Back in 1985, India started a program to vaccinate every child under age one against deadly diseases. By 1990, the program had reached the entire country — and it saved hundreds of thousands of young lives, according to new research from economist Santosh Kumar Gautam at the University of Notre Dame.
Gautam studied what happened to children born in districts that got the program earlier versus later. Because only babies under one year old could receive the vaccines, he could compare children born just before and just after the program arrived in their area. He used a national survey covering nearly 900,000 children to measure the results.
The findings, published in the Journal of Population Economics, show that the Universal Immunization Programme cut infant deaths by 0.4 percentage points and under-five deaths by 0.5 percentage points — significant progress at a time when nearly 1 in 10 babies died before turning one. The lives saved were concentrated among the children who needed help most: those in rural villages, from poor families, and from historically disadvantaged caste groups. Children from wealthier, urban, or higher-caste families saw little change, likely because many were already getting vaccinated privately.
"Vaccines are one of the most cost-effective investments a country can make in improving child health and human capital," Gautam said. "I wanted to understand not only how India's immunization program saved lives, but also how it affected educational trajectories and human capital development."
On education, the results were more complicated. The program reduced primary school completion but increased secondary school completion. Gautam believes this reflects who survived because of the vaccines. Some children who benefited were born into poorer health and might not have reached school age otherwise — and that shift in the student population may have lowered average primary completion rates. Meanwhile, healthier children who would have survived anyway were more likely to finish secondary school thanks to better physical and cognitive development. Classroom overcrowding as suddenly more children survived may have also played a role in the early grades.
Despite these mixed education results, Gautam says the broader lesson is clear: health and education policies work better when planned together rather than treated as separate problems. "This study illustrates how health and education planners can strengthen their coordination and produce better outcomes by working together," he said. "In addition to focusing on saving lives, governments should design policies that follow children into the classroom."
The research also challenges the idea that big public health programs in developing countries fail because of poor implementation. Even though India's health system has documented problems with staff absences and service gaps, the vaccination program still produced measurable reductions in child deaths. Each year, roughly 700,000 children worldwide die from diseases that vaccines could have prevented — nearly all of them in low- and middle-income countries. India's experience shows that national commitment and careful rollout can save lives at scale, even in challenging conditions.