Universal immunization program
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Universal Immunization Programme (UIP) - India
Background and History
The UIP is one of the largest public health programmes in the world, covering approximately 27 million newborns and 30 million pregnant women annually, across 27 lakh vaccine delivery points.
Origins:
- 1974 - WHO launched its Expanded Programme on Immunization (EPI) targeting 6 childhood diseases: diphtheria, pertussis, tetanus, polio, tuberculosis, and measles
- UNICEF in 1985 renamed it "Universal Child Immunization" (UCI), with the goal of achieving universal immunization by 1990
- India launched its EPI in 1978 - covering BCG, DPT, OPV, and typhoid (in urban areas)
- UIP was launched in November 1985 in India - initially in 30 selected districts and catchment areas of 50 Medical Colleges, later expanded to 242 Medical Colleges. Measles was added, typhoid removed, and focus shifted to children under 1 year.
Immunization Milestones - India (Chronological)
| Year | Milestone |
|---|---|
| 1962 | BCG introduced (first vaccine in India, under National TB Programme) |
| 1978 | EPI launched - BCG, DPT, OPV, typhoid (urban areas) |
| 1983 | TT vaccine for pregnant women |
| 1985 | UIP launched - measles added, typhoid removed |
| 1990 | Vitamin-A supplementation added |
| 1995 | Polio National Immunization Days (NIDs) introduced |
| 1997 | Vaccine Vial Monitor (VVM) introduced on UIP vaccines |
| 2002 | Hepatitis B introduced as pilot in 33 districts/10 states |
| 2005 | NRHM launched; Auto-disable (AD) syringes introduced |
| 2006 | JE vaccine introduced in endemic districts |
| 2007-08 | HepB expanded to 10 states; schedule revised to 4-dose |
| 2010 | Measles 2nd dose introduced |
| 2011 | HepB universalized; Pentavalent (Hib) introduced in 2 states; Open Vial Policy |
| 2013 | Pentavalent expanded to 9 states; 2nd dose of JE vaccine |
| 2014 | India and South-East Asia Region certified polio-free |
| 2015 | Maternal & Neonatal Tetanus eliminated; Pentavalent expanded to all states; IPV introduced |
| 2016 | Rotavirus Vaccine (RVV) introduced in 4 states; tOPV to bOPV switch; fractional IPV (fIPV) |
| 2017 | MR Vaccine introduced; PCV launched (phased) |
| 2020 | Covishield and Covaxin (COVID-19) introduced |
| 2026 | Coverage reached 98.4% (as of January 2026) |
Source: Park's Textbook of Preventive and Social Medicine; PIB India 2026
Diseases Covered Under UIP (12 + COVID-19)
The UIP currently provides free vaccines against 12 vaccine-preventable diseases:
- Tuberculosis
- Diphtheria
- Pertussis (Whooping cough)
- Tetanus
- Poliomyelitis
- Measles
- Hepatitis B
- Rotaviral gastroenteritis
- Japanese Encephalitis (JE)
- Rubella
- Pneumonia due to Haemophilus influenzae type B (Hib)
- Pneumococcal diseases (pneumonia and meningitis)
National Immunization Schedule (UIP - 2025)
At Birth
| Vaccine | Route | Site |
|---|---|---|
| BCG | Intradermal | Left upper arm |
| OPV-0 (birth dose) | Oral | - |
| Hepatitis B (birth dose) | Intramuscular | Antero-lateral mid-thigh |
6 Weeks
| Vaccine | Notes |
|---|---|
| OPV-1 | Oral |
| Pentavalent-1 (DPT + HepB + Hib) | IM, antero-lateral mid-thigh |
| Rotavirus Vaccine (RVV)-1 | Oral |
| fIPV-1 (fractional IPV) | Intradermal, right upper arm |
| PCV-1 | IM |
10 Weeks
- OPV-2, Pentavalent-2, RVV-2
14 Weeks
- OPV-3, Pentavalent-3, fIPV-2, RVV-3, PCV-2
9-12 Months
- MR-1 (Measles-Rubella), JE-1, PCV Booster
- Vitamin A (1st dose - 1 lakh IU)
16-24 Months
- MR-2, JE-2, DPT Booster-1, OPV Booster
- Vitamin A (2nd dose)
5-6 Years
- DPT Booster-2
10 Years and 16 Years
- Td (Tetanus-diphtheria)
Pregnant Women
- Td-1, Td-2 (or booster), and IFA tablets
Note: JE vaccine is given only in endemic districts.
Key Operational Features
Cold Chain System
A nationwide cold chain infrastructure maintains vaccine potency from manufacturer to recipient. Every vaccine vial carries a Vaccine Vial Monitor (VVM) (introduced 1997) that changes color when heat exposure invalidates the vaccine.
Open Vial Policy
Introduced in 2011 - allows opened vials to be used in subsequent sessions (for multi-dose vaccines), reducing wastage.
Auto-Disable Syringes
Introduced in 2005 to prevent reuse and reduce the risk of blood-borne infections.
Delivery System
Services are provided through existing health infrastructure: MCH centres, PHCs, sub-centres, hospitals, dispensaries, and ICDS units. There is no separate staff cadre for the UIP - ANMs, health workers, and AWWs carry out immunization.
Herd Immunity Threshold
When coverage reaches 80% or more, disease transmission is disrupted sufficiently to provide herd immunity protection even for unvaccinated children. - Park's Textbook of Preventive and Social Medicine
Important Practical Points
| Question | Answer |
|---|---|
| Child brought late for a dose - restart? | No - pick up where the schedule was left off (do not restart) |
| Only one injection permitted at 9 months - which one? | MR vaccine (priority), then OPV + Vitamin A |
| Child allergic to DPT or develops encephalopathy? | Give DTaP/DT instead (whole-cell pertussis component is usually the culprit) |
| Why DPT in antero-lateral thigh, not gluteal? | Avoids sciatic nerve damage; gluteal fat reduces immune response |
| Minimum gap between 2 doses of DPT? | 4 weeks (shorter interval impairs optimal antibody production) |
| Measles vaccine given only on right upper arm? | Maintains uniformity; aids surveyors in verifying vaccine receipt |
| If measles given before 9 months? | Still needs to be repeated per schedule (at 9-12 months and 16-24 months) |
Achievements and Current Status
Coverage progress:
- 1985-86 (at start): BCG 29%, DPT varied 41%
- 2018: BCG ~92%, DPT-3 ~89%, OPV-3 ~89%, HepB-3 ~89%
- January 2026: Full immunization coverage = 98.4%
- Zero-dose children declined from 0.11% (2023) to 0.06% (2024)
Disease reduction (1987 vs 2018):
- Poliomyelitis: 28,257 cases → 0 cases
- Diphtheria: 12,952 → 11,720
- Pertussis: 1,63,786 → significantly reduced
- Neonatal Tetanus: dramatically reduced after MNT elimination (2015)
Key milestones:
- India and the entire South-East Asia Region were declared polio-free in 2014
- Maternal and Neonatal Tetanus (MNT) eliminated in 2015
- National Vaccination Day observed every year on March 16
Programme Integration
- UIP became part of Child Survival and Safe Motherhood Programme (CSSMP) in 1992
- Has remained a key area under National Health Mission (NHM) since 2005
- Vaccine costs are entirely borne by Government of India, funded through taxes
- All UIP vaccines are included in the National List of Essential Medicines (NLEM)
Additional (IAP-Recommended) Vaccines - Not Part of UIP
These are recommended by the Indian Academy of Pediatrics but are NOT free under UIP and are available mainly at private clinics:
- Varicella
- Hepatitis A
- Typhoid Conjugate Vaccine (TCV)
- MMR (mumps-containing version, as opposed to MR under UIP)
- HPV (Human Papillomavirus)
Sources: Park's Textbook of Preventive and Social Medicine; PIB India (Jan 2026); Wikipedia - UIP; babynama.com IAP 2025 Schedule
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