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Effect of vaccination on children’s learning achievements: findings from the India Human Development Survey
  1. Catherine Arsenault1,
  2. Sam Harper2,3,
  3. Arijit Nandi2,3
  1. 1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  2. 2Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
  3. 3Institute for Health and Social Policy, McGill University, Montreal, Canada
  1. Correspondence to Catherine Arsenault, Harvard T.H. Chan School of Public Health, 90 Smith Street, Room 326, Boston, MA 02120, USA; carsenault{at}


Background Beyond the prevention of illness and death, vaccination may provide additional benefits such as improved educational outcomes. However, there is currently little evidence on this question. Our objective was to estimate the effect of childhood vaccination on learning achievements among primary school children in India.

Methods We used cohort data from the India Human Development Survey. Vaccination status and confounders were measured among children who were at least 12 months old at baseline in 2004–2005. In 2011–2012, the same children completed basic reading, writing and math tests. We estimated the effect of full vaccination during childhood on learning achievements using inverse probability of treatment-weighted logistic regression models and results reported on the risk difference scale. The propensity score included 33 potential community-, household-, mother- and child-level confounders as well as state fixed effects.

Results Among the 4877 children included in our analysis, 54% were fully vaccinated at baseline, and 54% could read by the age of 8–11 years. The estimated effect of full vaccination on learning achievements ranged from 4 to 6 percentage points, representing relative increases ranging from 6% to 12%. Bias analysis suggested that our observed effects could be explained by unmeasured confounding, but only in the case of strong associations with the treatment and outcome.

Conclusion These results support the hypothesis that vaccination has lasting effects on children’s learning achievements. Further work is needed to confirm findings and elucidate the potential mechanisms linking vaccines to educational outcomes.


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  • Twitter Catherine Arsenault @sbh4th.

  • Contributors CA and AN led the conception and design of the study. CA performed the analyses and wrote the first draft of the manuscript. SH contributed to the conception and design of the study. All authors contributed significantly to the intellectual content of this manuscript; participated in the data analyses and interpretation; and read, improved and approved the final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding CA acknowledges a doctoral fellowship from the Fonds de la recherche en santé du Québec (FRSQ). CA, SH and AN acknowledge funding from the Canadian Institutes of Health Research Operating Grant, ‘Examining the impact of social policies on health equity’ (ROH-115209), and the Foundation Grant, “Developmental epidemiology: identifying evidence-based interventions for improving population health and promoting health equity (FRN 148467). AN was supported by the Canada Research Chairs programme.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The India Human Development Survey was conducted under the scientific and administrative supervision of the National Council of Applied Economic Research (Delhi) and the University of Maryland, and was reviewed by the relevant ethics review board. Formal written consent was obtained for all the surveys. The McGill University Institutional Review Board considers this study as exempt from full review as it was based on an anonymous, publicly available data set with no identifiable information on participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The IHDS-I and IHDS-II data that support the findings in this study are available on Data Sharing for Demographic Research (DSDR) (Inter-university Consortium for Political and Social Research (ICPSR)) with the identifiers: doi: 10.3886/ICPSR22626.v11 and doi: 10.3886/ICPSR36151.v5.