REVIEW ARTICLE National Immunization Programme – Mission Indradhanush Programme: Newer Approaches and Interventions Ajeet Singh Bhadoria 1 & Surabhi Mishra 1 & Mahendra Singh 1 & Surekha Kishore 1 Received: 12 September 2018 /Accepted: 20 January 2019 # Dr. K C Chaudhuri Foundation 2019 Abstract Vaccines are globally accepted as instrumental in drastically bringing down vaccine preventable diseases (VPDs) related mortality and morbidity. Despite global relentless efforts, about 19.3 million children still go missing for full immunization and are at risk for VPDs. Government of India has tried to rejuvenate its four decades old Universal Immunization Programme (UIP) by recently launching Mission Indradhanush in 2014, followed by Intensified Mission Indradhanush in 2017 to boost up immunization coverage. UIP have also brought in newer vaccines, changed dose schedules, open vial policy and a robust surveillance system. Even then, country’ s average immunization coverage is much below par. Thus, there is a pressing need for transforming immunization program from simple vaccine delivery platform to a comprehensive disease control programme. Country should introduce newer vaccines through evidence-based policies and increase access to immunization services through system strengthening. Keywords Immunization . Vaccines . Mission Indradhanush . Universal immunization programme Introduction Vaccination under Routine Immunization (RI) is one of the most cost-effective health investment any country could make. Global relentless efforts to reach vulnerable in hard- to-reach pocket areas have saved countless lives over the years. Such an intervention not only protects individuals against disabling diseases but also marks opportunity for lead- ing a healthier and more productive life [1]. However, even today, vaccine-preventable diseases (VPDs) remain most common cause of childhood mortality, estimating around 1.5 million deaths each year [2]. According to Centre for Disease Control and Prevention (CDC) 2010 report, about 19.3 million children either are partially vacci- nated or unvaccinated and are at risk for VPDs-related mor- bidity and mortality; half of which still harbors in India, Nigeria, and Congo [3]. Presently, India is lagging behind in immunization-related services. National Family Health Survey-4 (NFHS-4) cites that national full immunization cov- erage against six vaccines [Bacillus Calmette-Guérin (BCG), measles, and three doses each of polio and Diptheria, Pertussis, Tetanus (DPT)] among children in 12–23 mo of age has reached only up to 62% that widely ranges between 35.7% in Nagaland and 91.1% in Puducherry (Table 1)[4]. Around 15 states/ Union Territories (UTs) are still performing below national average. No states/ UTs except Puducherry have achieved target of ≥90% immunization coverage. The country reports a dropout rate of 10.8% and 13.5% from BCG to measles and DPT-3 respectively [4], much higher among migrants with poor service utilization [5]. India being a signatory to Sustainable Development Goals (SDGs) is committed to warrant universal immunization cov- erage by 2030. India’ s immunization programme underwent many recent changes to address known determinants for country’ s poor immunization coverage. Government of India (GoI) launched BMission Indradhanush^ in 2014 and later BIntensified Mission Indradhanush^ in 2017 that targets high-risk areas with traditional low immunization coverage to achieve 90% immunization coverage by 2018 [6, 7]. However, to reach a cohort of more than 89 lakhs missing children, dwelling in hard-to-reach and underserved areas, is still a huge programmatic challenge [7]. * Ajeet Singh Bhadoria ajeetsinghbhadoria@gmail.com 1 Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India The Indian Journal of Pediatrics https://doi.org/10.1007/s12098-019-02880-0