Every year, around 700,000 children around the world die from vaccine-preventable diseases, almost all of them in low- and middle-income countries. A new study by Santosh Kumar Gautam, an economist at the University of Notre Dame, finds that India’s national childhood immunization program has helped address this persistent global health challenge, resulting in significant reductions in child deaths.
This study Journal of Population Economicswe also found that vaccination programs have different long-term effects on educational attainment. Exposure to the program decreased elementary school completion but increased middle school completion, suggesting that improvements in child survival can affect education through multiple channels. The findings highlight the importance of aligning health and education policies to balance improvements in child survival with investments in schools and learning.
Vaccines are one of the most cost-effective investments a country can make to improve children’s health and human capital. I wanted to understand not only how India’s vaccination program saved lives, but also how it impacted educational trajectories and human capital development. ”
Santosh Kumar Gautam, Professor of Development and International Health Economics, Keough School of International Studies, University of Notre Dame
Experiments that reduced infant mortality
India launched a universal immunization program in 1985, implementing it district by district, with complete nationwide coverage by 1990. Because some districts received the program years earlier than others, and because only children under the age of 1 were eligible for vaccination, Gautam was able to compare children born just before and after the program was introduced in their district.
Based on a national survey of about 900,000 children, Gautam found that the program reduced infant mortality by 0.4 percentage points and under-five mortality by 0.5 percentage points. This was a significant improvement since nearly one in 10 infants die before their first birthday.
These increases in mortality were concentrated among children from poor rural families and historically disadvantaged caste groups. Gautam said children from wealthy urban and upper-caste families saw little change. This may be because many people were already vaccinated before the program came into existence.
various educational outcomes
The study also found subtle effects on educational attainment. Immunization programs reduced elementary school completion rates but increased middle school completion rates among surviving children.
Gautam said the results may reflect who survived thanks to the program. Some children who benefit from vaccination may not have reached school age without vaccination. As a group, there was a tendency for basic health conditions to deteriorate. Changes in the number of students may have lowered the average elementary school completion rate.
Meanwhile, children who would have survived even if they had been vaccinated, but who would have been healthier because of the vaccination, were more likely to graduate from middle school. Gautam said strained school infrastructure may also have reinforced this pattern. A sudden increase in the number of surviving children could crowd classrooms and strain already limited resources, especially in the early grades.
Designing health and education policy together
Ultimately, this study shows that investments in health and education are most effective when planned holistically, rather than treated as unrelated priorities, Gautam said.
“This study shows that when health and education planners work together, they can strengthen collaboration and produce better outcomes,” Gautam said. “In addition to focusing on saving lives, governments should develop policies that follow children until they enter the classroom.”
The study also questions the assumption that large-scale public health campaigns in developing countries are inevitably undermined by weak implementation, Gautam said. Despite documented problems with medical absenteeism and service delivery in India’s health system, the program still measurably reduced child deaths.
This study contributes to Gautam’s extensive research as an economist, studying how investing in the health of infants and mothers can reduce poverty and help people prosper. This is particularly relevant in resource-constrained environments, where smarter policy design is important to improve outcomes with limited funding.
“Effective immunization policies need to measure not just who vaccines protect, but also how they shape broader human capital and help make the best use of scarce public resources,” Gautam said.
Mr. Gautam, an expert on Notre Dame development and global health economics, is the Keogh School’s doctoral research director. in Sustainable Development and directs the Sustainable Development major in the school’s Master of International Affairs program. He is affiliated with the University of Notre Dame’s Eck Institute for Global Health and the Building Inclusive Growth (BIG) Institute (part of the Keough School’s Pulte Institute for Global Development), and is a faculty fellow at the Keough School’s Kellogg Institute.
This research received open access funding from the Hesburgh Library at the University of Notre Dame.
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Reference magazines:
Gautam, SC (2026) The impact of childhood immunization programs on health and education: Trace evidence from India. Journal of Population Economics. DOI: 10.1007/s00148-026-01186-8. https://link.springer.com/article/10.1007/s00148-026-01186-8
