India’s immunisation programme is often celebrated as a public health success story. Childhood vaccination coverage has improved drastically over the years, helping reduce the burden of several infectious diseases. The story is quite the opposite when it comes to adult immunisation.
A paper titled “Establishing Adult Vaccination Clinics in India: A Proposed Framework,” published in the journal of The Association of Physicians of India, highlights that while childhood vaccination has become routine, adult immunisation occupies low priority in public health conversations and healthcare practices. Yet it is inconspicuous.
Commonly recommended vaccines for adults include influenza, pneumococcal, shingles, tetanus-diphtheria-pertussis (Tdap), hepatitis B and COVID-19 vaccines.
According to the data from 2017-18 cited in the paper, vaccination coverage among Indians aged 60 years and above remains extremely low. Pneumococcal vaccine coverage stands at just 0.74%, while even the highest uptake, for diphtheria and tetanus vaccines, is only 2.75%. The paper observes that more than 80% of Indian adults are unaware of the importance of adult vaccination.
The findings assume significance against the backdrop of increased life expectancy and a growing population of older adults.
“Vaccines are important throughout life, not just during childhood. Some vaccines given in childhood may lose effectiveness over time, while others are specifically recommended for adults and seniors. Adults can still catch serious infections, especially if they have chronic health conditions or weakened immunity,” says Dr Pradeep Narayan Sahoo, consultant, internal medicine, at Manipal Hospital, Bhubaneswar.
Why ageing changes immunity
Ageing affects every organ system in the body, including the immune system. As people grow older, their natural ability to fight infections gradually declines, a phenomenon known as immunosenescence.
“As we grow older, our immune system naturally becomes less effective at fighting infections,” explains Dr Sahoo. He adds, “A 30-year-old generally has a stronger immune response than a 60-year-old. In addition, older adults are more likely to have health conditions such as diabetes, heart disease or kidney disease, which can further increase their risk.
This makes older adults particularly vulnerable to vaccine-preventable diseases such as influenza, pneumonia, shingles, hepatitis B and COVID-19.
Unfortunately, many of these illnesses continue to be underestimated. Flu is often seen as a minor illness, while pneumonia is considered a normal part of ageing. However, these infections can lead to severe complications, hospitalisation and even death in older adults,” expresses Dr Sahoo.
The double burden of chronic diseases
The need for adult vaccination becomes even more urgent for people living with chronic illnesses.
India is already burdened with one of the world’s largest populations of people living with diabetes. Cases of heart disease, chronic lung disease and kidney disorders are also rising steadily. These conditions, besides affecting quality of life, also weaken the body’s ability to fight infections.
“Living with a long-term illness like diabetes, heart disease, lung disease or kidney problems takes a real toll on your immune system,” says Dr Vamshi V, Consultant, Internal Medicine at Gleneagles AWARE Hospital, Hyderabad. For such patients, an infection can have far-reaching consequences.
The flu in a heart patient can set off major inflammation and increase the risk of a heart attack or stroke. In someone with diabetes, it can push them into a dangerous metabolic crisis. For adults with these conditions, catching a preventable infection like flu, pneumococcal pneumonia or shingles isn’t just getting sick, it makes the underlying disease worse.”
Vaccination, he emphasises, acts as a safety net by preventing infections from triggering a cascade of complications.
Some groups need to prioritise adult vaccination
While vaccination benefits all adults, some groups need it more urgently than others.
These include adults aged 60 years and above, people living with chronic illnesses, individuals with weakened immune systems, cancer patients, transplant recipients, healthcare workers and caregivers. Health experts also point out that vaccination recommendations may vary based on age, medical history and risk factors.
“If you live with or care for infants, elderly parents or someone who is bedridden, getting vaccinated protects them too; you create a cocoon of safety around people who may not be able to protect themselves,” says Dr Vamshi.
Adult vaccination is an investment in prevention
One reason adult vaccination often takes a back seat is because people view it as an additional expense. Yet experts argue that prevention is far more affordable than treatment.
“There is strong global evidence that adult vaccines save money and help people stay independent longer,” states Dr. Vamshi.
Preventing infections results in fewer hospital admissions, reduced need for intensive care, shorter recovery periods and lower healthcare costs.
Vaccination can increase productivity among working adults, ease the caregiving burden on families and prevent medical expenses that can be financially overwhelming.
“For older adults, one severe episode of flu or pneumonia can lead to a permanent loss of mobility and independence. Vaccines help people stay active, stay sharp and continue living on their own terms,” Dr Vamshi notes.
The myths surrounding vaccinations
Misconceptions about vaccines pose a major hindrance in the way of their uptake.
One of the most common beliefs is that vaccines are only meant for children.
“Many adults think that if they are healthy, they do not need vaccines. Others believe vaccines can cause the disease they are designed to prevent,” reveals Dr Sahoo.
Dr Pankaj Khatana, Senior Consultant, Internal Medicine at Marengo Asia Hospitals, Gurugram, says myths continue to influence health decisions across age groups and social backgrounds.
“Adults don’t need vaccines—those are just for kids—is probably the most common misconception. Many people assume childhood vaccination provides lifelong protection, which is not always true. Immunity can wane and new risks emerge with age,” reveals Dr Khatana.
He also points out that diseases such as influenza, pneumonia and shingles remain significant health threats despite being vaccine-preventable.
Another common misconception is that natural immunity is always better than vaccine-induced protection. While infection can provide immunity, it can also result in severe complications, long-term disability or even death. Vaccination offers protection without those risks.
Role of COVID-19 in changing perceptions
The COVID-19 pandemic significantly altered public attitudes towards vaccination.
It improved awareness about vaccines and preventive healthcare. Many people became more familiar with concepts such as immunity, vaccine development and disease prevention.
However, the pandemic also fuelled misinformation. “COVID brought an infodemic along with the pandemic. Now even routine adult vaccines are being questioned,” says Dr Vamshi.
Dr Khatana agrees that vaccine hesitancy remains a challenge. “COVID increased awareness but also amplified mistrust and misinformation. Conversations can sometimes be more difficult today because skepticism has become more entrenched. However, many people remain receptive when healthcare providers discuss benefits and risks personally.” He believes that trust in healthcare providers remains a key factor in improving acceptance.
How to approach adult immunisation
Taking care of health shouldn’t be restricted to the routine monitoring of blood pressure, blood sugar and cholesterol levels; vaccination should be a natural part of preventive healthcare among adults.
The authors of the Establishing Adult Vaccination Clinics in India: A Proposed Framework paper believe that dedicated adult vaccination clinics, stronger awareness campaigns and greater engagement by healthcare providers could help improve uptake.
The objective is not merely to extend life but to improve the quality of those additional years.
Healthy ageing requires stronger protection
According to a report, “Senior Care Reforms in India,” published by Niti Aayog in 2024, “The elderly in India currently comprise a little over 10% of the population, translating to about 104 million, and are projected to reach 19.5% of the total population by 2050.”
For a country preparing for an ageing future, adult vaccination becomes more important than ever before.
Adult vaccination is not simply about preventing infections. It is about preventing hospitalisation, maintaining independence, reducing healthcare costs and helping people age well.
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