Intensified Mission Indradhanush

The government launched massive routine immunisation campaigns, i.e. Mission Indradhanush (MI) and Intensified Mission Indradhanush (IMI), to improve immunisation coverage and achieve 90% immunisation coverage in India. The MI and IMI reflect the government’s efforts to reduce child morbidity and mortality under the universal immunisation programme.

The government launched Mission Indradhanush in December 2014 to achieve full immunisation coverage for all pregnant women and children at a rapid pace. The Intensified Mission Indradhanush followed the MI in October 2017 to reach the drop-out and left-out children for immunisation.

Objectives of IMI

The IMI aims to reach the unreached with all available vaccines and accelerate the complete immunisation coverage of pregnant women and children in the identified critical districts. The objectives of the IMI are as follows:

• Rapidly build full immunisation coverage to more than 90% of identified districts and urban cities by December 2018. 
• Enhance administrative, political and financial commitment through advocacy with key departments or ministries and stakeholders towards full immunisation coverage for each child.
• Reach all children with the universal immunisation programme vaccines due for the age as per the national immunisation schedule in the geographic area focusing on children up to two years and pregnant women. However, vaccination will be provided to children up to five years.
• Sustain the gains made through IMI through routine immunisation using IT-based platforms for further follow-up and planning.

Vaccines Under IMI

The IMI provides vaccination against 12 Vaccine-Preventable Diseases (VPD), which are as follows:

• Diphtheria
• Whooping cough
• Tetanus
• Polio
• Tuberculosis
• Hepatitis B
• Meningitis and pneumonia
• Haemophilus influenza type B infections
• Japanese encephalitis (JE)
• Rotavirus vaccine
• Pneumococcal Conjugate Vaccine (PCV)
• Measles-Rubella (MR)

However, vaccination against Haemophilus influenza type B and Japanese encephalitis is provided in selected districts of the country.

Focus Area of IMI

The IMI strategy includes two broad interventions, i.e. Intensified Mission Indradhanush drive and Routine Immunisation System Strengthening. The immunisation drive is implemented in all identified urban cities and districts to ensure 90% immunisation coverage. 

The low-performing areas are identified across the selected districts or urban areas under the IMI, with a focus on the following areas:

• Areas with vacant sub-centres, i.e. where the Auxiliary Nurse Midwife (ANM) is not posted or absent for more than three months.
• Unserved or low coverage pockets in urban or sub-centre areas due to issues around vaccine hesitancy reach and sub-centre or ANM catering to populations much higher than the norms.
• Villages or areas with three or more consecutive missed routine immunisation sessions.
• High-Risk Areas (HRAs) identified by the polio eradication programme not having independent routine immunisation sessions and are clubbed with other routine immunisation sessions. These include the populations living in the following areas:
  • Urban slums with migration. 
  • Brick kilns.
  • B construction sites.
  • Nomadic sites.
  • Underserved and hard-to-reach populations (tribal and forested populations, hilly areas, etc.).
  • Other migrant settlements (riverine areas with shifting populations and fishermen villages).
• Areas with low Routine Immunisation (RI) coverage identified through cases of diphtheria, measles outbreaks and neonatal tetanus in the last two years.

Phases of IMI

The IMI is implemented in phases. The details of the IMI phases are as follows:

IMI

The government launched the IMI to reach every pregnant woman and child under two years who were not covered under the routine immunisation programme. The special drive focuses on improving immunisation coverage in select cities and districts to ensure more than 90% immunisation by December 2018.

Under the IMI, four consecutive rounds were conducted for seven days in 173 districts each month between October 2017 and January 2018, with a sharpened focus on urban areas and high-priority districts. The 173 districts consist of 52 districts in eight North-Eastern states and 121 districts and 17 cities in 16 states. These areas were selected through triangulation of available data under the national surveys, World Health Organisation concurrent monitoring data and Health Management Information System data.

IMI 2.0

The government launched the IMI 2.0 in 2020, intending to reach out to unvaccinated and partially vaccinated children with all available vaccines under the universal immunisation program across 381 districts in 29 states/UTs. The IMI programme was completed by March 2020, supported by various ministries, including the Ministry of Urban Development, Ministry of Youth Affairs, Ministry of Women and Child Development, and Panchayati Raj, amongst others, to ensure the benefits of vaccines.

IMI 3.0

The government introduced the IMI 3.0 to boost routine immunisation coverage, ensure reaching the unreached with available vaccines, and accelerate the coverage of pregnant women and children in the identified blocks and districts from February-March 2021.

The IMI 3.0 had two rounds, starting on 22 February 2021 and 22 March 2021 and was conducted in pre-identified 250 urban areas or districts across 29 states/UTs. As per the IMI 3.0 guidelines, the districts were classified to reflect 313 low-risk, 152 medium-risk and 250 high-risk districts. The focus of the IMI 3.0 were pregnant women and children who had missed their vaccine doses during the COVID-19 pandemic. 

IMI 4.0

The government launched IMI 4.0 in February 2022. Three rounds will be conducted under the IMI 4.0 across 416 districts (including 75 districts identified for the Azadi ka Amrit Mahotsav) across 33 states/UTs in India. In the first round (February-April 2022), 11 states will conduct IMI 4.0. The remaining 22 states will conduct the rounds from April-May 2022. 

Ten phases of the Mission Indradhanush have been completed covering 701 districts across India. As of April 2021, a total of 96.8 lakh pregnant women and 3.86 crore children have been vaccinated during the various phases of IMI.