Surreal illustration depicting the complex relationship between economic indicators, immunization, and data analysis in the context of India's health programs.

Did India's Childhood Immunization Program Really Boost Wages?

Nico Varela in Health & Wellness November 2025 • 4 min read.

"A closer look at the long-term economic effects of the Universal Immunization Programme reveals surprising insights."

A recent study by Summan, Nandi, and Bloom (SNB) suggested a compelling link between India's Universal Immunization Programme (UIP) and increased wages, as well as household expenditure in early adulthood. Their research indicated that exposure to the UIP during infancy led to improved economic outcomes later in life, sparking interest in the long-term benefits of public health initiatives.

However, a new analysis raises questions about the original study's conclusions. This critical review suggests that the apparent benefits of the UIP might be influenced by factors unrelated to the program itself. It argues that the way data was collected and analyzed could have inadvertently created the impression of a direct link between immunization and economic prosperity.

This article explores these counterarguments, diving into the complexities of data interpretation and highlighting the importance of considering alternative explanations. By examining survey methodologies, economic trends, and potential biases, we aim to provide a balanced perspective on the true impact of India's childhood immunization program.

Unpacking the Research: How Was the Impact Assessed?

Surreal illustration depicting the complex relationship between economic indicators, immunization, and data analysis in the context of India's health programs.

The original study (SNB) based its findings on data from the late 1980s, a period when the UIP was being rolled out across different districts in India. Researchers classified individuals as 'treated' if they were born in a district and year after the UIP had begun operating there. They then compared the wages and household expenditure of this group with those who were not exposed to the program during infancy.

However, the critical review points out a potential flaw in this approach. Because the study controlled for age at the time of the follow-up survey, and because year of birth and age are closely related, the identifying variation does not come from the staggered rollout of the UIP. Instead, the progression of time during the follow-up period, which may have had higher wages and household expenditure, was more likely to have affected the outcomes.

Staggered Rollout: The UIP was introduced gradually across districts, creating a natural experiment.
Treatment Definition: Individuals born after the UIP launch in their district were considered 'treated.'
Age as a Control: The study adjusted for the age of participants at the time of the survey.

To illustrate this point, the new analysis conducts a randomization exercise. It hypothetically reschedules the program's launch across districts and finds that even with this randomized treatment, similar positive results emerge. This suggests that something other than the UIP's actual implementation might be driving the observed outcomes.

The Real Takeaway: What Does This Mean for Future Research?

While the initial study offered an optimistic view of the UIP's long-term economic benefits, this new analysis urges caution. It highlights the importance of scrutinizing research methodologies and considering alternative explanations, such as economic growth, inflation, and survey sequencing, when evaluating the impact of large-scale public health programs. By understanding these nuances, future research can provide more accurate and reliable insights into the true effects of interventions like India's Universal Immunization Programme.

About this Article -

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This article is based on research published under:

DOI-LINK: https://doi.org/10.48550/arXiv.2401.111,

Title: Long-Term Effects Of India'S Childhood Immunization Program On Earnings And Consumption Expenditure: Comment

Subject: econ.gn q-fin.ec

Authors: David Roodman

Published: 19-01-2024

Everything You Need To Know

What was the primary finding of the Summan, Nandi, and Bloom (SNB) study regarding India's Universal Immunization Programme (UIP)?

The Summan, Nandi, and Bloom (SNB) study indicated that individuals exposed to India's Universal Immunization Programme (UIP) during infancy experienced increased wages and improved household expenditure in their early adulthood. This suggested a positive long-term economic impact of the public health initiative.

What potential flaw does the critical review point out in the original study's (SNB) methodology concerning the Universal Immunization Programme (UIP) impact assessment?

The critical review suggests that the apparent benefits of the Universal Immunization Programme (UIP) observed in the Summan, Nandi, and Bloom (SNB) study might be influenced by factors unrelated to the program itself. Specifically, controlling for age at the time of the follow-up survey could mean that the identifying variation does not come from the staggered rollout of the UIP, but rather from other time-dependent factors such as economic growth.

How did the original study (SNB) define 'treatment' in relation to the Universal Immunization Programme (UIP) when assessing its impact?

In the Summan, Nandi, and Bloom (SNB) study, individuals were classified as 'treated' if they were born in a district and year after the Universal Immunization Programme (UIP) had begun operating there. This meant they were considered to have been exposed to the program during infancy, and their outcomes were then compared with those who were not exposed.

What alternative explanations does the critical review suggest might account for the observed economic benefits initially attributed to India's Universal Immunization Programme (UIP)?

The critical review suggests alternative explanations, such as economic growth, inflation, and survey sequencing, might account for the observed economic benefits initially attributed to India's Universal Immunization Programme (UIP). The analysis emphasizes that the staggered rollout and potential correlations with age could lead to misinterpretations if these broader economic trends are not adequately considered.

What kind of randomization exercise was conducted in the new analysis and what did it reveal about the findings related to the Universal Immunization Programme (UIP)?

The new analysis conducted a randomization exercise that hypothetically rescheduled the Universal Immunization Programme's (UIP) launch across districts. Even with this randomized treatment, similar positive results emerged as in the original Summan, Nandi, and Bloom (SNB) study. This suggests that something other than the UIP's actual implementation like general economic development or flaws in the SNB methodology might be driving the observed outcomes.