Varsha Venugopal

Yeah.

But if you see in there, I think more recently it has also been stagnating.

And I think that's where these problems of last mile and under vaccination and demand side challenges come in.

The last couple of years, we know the trend has to do with COVID related lockdowns with millions of additional kids dropping off.

But the broader trend of stagnation seems more to do with under vaccination.

For instance, you know, we have three doses of measles vaccines recommended.

And even though 85% of kids worldwide got their first vaccine, it dropped to 64% for the second dose.

Yeah, no, that's a great point.

Especially these days, there is so much more conversation on vaccine hesitancy, and it's really useful to, I guess, emphasize that that's not the kind of challenge we are facing here.

There are several reasons for this, and we can go into that, but broadly, people seem to trust vaccines, which is why they get the birth dose, and they also get at least one other dose, and then drop off for a variety of reasons, which have nothing to do with the supply-side challenges.

Yes.

There have been at least two surveys of this kind that have been done in India.

So one was a recent survey that was conducted in 2018 of nearly 40,000 caregivers of under-vaccinated children in the lowest vaccine coverage districts, where they found that the most common reason for missed appointments was an awareness gap.

Then there was another nationwide survey, which is slightly older.

It was conducted by UNICEF in 2009, where respondents were four times more likely to describe demand side issues than supply side ones when giving reasons for a child being partially or not immunized at all.

So it seems largely, at least in India, the challenge is on the demand side.

And there is further breakdown and hypothesis around why these parents choose not to complete the vaccination.

The common barriers are around taking time off work, low uptake of routine immunization in rural areas where education rates are low or information can be confusing or just difficult to access.

I don't think so.

In fact, to India's credit, it is one of the top manufacturers of vaccines.