine community dialogue are not optional add-ons; they are the core of what comes next. Equity must be the organising principle: not just reaching more children, but specifically reaching those whom geography, poverty, and mobility have made hardest to reach.

India has demonstrated to the world that immunisation at scale is possible. The next demonstration must be that it is also permanent and that it leaves no child behind, regardless of where they were born or where their family has since moved.

References

Ministry of Health and Family Welfare. (2023). IMI 5.0 campaign completion update [Press release]. Press Information Bureau. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1966931

Ministry of Health and Family Welfare. (2024). Government response on zero-dose children data. News on AIR. https://www.newsonair.gov.in/unicef-report-misrepresents-indias-immunization-data-on-zero-dose-children-govt

Clarke-Deelder, E., Gupta, N., Shet, A., & Johri, M. (2024). Health impact and cost-effectiveness of expanding routine immunization coverage in India through Intensified Mission Indradhanush. Health Policy and Planning, 39(6), 583–592. https://doi.org/10.1093/heapol/czae024

Cata-Preta, B. O., Barros, A. J. D., Victora, C. G., & Wehrmeister, F. C. (2021). Reaching zero-dose children in India: Progress and challenges ahead. The Lancet Global Health. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00406-X/fulltext

JSI India. (2024). Operational guidelines for IMI 4.0. https://jsiindia.in/wp-content/uploads/2024/07/imi.pdf

National Health Mission. (n.d.). Immunisation: Mission Indradhanush. Ministry of Health and Family Welfare, Government of India. https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=824&lid=220

Ministry of Finance. (2024). Union Budget 2024-25: Expenditure profile — Ministry of Health and Family Welfare. Government of India. https://www.deccanherald.com/business/union-budget/health-ministry-allocated-over-rs-90658-crore-in-interim-budget-2875248

World Health Organization India. (2022). Reaching life-saving vaccines to all: IMI 4.0. WHO India Country Office. https://www.who.int/india/news-room/feature-stories/detail/reaching-life-saving-vaccines-to-all

National Health Mission. (n.d.). NHM official portal. Ministry of Health and Family Welfare, Government of India. https://nhm.gov.in

Ministry of Health and Family Welfare. (n.d.). U-WIN immunisation platform. Government of India. https://uwin.mohfw.gov.in

About the Contributor

Lubina Dua has a strong interest in public policy and governance. She has represented India at the Harvard Conference on Asian and International Relations (HPAIR) and participated in the World Bank Youth Summit. Her work focuses on institutional design, welfare delivery, and evidence-based policymaking.