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

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].