Introducing the hexavalent (six-in-one) vaccine into India's Universal Immunization Programme (UIP) could improve the efficiency of the country's childhood immunization programme by reducing the number of injections for infants, lowering operational burden on healthcare workers, and generating economic benefits if the vaccine is made available at an affordable price, according to a new study. 

The study was led by Dr. Pawan Kumar and Dr. Kapil Singh from the Ministry of Health and Family Welfare, Government of India, along with researchers from The George Institute for Global Health India, the Gates Foundation, Gavi, The Vaccine Alliance, and John Snow India Private Limited.

Published in the peer-reviewed journal Human Vaccines & Immunotherapeutics, the research evaluated the potential impact of replacing the existing pentavalent and fractional inactivated polio vaccine (IPV) schedule with the hexavalent vaccine, which protects against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b (Hib), and polio in a single injection.

India vaccinates nearly 26 million infants annually under the UIP. Currently, children receive multiple injections during routine immunization visits, increasing the burden on caregivers and healthcare providers. 

The study found that the hexavalent vaccine could significantly reduce the number of injections administered to infants while lowering the need for syringes and other vaccination supplies. It also highlighted potential reductions in cold-chain storage requirements, workload for Auxiliary Nurse Midwives (ANMs), vaccine managers and cold-chain handlers, as well as time spent by parents and caregivers during immunization visits. 

Researchers assessed two implementation scenarios: replacing the current primary immunization schedule with the hexavalent vaccine, and extending its use to replace both the primary schedule and the DTP booster dose. The analysis considered costs from both government and household perspectives, including vaccine procurement, logistics, healthcare worker time, and caregiver time.

The study identified vaccine pricing as the key determinant of programme costs. Based on historical procurement trends in India, researchers estimated that a 50% reduction in the price of the hexavalent vaccine would allow operational and system-level savings to offset the higher procurement costs associated with the vaccine.

Dr. Susmita Chatterjee, Program Head – Health Economics, The George Institute for Global Health India, said, "Combination vaccines have long been recognised for simplifying immunization programmes while improving convenience for families and health systems.  

“Our study demonstrates that although the hexavalent vaccine carries a higher upfront procurement cost, it also generates important efficiencies by reducing injections, easing pressure on frontline health workers, lowering cold-chain requirements and saving caregivers' time. These findings provide important economic evidence that can inform future policy discussions on strengthening India's immunization programme,” added Chatterjee.