India considers cost-effective switch to six-in-one vaccine to streamline childhood immunisation

Introducing a six-in-one vaccine into India’s Universal Immunisation Programme could enhance operational efficiency and reduce burden on families, with studies indicating economic viability if vaccine prices decrease.

Introducing a six-in-one vaccine into India’s Universal Immunisation Programme could make childhood immunisation more efficient and less burdensome for families and health staff, according to a study carried out with the Union Health Ministry, the George Institute for Global Health India, the Gates Foundation, Gavi, the Vaccine Alliance, and John Snow India Private Limited. The vaccine combines protection against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b and polio in one injection, reducing the number of jabs infants need during routine visits.

The study, published in Human Vaccines & Immunotherapeutics, assessed two possible roll-out models: replacing the current pentavalent and fractional IPV doses in the primary schedule, and extending the switch to the DTP booster as well. It found that the hexavalent option would bring operational gains through fewer injections, lighter pressure on frontline workers, lower cold-chain demand and less time lost by caregivers, even though the vaccine itself would cost more upfront. Researchers said vaccine price was the biggest factor shaping total programme costs.

According to the analysis, a 50% fall in the procurement price would be enough to offset the extra vaccine expense under the primary schedule alone. With deeper price cuts, the second scenario, which also replaces the booster dose, could produce net savings. The authors considered costs from both the government and household perspectives, including syringes, logistics, staff time and the time parents spend getting children vaccinated.

The findings come against a broader global move towards combination vaccines. Gavi says countries eligible for its support can apply to switch to a whole-cell pertussis hexavalent vaccine, which it says is designed to make delivery more efficient and to reduce the complications of giving multiple injections. In India, the introduction of the pentavalent vaccine in 2014 marked a major expansion of routine immunisation, and the new study suggests a further step may now be economically and operationally viable if procurement prices can be brought down.