IJDMMS- International Journal for Doctor of Medicine and Medical Students (IJDMMS)

Offer for Students ₹ 999 INR ( offer valid till 31st December 2025)

59. Comparative Analysis of Immunization Schedules: Kyrgyzstan vs India

Authors:

Abzhaparova A.Z.
Kungar Shubham Dnyaneshwar
Verma Prashant
Durwank Patade
Siddque Ali
Hauque Injamamul

(1, Teacher, Department of public health with a course in evidence based medicine, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.

2,3,4,5,6 Student, 4th Year, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)

Abstract

Immunization continues to be one of the most cost-effective public health measures for lowering the number of deaths and illnesses caused by diseases that can be prevented by vaccines. This paper presents a formal comparative analysis of the national immunization schedules, program structure, coverage performance, recent trends, and operational challenges in Kyrgyzstan and India. The article uses national program documents, WHO–UNICEF coverage estimates, and peer-reviewed literature to compare the composition of schedules, the timing of doses, the history of vaccine introduction, coverage indicators (such as DTP3, MCV1/2, BCG, and Pol3), and recent program responses (such as catch-up campaigns, stockouts, and cold chain issues). The analysis emphasizes structural disparities influenced by health system scale, funding, and epidemiological context, offering recommendations pertinent to MBBS-level students and public health professionals. The main findings are

(1) that both countries follow WHO-recommended infant schedules but make changes that are specific to each country;

(2) India's Universal Immunization. Ministry of Health and Family Welfare+1

Aim and Objective

The main goal is to write a clinically and programmatically useful MBBS-level, evidence-based comparative review. The specific objectives are to summarise and compare the national immunisation schedules of Kyrgyzstan and India for infants, children, and pregnant women. 1. To show and compare important coverage indicators (DTP3, MCV1/MCV2, BCG, Pol3) using WHO–UNICEF estimates. 2. To look at the program’s strengths, weaknesses, and recent trends, such as catch-up campaigns and problems with supplies. 3. To make suggestions for how to improve routine immunisation and stop outbreaks in each country’s situation.

Introduction

Vaccination is a basic way to prevent disease in primary health care and a main job of national health systems. The World Health Organisation (WHO) suggests a basic immunisation schedule for babies, kids, teens, and pregnant women. However, countries change the schedule based on how many diseases are present, how many vaccines are available, how much money is available, and how well the health system can handle the workload. Comparative analyses of national schedules reveal strengths, deficiencies, and transferable insights for program enhancement.

India and Kyrgyzstan are very different places: India has a lot of people and a lot of different types of land. It has a Universal Immunisation Programme (UIP) that is funded by the government and covers millions of births each year.

Kyrgyzstan is a smaller, middle-income country in Central Asia that has been immunising people regularly since the Soviet era. Both countries want to keep a high level of vaccination and grow. Ministry of Health and Family Welfare+1

Methodology

This is a descriptive comparative analysis utilising secondary data sources. We got national immunisation schedules from official documents, like India’s National Immunisation Schedule and Universal Immunisation Programme (Ministry of Health and Family Welfare) and Kyrgyzstan’s country profile and program descriptions from WHO/UNICEF and peer-reviewed literature. The WHO–UNICEF national immunisation coverage (WUENIC) reports and country profiles (the most recent estimates as of mid-2024) were used to get coverage estimates.

We got more information about the program, like catch-up campaigns, from communications from the WHO Regional Office and UNICEF country pages. When peer-reviewed articles included operational details (like missed chances and facility practices), these were used to put the findings in context. Data extraction focused on the most recent official documents, such as program schedules and WUENIC country profiles, as well as communications from authoritative agencies. National Health Mission+2WHO CDN+2

National Immunization Schedules — Overview and Key Differences

India — Universal Immunization Programme (UIP)

The Ministry of Health and Family Welfare (Mo HFW) runs India’s Universal Immunisation Programme (UIP), which is one of the biggest routine immunisation programs in the world. The UIP gives out vaccines for free at public places and has gradually added more antigens to its coverage. For example, it has added the Inactivated Polio Vaccine (IPV), the Rotavirus vaccine, the Pneumococcal Conjugate Vaccine (PCV), and the Measles–Rubella (MR) vaccine in stages. India’s national immunisation schedule says that babies should get vaccines at birth (BCG, OPV0, Hep B birth dose), at 6, 10, and 14 weeks (Pentavalent/DTP-Hep B-Hib or a similar vaccine, OPV/IPV, PCV, and rotavirus if available), and more doses and boosters throughout infancy and childhood, including MMR/MR and DTP boosters. Pregnant women should get tetanus and diphtheria vaccines according to antenatal guidelines. The UIP puts a lot of emphasis on fixed, outreach, and mobile sessions with cold chain support. Ministry of Health and Family Welfare+1

Kyrgyzstan — National Immunization Programme

Although Kyrgyzstan's national childhood vaccination program adheres to WHO guidelines, it has a smaller antigen list than India, which has recently expanded. Due to the legacy of the Soviet immunisation infrastructure, Kyrgyzstan historically had high DTP coverage among surviving infants (>90%); however, recent reports raise concerns about declines and the necessity of catch-up campaigns. OPV/IPV variants as part of polio control, MCV doses for measles (sometimes part of MR campaigns), DTP-containing vaccine (three doses in infancy with subsequent boosters), BCG and HepB at birth, and a few other antigens based on national policy are all part of Kyrgyzstan's routine (e.g., pneumococcal and hepatitis B strategies vary with introduction timelines). The start of catch-up campaigns to address missing children and improve herd immunity is highlighted in recent WHO communications. UNICEF+1

Table 1. Simplified comparison of infant/child immunization schedules (selected antigens) — India vs Kyrgyzstan

Note: Simplified versions of national schedules are displayed. Certain catch-up or campaign doses have different timing, formulations (such as combination vaccines), and specific brands depending on the year and subnational adaptation. For operational use, always refer to the most recent national program document.

Antigen (selected)

India — Recommended timing (national schedule)

Kyrgyzstan — Typical timing (national schedule)

BCG

At birth (or as early as possible) (single dose)

At birth (single dose).

Hepatitis B (birth dose)

At birth (within 24 hrs) + subsequent doses in pentavalent schedule

Birth dose, then further doses as per national schedule.

DTP / Pentavalent (DTP-HepB-Hib)

6, 10, 14 weeks (3 doses); booster at 16–24 months and 5–6 years (varies)

6, 10, 14 weeks (3 doses) with boosters per schedule (often at 18 months/6 years depending on policy).

Oral Polio Vaccine (OPV) / IPV

OPV in primary series (6, 10, 14 wks) + IPV doses introduced; national polio campaign strategies vary

OPV/IPV in infancy; national strategy updated with global polio eradication context.

Measles / Measles–Rubella (MR)

MCV1 at 9–12 months (depending on state policy), MCV2 at 16–24 months or 15–18 months after MR introduction

MCV1 at 9–12 months; MCV2 or MR second dose as per NIP or mass-campaign schedules.

Pneumococcal Conjugate Vaccine (PCV)

Introduced in phases; 6, 14 wks / 9 & 15 months depending on schedule

Introduction may be limited or later; depends on national procurement and Gavi/partner support.

Rotavirus

Introduced in phased manner; schedule depends on product (2 or 3 doses)

Introduction variable; may be absent or limited depending on programme decisions.

HPV

Adolescents in phased introduction in India; school-based where available

HPV introduction variable; many upper-middle income/low-income countries introduce later.

(Sources: MoHFW India—National Immunization Schedule & UIP; WHO country profile and UNICEF summaries for Kyrgyzstan). National Health Mission+1

Coverage Indicators — Comparative Data and Interpretation

The WHO–UNICEF Estimates of National Immunisation Coverage (WUENIC), which integrate administrative data, surveys, and expert review, are trustworthy, globally comparable coverage estimates. Key coverage indicators (based on the most recent WUENIC data available in the mid-2024/2023 revision) for both countries are summarised in the following table: BCG, MCV1, Pol3, and DTP3 (three doses of DTP). These metrics for program performance are frequently used.

Indicator

India (WUENIC latest revision 2023/2024)

Kyrgyzstan (WUENIC latest revision 2023/2024)

DTP3 coverage (%)

~90–94% (country-level trend improved in recent years; see WUENIC country profile).

Historically ≥90% but recent surveys show declines and subnational gaps; WUENIC profile indicates high historical coverage with concerns.

BCG coverage (%)

Variable across states; national estimates often ~90% but timely birth dose coverage lower in some settings.

High (often reported above 90%), due to routine newborn vaccination tradition.

MCV1 coverage (%)

Varies; national MCV1 around high 80s–90s depending on year and measles–rubella campaign reach.

MCV1 historically high (>90%) but outbreaks and coverage declines observed in recent years.

Pol3 coverage (%)

High (>80–90%) with programmatic IPV introduction; polio surveillance remains a priority.

High historically; polio pulsed campaigns may supplement routine.

Table 2. Selected immunization coverage indicators (WHO–UNICEF estimates; latest available revision)

Interpretation: India’s large birth cohort leads to heterogeneity; national averages conceal subnational disparities, while some states and union territories attain >95% coverage while others lag. However, recent program signals (WHO/UNICEF, UNICEF country updates) show declining trends or pockets of under-coverage that prompted catch-up campaigns. Historically, Kyrgyzstan maintained high DTP3 coverage (>90%). WHO CDN+2WHO CDN+2

Programme Structure, Financing and Delivery Mechanisms

India — Structure and Financing

The Indian government provides central funding for the UIP, which is carried out through state health systems with technical assistance from partners (WHO, UNICEF, Gavi in previous years). Delivery reaches rural populations through a combination of outreach sessions (sub-centers, anganwadi centres) and fixed-site immunisation sessions in primary health centres. Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), and cold-chain technicians are examples of human resources. In addition to economies of scale, the size of UIP increases the logistical complexity of cold chain expansion, microplanning, and vaccine procurement. To manage cold chain and stock data, India has made investments in digital registries (such as eVIN, or electronic Vaccine Intelligence Network) and domestic vaccine production capacity.Ministry of Health and Family Welfare

Kyrgyzstan — Structure and Financing

Traditionally, Kyrgyzstan’s vaccination program is administered through primary health centres, maternity hospitals (birth doses), and outreach to rural oblasts. It is integrated into the country’s primary health care network. Historically, state budgets were used for funding; where appropriate, technical assistance and vaccines for new introductions were supplied by international partners (WHO, UNICEF, and Gavi for eligible periods). Despite resource limitations that affected outreach capabilities and vaccine procurement, Kyrgyzstan maintained many of its system strengths (facility-based maternal and child services) in the post-Soviet era. Catch-up campaigns and bolstering surveillance have been the focus of recent operations.UNICEF+1

Recent Trends and Operational Challenges

India — Recent Developments and Challenges

India has been expanding antigen coverage (PCV, rotavirus, HPV in pilots/roll-outs) while strengthening cold chain and digital monitoring (eVIN). Important difficulties include:

Subnational heterogeneity: Significant variations in coverage between states; isolated rural and urban slums with pockets of under-immunized and zero-dose children.

Vaccine hesitancy and misinformation: The adoption of more recent vaccines, such as HPV, may be impacted by localised hesitancy.

Timeliness of birth doses: Delayed birth doses of BCG and HepB in environments with significant institutional delivery delays or gaps.

Logistics and human resources: Reaching a sizable population spread across different regions necessitates ongoing workforce assistance and microplanning.Ministry of Health and Family Welfare+1

Kyrgyzstan — Recent Developments and Challenges

Kyrgyzstan’s catch-up vaccination campaign, which was started during European Immunisation Week to address children who missed scheduled doses, was highlighted in WHO-Europe announcements in 2025. Important difficulties include:

Declining coverage trends: Although historically >90% for DTP3, latest surveys and programme reports indicate declines and need for catch-up.

Missed opportunities and access gaps: Missed opportunities for vaccination in health encounters—facility practices and parental knowledge gaps are documented concerns.

Vaccine stockouts and supply issues: Programme reports note episodic stockouts at subnational levels; catch-up campaigns partly aim to mitigate these gaps.

Surveillance and outbreak risk: Reduced coverage increases risk of measles and pertussis outbreaks, requiring robust surveillance and rapid response capacity. World Health Organization+1

Comparative Analysis — Strengths, Weaknesses and Contextual Drivers

Coverage and Equity

India: Weakness: heterogeneity and a high absolute number of children receiving zero and underdoses; Strength: wide range of products and recent antigen scale-up. Because of its diversity, India necessitates state-specific approaches and focused microplanning to reach underserved communities. WHO CDN

Kyrgyzstan: Strength —Weakness: recent declines and subnational pockets of under-coverage require catch-up efforts; Strengths: historically high routine coverage and institutional delivery rates that facilitate birth vaccinations.UNICEF+1

Schedule Composition and Policy Choices

With several newly introduced antigens, India’s schedule has grown increasingly complicated. This is a result of increased funding and domestic vaccine production capabilities, as well as a focus on lowering vaccine-preventable morbidities like pneumonia and diarrhoea. Despite being in line with WHO core vaccines, Kyrgyzstan’s schedule has been slower to include some newer antigens because of procurement and resource limitations.

Service Delivery and Systems

Supply management benefits from India’s sizable workforce (ANMs, ASHAs) and digital investments (eVIN). While timely birth vaccinations are made possible by the continuity of facility-based maternal and newborn services in Kyrgyzstan, the country may not have enough resources for nationwide mass campaigns or quick antigen scale-up.

Financing and International Support

In addition to producing vaccines domestically, India’s central financing model enables ongoing national procurement and scale-up. Gavi eligibility and external funding cycles can affect the rate at which new vaccines are introduced; historically, Kyrgyzstan has relied more on state funding with sporadic partner support.

Epidemiological Drivers

Vaccine policy is informed by outbreak history and differences in disease burden. While Kyrgyzstan’s subnational gaps could lead to outbreaks despite high national averages, India’s high population density and internal migration increase the risk of localised outbreaks.

Programmatic Recommendations (MBBS Student Perspective — Practical & Feasible)

1. Strengthen microplanning and targeted outreach: Subnational microplans that pinpoint zero-dose areas and customise outreach (school-based, urban slum outreach, nomadic population strategies) ought to be given top priority in both nations. In India, this entails state and district microplans; in Kyrgyzstan, campaigns can be guided by oblast-level rapid assessments.

2. Improve timeliness of birth doses: Prioritise improving newborn immunisation programs; make sure that maternity hospitals and early postnatal contacts administer BCG and Hep B birth doses.

3. Catch-up and Supplementary Immunization Activities (SIAs): Plan targeted SIAs for polio and measles/MR as necessary in areas where coverage has decreased or surveillance shows susceptibility; Kyrgyzstan's 2025 campaign serves as an illustration of prompt action.World Health Organization

4. Enhance vaccine supply-chain visibility:Increase cold-chain monitoring and digital tools (like eVIN-style systems) to cut down on stockouts. Kyrgyzstan might profit from customised, less expensive digital solutions; India’s experience with eVIN is instructive for scaled implementation.

5. Surveillance and laboratory strengthening:For measles, rubella, pertussis, and polio, strong case-based surveillance allows for early outbreak detection and prompt response.

Community engagement and risk communication: Address hesitancy through trusted local health workers, community leaders and school health programs. Targeted IEC (information, education and communication) for new vaccines can accelerate acceptance.

1. Capacity building for missed-opportunity reduction: Train frontline workers to use every health contact to check and provide missed vaccines (OPV/IVP, DTP, MCV).

2. Data-driven decision making: Use WUENIC, health management information systems and survey data to prioritise interventions. Maintain routine coverage monitoring and supportive supervision.

Case Examples and Practical Scenarios (for MBBS Students)

Case 1: Newborn with delayed BCG in a rural primary health centre (India)

Due to a shortage of supplies, a newborn born at a remote facility shows up on day seven without BCG. If available, the frontline ANM can administer BCG right away or schedule a priority vaccination for the following fixed-site session. They can also advise the mother on the timing of HB’s birth dose. Cold chain managers must be informed of stockout trends at the district level, and vaccine reallocation is done using eVIN data. This exemplifies promptness, stock control, and therapy.

Case 2: Child missed routine DTP doses due to parental migration (Kyrgyzstan)

DTP2/3 was missed by a 9-month-old child who was transferred from a rural oblast to an urban centre. Facility staff should screen for missed vaccinations at every visit and provide catch-up dosing in accordance with WHO catch-up schedules; a rapid catch-up schedule that adheres to national guidelines should be implemented. Communication between facilities and record-keeping are crucial.

Discussion

It is instructive to compare India and Kyrgyzstan: Schedule complexity, coverage performance, and program adaptability are influenced by the national context, which includes factors like population size, funding, and historical infrastructure. Although it struggles with equity across subnational populations, India’s extensive UIP shows the ability to introduce multiple antigens and leverage domestic vaccine production. Kyrgyzstan demonstrates the importance of long-standing routine practices (birth doses in a facility), but it is vulnerable when supply or access problems cause immunity gaps to appear. From the standpoint of clinical education, MBBS students should comprehend operational determinants (cold chain, workforce, microplanning) as well as the scientific justification for schedules (age-specific immunogenicity, maternal antibody interference, safety). Future clinicians will be better able to actively engage in vaccination delivery, counselling, and surveillance if they acknowledge that schedules are policy tools based on epidemiology and resource realities. AP News+1

Limitations of the Analysis

This study is based on WHO-UNICEF country profiles (WUENIC) and national program documents that are accessible to the public. Potential data lag (WUENIC revisions are made annually), subnational heterogeneity not being fully reflected in national averages, and quick policy changes (such as new introductions or campaign dates) that might have happened after the most recent documents are some of the limitations. Practitioners must refer to the most recent regional health authority notices and national immunisation operational guidelines when planning their operations. Furthermore, there weren’t many peer-reviewed operational studies that were unique to Kyrgyzstan, so operational details were based on selected studies and WHO/UNICEF updates.

Conclusion

India and Kyrgyzstan both follow WHO-recommended vaccination schedules that are modified for local conditions. Although Kyrgyzstan enjoys the advantages of a long and robust routine immunisation tradition, recent coverage declines necessitate targeted catch-up efforts. In contrast, India’s UIP is dynamic and broad, reflecting capacity for antigen expansion and centralised procurement. The comparative viewpoint emphasises the significance of comprehending schedule justification, delivery methods, surveillance, and the necessity of equity-focused vaccination strategies for MBBS students and aspiring public health professionals. To sustain and increase vaccination coverage and stop outbreaks of vaccine-preventable diseases, ongoing surveillance, improved supply chains, focused outreach, and community involvement are still crucial.

Acknowledgments

This comprehensive review synthesizes evidence from authoritative sources including the Centers for Disease Control and Prevention, National Institutes of Health, World Health Organization, European Centre for Disease Prevention and Control, and peer-reviewed medical literature. The information reflects current knowledge and clinical guidelines as of October 2025.

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10171130/

2. https://www.mayoclinic.org/diseases-conditions/botulism/symptoms-causes/syc-20370262

3. https://en.wikipedia.org/wiki/Botulism

4. https://www.ncbi.nlm.nih.gov/books/NBK459273/

5. https://www.cdc.gov/botulism/signs-symptoms/index.html

6. https://emedicine.medscape.com/article/213311-followup

7. https://emedicine.medscape.com/article/213311-overview

8. https://my.clevelandclinic.org/health/diseases/17828-botulism

9. https://www.news-medical.net/health/Botulism-Prognosis.aspx

10. https://www.who.int/news-room/fact-sheets/detail/botulism

11. https://emedicine.medscape.com/article/213311-clinical

12. https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm