Immunisation remains one of the most effective public health interventions available to us. India’s Universal Immunisation Programme has protected millions of pregnant women and children from vaccine-preventable diseases and contributed significantly to improvements in child health and survival. Yet the final stretch towards universal immunisation remains challenging. The children still being missed are often those living furthest from services or facing social barriers that conventional outreach approaches struggle to overcome.
The recently released National Family Health Survey-6 (NFHS-6) shows that full vaccination coverage among children aged 12–23 months is at 75.3% in Meghalaya. This progress is encouraging, but it also highlights the work that remains to ensure every child is reached. The state’s experience demonstrates that universal immunisation depends on two equally important foundations: Strong delivery systems and strong community trust. Vaccines must be available and accessible, but they must also be understood, trusted, and accepted by communities. Recognising this reality, the government of Meghalaya has increasingly focused on making immunisation efforts more community-centred, culturally responsive, and inclusive of local contexts.
While the state has made significant progress in expanding immunisation coverage, some children continue to miss lifesaving vaccines. This is not because services are absent. Rather, the social realities shaping household decisions are often more complex than conventional health messaging acknowledges.
One challenge is the limited engagement of fathers and other family decision-makers in immunisation conversations. While vaccination campaigns have traditionally focused on mothers, decisions regarding childcare and health care are often influenced by fathers, grandparents, community elders, and local leaders. In Meghalaya’s tribal communities, trust often rests with the rangbah shnong, nokmas, village dorbars, church elders, and clan leaders who help shape collective decisions. Traditional beliefs, limited visibility of vaccine preventable diseases, and misinformation can sometimes weaken confidence in vaccination.
Geographical topography and social exclusion remain major barriers to universal immunisation. In remote and hard to reach settlements across Meghalaya’s hilly terrain, poor road connectivity, seasonal migration, and difficult terrain often disrupt continuity of care. Teenage pregnancies and dependence on traditional birth attendants or unregistered home deliveries can result in newborns missing critical birth dose vaccinations and early postnatal checkups.
These challenges are even more pronounced among socially marginalized and often overlooked populations, including undocumented mining communities, waste picker families, and communities living near international borders. Standard outreach approaches often struggle to consistently reach such populations, reinforcing long standing inequities in health care access.
Rather than relying solely on generic awareness campaigns, Meghalaya is working to address the underlying social and behavioural drivers influencing community decisions. Through collaborations involving the Community of Practice Demand (CoPD), an immunization think tank led by the ministry of health and family welfare and supported by Gavi, the Vaccine Alliance, and the United Nations Development Programme, the Meghalaya state government is working with frontline workers, civil society organisations, and local community networks to co-design communication strategies rooted in local realities.
For instance, in East Khasi Hills, interventions are being tested with the direct involvement of rangbah shnong and church leaders. Village Health Councils are bringing together local leaders, health workers, schools, and community groups to strengthen accountability and support community health goals. Frontline workers are also being equipped with practical communication skills and simple messages on vaccine benefits and adverse events following immunisation, tailored to local dialects and cultural contexts.
A major focus has been strengthening the role of fathers in child health and immunisation. Community discussions show that vaccination is often viewed as the mother’s responsibility, while fathers are seen primarily as providers. To address this, communication efforts increasingly frame immunisation as a shared parental responsibility. Messages encouraging fathers to support antenatal visits and vaccination sessions help reinforce the idea that protecting children is a responsibility shared across the family.
These efforts are reinforced through radio programmes, community outreach, church announcements, and local media engagement, helping deliver immunization messages through trusted channels. The messages may appear simple, but they reflect a deeper behavioural shift. They move vaccination from being perceived as a routine medical task to becoming part of responsible parenting and collective family care.
Alongside efforts to strengthen demand and trust, Meghalaya continues to invest in service delivery systems. ASHAs, ANMs, and mobile health teams regularly travel long distances through forests, hills, and remote settlements to ensure essential services reach vulnerable populations.
Digital platforms such as U-WIN and eVIN are further strengthening these efforts by improving beneficiary tracking, follow-up, vaccine logistics, and cold-chain management, helping ensure uninterrupted service delivery even in remote areas.
Meghalaya’s experience shows that universal immunisation requires more than vaccines and infrastructure alone. Strong supply chains, frontline workers, and digital platforms remain essential. Equally important are trusted local institutions, informed parents, and community leaders who help build confidence in vaccination.
The final mile is ultimately about ensuring that every child, regardless of geography or circumstance, has access to life-saving protection. When strong systems and strong communities work together, no child needs to be left behind.
(The views expressed are personal)
This article is authored by Wailadmiki Shylla, minister, health and family welfare, Meghalaya and Angela Lusigi, resident representative, UNDP India.
