By Moa Jamir
The launching of National Immunisation Day (NID) on June 28, during which Nagaland aims to administer oral polio vaccine to more than 1.43 lakh children below five years, is more than an annual public health exercise. Nagaland’s polio-free status since 1997 stands as a public health success story, but it is also a reminder that such achievements depend on sustained public trust, continuous vigilance and an effective immunisation system.
The greater test now is not simply maintaining a polio-free State, but ensuring that every eligible child receives routine immunisation, a benchmark against which Nagaland continues to fall well short.
The latest National Family Health Survey (NFHS-6) is a case in point. Viewed in isolation, the findings suggest encouraging progress, with the proportion of children aged 12–23 months who are fully vaccinated rising from 57.9 per cent (NFHS-5) to 64.3 per cent (NHFS-6). However, that optimism fades when the figures are viewed in context: Nagaland still trails the national average of over 82 per cent by a considerable margin.
Even widely publicised and successful Pulse Polio Immunisation coverage stood at 68.5 per cent against a national average of around 85 per cent. These figures raise an uncomfortable question: why does immunisation coverage continue to lag?
Vaccine hesitancy is undoubtedly part of the answer. Nagaland has repeatedly witnessed misinformation and rumours undermining vaccination campaigns. During the 2018 Measles-Rubella drive, false claims about vaccine safety spread widely on social media, while sections of religious groups publicly questioned the programme. Similar resistance, including legal challenges, resurfaced during the COVID-19 vaccination campaign. Such episodes demonstrate that public confidence cannot be taken for granted.
However, hesitancy alone does not explain the State’s immunisation gap.
The 2021 study, Determinants of Childhood Vaccination in Nagaland, India: A Cross-sectional Study with Multilevel Modelling, found that higher utilisation of antenatal care, reliable transportation to health centres and effective financial management by village health committees were among the key factors associated with improved childhood vaccination coverage. Likewise, the Ministry of Health and Family Welfare-UNICEF report, Immunization among Tribal Population in India: A Need Assessment Report (2021), highlighted poor connectivity, difficult terrain, inadequate transport, shortages of health personnel and weak infrastructure as persistent barriers to immunisation in tribal regions. Although the report did not include Nagaland, many of these challenges are readily recognisable in the State.
Policymakers are not unaware of the challenge. Official consultations have repeatedly identified vaccine hesitancy and the need to work with faith-based organisations, civil society groups, village councils and other community stakeholders. However, diagnosis without treatment offers little relief; unless acknowledgement is followed by decisive action, the challenge will remain chronic.
The prescription is to bridge the gap between policy and healthcare delivery through sustained community engagement, stronger frontline services and improved access to healthcare, instead of merely relying on campaign-driven interventions.
The challenge extends beyond public awareness and combating hesitancy. Equally important is bridging the disconnect between policy and healthcare delivery. Ambitious targets and periodic campaigns will have limited impact if mothers cannot easily access antenatal care, if difficult terrain and poor transport continue to impede outreach, or if frontline health services lack the support needed to reach every child.
As both research and experience suggest, improving immunisation is as much about strengthening healthcare delivery as it is about changing public perception. Until then, Nagaland’s immunisation gaps are unlikely to close soon.
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