Examine the administrative and infrastructural challenges in scaling up adolescent vaccination programmes across India's federal health system.

Q. Examine the administrative and infrastructural challenges in scaling up adolescent vaccination programmes across India's federal health system. (15 marks, 250-350 words)

Public health being a State subject (Entry 6, List II), nationwide adolescent vaccination depends on Centre-designed programmes delivered through unevenly capable State systems. India's HPV vaccination drive for 14-year-old girls, launched in February 2026 for about 1.15 crore beneficiaries [2], illustrates both the promise and the friction of such scaling.

Administrative challenges - Federal coordination: the Centre funds, procures and sets protocol while 36 States/UTs execute; differing health-worker density and governance capacity produce wide coverage variation [1]. - Human resource and training load: medical and paramedical staff had to be trained across all 36 States/UTs before scale-up — a sequencing bottleneck for any new antigen [1]. - Consent and hesitancy: vaccination is voluntary and needs parental consent [2], so refusal, rumour and misinformation directly cap coverage, unlike infant immunisation. - Reaching the adolescent cohort: adolescents lack the routine facility contact infants have; out-of-school, migrant and married girls require school-health and departmental convergence. - Data and tracking: real-time monitoring via the U-WIN platform demands digital literacy and connectivity at the last mile [1].

Infrastructural challenges - Last-mile delivery points: dependence on Ayushman Arogya Mandirs, PHCs, CHCs, sub-district/district hospitals and medical colleges [1][2] strains thinly served rural, tribal and urban-slum areas. - Cold chain and campaign compression: a crore-scale cohort within a short intensive window tests vaccine logistics, storage and AEFI-management readiness. - Continuum-of-care gaps: prevention succeeds only with screening at primary level and treatment through Day Care Cancer Centres [1] — capacity that is still being built. - Absorption lag: roughly 52 lakh girls vaccinated by mid-July 2026 against a 1.2 crore target [1] shows scale-up, not saturation.

Thus the constraint is less scientific than systemic. Strengthening frontline staffing, school-based delivery, IEC for consent, and States' diagnostic-treatment capacity — with U-WIN-based equity monitoring — can convert the campaign into durable routine immunisation, advancing WHO's 90-70-90 cervical cancer elimination targets for 2030 [3].

(~315 words)

Sources: 1. Update on HPV Vaccination Programme and Cervical Cancer Prevention, Ministry of Health and Family Welfare, PIB (21 July 2026) — 52,10,302 girls vaccinated by 15 July 2026; staff training completed in all 36 States/UTs; U-WIN tracking; delivery points; Day Care Cancer Centres 2. Prime Minister Shri Narendra Modi Launches Nationwide HPV Vaccination Drive for 14-Year-Old Girls from Ajmer, Rajasthan, PIB (28 February 2026) — ~1.15 crore target cohort; free, voluntary vaccination with parental consent; government facility-based delivery 3. WHO, Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem (2020) — 90-70-90 elimination targets by 2030