<p>This review examines the recent increase and the changing epidemiology of vaccine-preventable diseases (VPDs) in pediatric age group in India, explores the current challenges, and outlines strategies to restore and sustain vaccination coverage gains in the country. Data were sourced from the desk review of published literature, WHO Global Health Observatory and the Integrated Disease Surveillance Programme (IDSP) of India. Authors analysed trends in immunization coverage and outbreak patterns. The findings show that the vaccination coverage and basket of vaccines being offered to children in India is increasing and vaccine preventable diseases burden has come down. However, in the recent years, there has been spikes in reported measles cases in Indian states. There has been a notable rise in mumps cases, particularly among older children. The overall incidence of rubella has declined, but pockets of under-immunized populations continue to impede elimination efforts. There has been re-emergence of diphtheria cases in states such as Kerala and Assam, accompanied by a shifting disease burden towards adolescents and adults. India’s childhood immunization program has matured and coverage is more than ever; however, there are geographical and income inequities in coverage and surges in pediatric age group about vaccine-preventable diseases. There is a need for regular field assessments for these factors to ensure high and sustained coverage with quality vaccines. There is also a need for Digital platforms like Co-WIN and U-WIN which are pivotal for real-time tracking and enhanced vaccine delivery. Alongside, there is a need for making India’s Universal Immunization Programme (UIP) a truly integrated effort of life course vaccination; that is how we can control the future surge in pediatric or any other age group.</p>