Outbreaks of Vaccine Preventable Diseases (VPD) are more common in urban slums owing to high population density and continuous influx of a new pool of infective agents with the immigrating population. The lack of social fabric in urban slums often limits interpersonal interaction and information about services. Urban poor are often not able to muster enough confidence to access services even when services are proximal. Working mothers do not get the support required to attend to their child’s health needs when they are occupied in livelihood generation activities.

Evidence suggests that poor uptake of immunization in urban areas is associated with mother’s unawareness about repeat visits to achieve complete immunization rather than overall vaccine awareness. Slum dwellers are unable to demand services owing to weak community organisation and low collective confidence which is known to increase utilisation of health services. Immunization programmes in urban areas can exert significant effects on VPD associated mortality by limiting number of cases, decreasing clustering of cases within households and increasing time lapse between outbreaks.

The urban poor population is most vulnerable and deprived when it comes to accessing health care services like immunization. With low immunization coverage in urban and peri-urban pockets, slums and illegal squatter settlements are at a high-risk for outbreaks of VPDs resulting in high morbidity and mortality among infants, children, adolescents and pregnant women. The management of these situations is both challenging and resource-intensive.

The findings of the National Family Health Survey (NFHS)-5 reflect a marginal deterioration in immunization coverage in urban areas. Proportion of fully immunized children, which was marginally higher in urban areas from national and rural averages as per findings of the NFHS-4 survey showed an inverted pattern in NFHS-5 with proportion in urban areas less than both the national as well as rural average.