Each year, roughly 700,000 children worldwide die from vaccine-preventable diseases, nearly all in low- and middle-income countries. New research from University of Notre Dame economist Santosh Kumar Gautam finds that India’s national childhood immunization program substantially reduced child deaths, though its effects on educational attainment were more mixed.

India launched its Universal Immunization Programme in 1985 and rolled it out district by district, reaching full national coverage by 1990. Drawing on a national survey of nearly 900,000 children, Gautam found the program reduced infant mortality by 0.4 percentage points and under-five mortality by 0.5 percentage points. Those gains were concentrated among children in rural areas, from poor households, and from historically disadvantaged caste groups; children from wealthier, urban or higher-caste households saw little change.

The study, published in the Journal of Population Economics, found that while the program reduced primary school completion, it increased secondary school completion among surviving children — a pattern Gautam says may reflect who survived because of the program, since some children who benefited from vaccination might not have reached school age otherwise and, as a group, had poorer underlying health.

“Vaccines are one of the most cost-effective investments a country can make in improving child health. Health and education planners can strengthen their coordination and produce better outcomes by working together.”

Santosh Kumar Gautam, Notre Dame’s Keough School of Global Affairs

The study also challenges the assumption that large public health campaigns in developing countries are inevitably undermined by weak implementation. Despite documented problems with medical absenteeism and service delivery in India’s health system, the program still produced a measurable reduction in child deaths, underscoring the importance of coordinating health and education policy so that gains in child survival are matched by investment in schools and learning.

Publication

The study, “The effects of childhood immunization programs on health and education: micro-evidence from India,” was published in the Journal of Population Economics (DOI: 10.1007/s00148-026-01186-8), supported by the University of Notre Dame’s Hesburgh Libraries.