Comprehending the Dynamics of Multiple Newer Vaccine Introductions and Uptake in A High-Volume Private-Sector Model Immunization Clinic
Abstract
Introduction: Besides routine Universal Immunization Program (UIP) vaccines, the Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization Practices (IAP-ACVIP) has periodically recommended several additional non-UIP vaccines based on updated clinical evidence, for private sector practice in India, procurable out-of-pocket. While there are examples of ‘individual new vaccine’ post-introduction evaluations into existing immunization schedules, a hypothetical analysis of the dynamics of ‘multiple new vaccine’ introductions in quick succession - as recommended by the IAP-ACVIP, together with robust statistical data substantiating such analysis, is currently unavailable in India.
Materials and Methods: This paper tracks the chronology of successive introduction of several newer vaccines (as single/multiple doses and routine/optional) into existing IAP-ACVIP schedules, enumerates factors influencing their uptake, and captures data and time trends following their introduction into a high-volume community-level model immunization clinic catering exclusively to pediatric vaccination in a private sector tertiary care institution. All data presented and analysed are from manually entered, internally computed, and computerized records from years 2003 -2019.
Results: Newly introduced vaccines that find timeslots in an already existing schedule would disproportionately affect first, the overall number of injections delivered; whereas those that do not find such timeslots, on the contrary, would first disproportionately affect the overall number of child visits. Successive introduction of multiple vaccines with multiple schedules would shift the progression of the total number of child visits and the total number of injections delivered from the so-called ‘first order’ towards ‘zero order’ kinetics.
Conclusion: Understanding vaccine uptake dynamics would facilitate better programmatic preparedness for budget outlines towards vaccine supply and cold chain infrastructure, training and manpower for vaccine delivery and documentation, expected rates of adverse events following immunization, among others.
References
John TJ. India’s National Technical Advisory Group on Immunisation. Vaccine. 2010 Apr 19;The Role of National Advisory Committees in Supporting Evidence-Based Decision Making for National Immunisation Programs28:A88–90. doi: https://doi.org/10.1016/j.vaccine.2010.02.041
Jacob John T, Kompithra RZ. India’s universal immunization program: A review of successes, challenges, and future directions. Indian J Med Microbiol. 2025;55:100854. doi: https://doi.org/10.1016/j.ijmmb.2025.100854
Kompithra RZ, Mathew LG, Verghese VP, Mathai S, John TJ. High public demand and acceptance of newer vaccines in private sector immunisation in Vellore, South India: Implications for India’s national immunisation program. Indian J Med Microbiol. 2025;56:100913. doi: https://doi.org/10.1016/j.ijmmb.2025.100913
Donadieu J, Bernard F, van Noesel M, Barkaoui M, Bardet O, Mura R, Arico M, Piguet C, Gandemer V, Armari Alla C, Clausen N, Jeziorski E, Lambilliote A, Weitzman S, Henter JI, Van Den Bos C, Salvage Group of the Histiocyte Society. Cladribine and cytarabine in refractory multisystem Langerhans cell histiocytosis: results of an international phase 2 study. Blood. 2015 Sep 17;126(12):1415–23. doi: https://doi.org/10.1182/blood-2015-03-635151
New Vaccine Post-Introduction Evaluation Tool [Internet]. [cited 2026 May 6]. Available from: https://www.who.int/publications/i/item/new-vaccine-post-introduction-evaluation-tool
Hyde TB, Dentz H, Wang SA, Burchett HE, Mounier-Jack S, Mantel CF. The impact of new vaccine introduction on immunization and health systems: A review of the published literature. Vaccine. 2012 Oct 5;30(45):6347–58. doi: https://doi.org/10.1016/j.vaccine.2012.08.029
Vaccine demand forecasting [Internet]. [cited 2026 May 7]. Available from: https://www.gavi.org/our-work/market-shaping/vaccine-demand-forecasting
Kompithra RZ, R M, Mathew LG, Verghese VP, John TJ. A High Volume, User-Friendly Immunization Clinic in Vellore, India: A Model for Urban Hospitals. J Immun. 2016 Mar 20;1(1):1–8. doi: https://doi.org/10.14302/issn.2577-137X.ji-15-834
Indian Pediatrics - Editorial [Internet]. [cited 2026 May 6]. Available from: https://www.indianpediatrics.net/mar2004/mar-239-244.htm
Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus recommendations on immunization, 2008. Indian Pediatr. 2008 Aug;45(8):635–48. PubMed PMID: 18723905.
Scribd [Internet]. [cited 2026 May 6]. Iap Guide Book On Immunization 2009 - 2010 | PDF | Adaptive Immune System | Immune System. Available from: https://www.scribd.com/document/83925878/Iap-Guide-Book-on-Immunization-2009-2010
Scribd [Internet]. [cited 2026 May 6]. Iap Guide Book On Immunization 2009 - 2010 | PDF | Adaptive Immune System | Immune System. Available from: https://www.scribd.com/document/83925878/Iap-Guide-Book-on-Immunization-2009-2010
Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus recommendations on immunization and IAP immunization timetable 2012. Indian Pediatr. 2012 Jul;49(7):549–64. doi: https://doi.org/10.1007/s13312-012-0116-3
JaypeeDigital | IAP Textbook of Vaccines [Internet]. [cited 2026 May 6]. Available from: https://www.jaypeedigital.com/book/9789350909478
Vashishtha VM, Choudhury P, Kalra A, Bose A, Thacker N, Yewale VN, Bansal CP, Mehta PJ, Indian Academy of Pediatrics. Indian Academy of Pediatrics (IAP) recommended immunization schedule for children aged 0 through 18 years--India, 2014 and updates on immunization. Indian Pediatr. 2014 Oct;51(10):785–800. doi: https://doi.org/10.1007/s13312-014-0504-y
Vashishtha VM, Choudhary J, Jog P, Yadav S, Unni JC, Kamath SS, Sachdeva A , et.al. Indian Academy of Pediatrics (IAP) Recommended Immunization Schedule for Children Aged 0 through 18 years — India, 2016 and Updates on Immunization [Internet]. 2016 Aug 27. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://acvip.org/professional/columns/pdf/IAP-immunization-schedule-2016-IP-2016-Epub.pdf
Balasubramanian S, Shah A, Pemde HK, Chatterjee P, Shivananda S, Guduru VK, Soans S, Shastri D, Kumar R, IAP Advisory Committee on Vaccines and Immunization Practices, 2018-19. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr. 2018 Dec 15;55(12):1066–74. PubMed PMID: 30745480.
Immunization coverage [Internet]. [cited 2026 May 6]. Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage
Madlon-Kay DJ, Harper PG. Too many shots? Parent, nurse, and physician attitudes toward multiple simultaneous childhood vaccinations. Arch Fam Med. 1994 Jul;3(7):610–3. doi: https://doi.org/10.1001/archfami.3.7.610
Verghese VP, Friberg IK, Cherian T, Raghupathy P, Balaji V, Lalitha MK, Thomas K, John TJ, Steinhoff MC. Community effect of Haemophilus influenzae type b vaccination in India. Pediatr Infect Dis J. 2009 Aug;28(8):738–40. doi: https://doi.org/10.1097/INF.0b013e318199f2a1
Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine [Internet]. [cited 2026 May 6]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm
McCormack PL. DTaP-IPV-Hep B-Hib vaccine (Hexaxim®) : a review of its use in primary and booster vaccination. Paediatr Drugs. 2013 Feb;15(1):59–70. doi: https://doi.org/10.1007/s40272-013-0007-7
John J, Giri S, Karthikeyan AS, Iturriza-Gomara M, Muliyil J, Abraham A, Grassly NC, Kang G. Effect of a single inactivated poliovirus vaccine dose on intestinal immunity against poliovirus in children previously given oral vaccine: an open-label, randomised controlled trial. The Lancet. 2014 Oct 25;384(9953):1505–12. doi: https://doi.org/10.1016/s0140-6736(14)60934-x
Musa SM, Haruna UA, Aliyu LJ, Zubairu M, Lucero-Prisno DE. Leveraging AI to optimize vaccines supply chain and logistics in Africa: opportunities and challenges. Front Pharmacol. 2025 Feb 10;16:1531141. doi: https://doi.org/10.3389/fphar.2025.1531141
Mueller LE, Haidari LA, Wateska AR, Phillips RJ, Schmitz MM, Connor DL, Norman BA, Brown ST, Welling JS, Lee BY. The impact of implementing a demand forecasting system into a low-income country’s supply chain. Vaccine. 2016 Jul 12;34(32):3663–9. doi: https://doi.org/10.1016/j.vaccine.2016.05.027
