Adult immunisation gap:Why India still lacks a strong lifelong vaccination culture

By Admin

16 Mar, 2026

For decades, vaccination in India has been closely linked with childhood healthcare. National programmes such as the Universal Immunisation Programme (UIP) have significantly improved vaccination coverage among children and helped reduce deaths from infectious diseases. These efforts have been widely recognised as a major success in public health.

However, once individuals move beyond adolescence, immunisation largely disappears from the national health conversation. Adult vaccination remains an overlooked area, even though infectious diseases continue to affect millions of adults across the country. This gap raises an important question: why does India still lack a strong culture of lifelong vaccination?

India’s Global Leadership in Vaccine Production

India holds a remarkable position in the global vaccine ecosystem. The country is the largest vaccine manufacturer in the world by volume and contributes more than 60% of global vaccine production. India also supplies over 40% of the world’s vaccines and is home to the largest vaccine manufacturer globally.

Despite this strong manufacturing capacity and global influence, the domestic uptake of vaccines among adults remains extremely low. In many developed countries such as the United States and Canada, around 70% of adults aged 65 and above receive the influenza vaccine. In contrast, adult influenza vaccination coverage in India remains below 2%.

This contrast highlights a significant paradox: while India produces vaccines for the world, it has yet to establish a robust culture of lifelong immunisation for its own population.

Why Adult Vaccination Matters

Adult immunisation plays a critical role in preventing severe illnesses and reducing healthcare burdens. According to a report by the Observer Research Foundation (ORF), more than 95% of deaths associated with vaccine-preventable diseases (VPDs) in India occur among adults.

At the same time, India’s demographic structure is changing rapidly. Although the country is often described as a young nation, its elderly population is expanding quickly. According to the United Nations Population Fund, India is expected to have nearly 193 million older persons by 2030, representing about 13% of the total population.

Ageing populations face greater health risks, especially when combined with chronic conditions such as diabetes, cardiovascular diseases, or lung disorders. These conditions make individuals more vulnerable to infections that vaccines can prevent.

Several diseases continue to affect adults in India, including pneumococcal pneumonia, hepatitis B, and cancers linked to human papillomavirus (HPV). HPV alone is responsible for around 88–98% of cervical cancer cases, one of the most common cancers among Indian women.

Despite these risks, ORF estimates that the uptake of common adult vaccines such as influenza, pneumococcal, typhoid, and hepatitis B ranges between just 0.6% and 1.9% among adults.

The Current State of Adult Immunisation in India

Public health experts believe that adult immunisation in India remains significantly underdeveloped. Dr. Reena Marbate, a public health professional who has worked extensively in community health and immunisation programmes, notes that vaccination coverage among adults remains extremely low compared to childhood immunisation.

According to Dr. Marbate, several factors contribute to this gap, including limited awareness, policy challenges, and affordability issues.

One of the most important barriers is the lack of awareness, not only among the general population but sometimes even within the medical community. Studies indicate that more than 80% of adults in India are unaware that vaccines may be required beyond childhood.

Misinformation and socio-cultural beliefs also contribute to vaccine hesitancy. During the COVID-19 vaccination drive, rumours and myths such as concerns about infertility spread quickly and influenced public perceptions. Similar misconceptions continue to affect adult vaccination today.

Policy Gaps and Lack of Structured Programmes

Another major challenge is the absence of a dedicated national programme for adult vaccination. While India has a well-defined immunisation schedule for children under the Universal Immunisation Programme, comparable clarity is largely missing for adults.

Dr. Marbate points out that the country’s health priorities have increasingly focused on non-communicable diseases such as diabetes and cardiovascular disorders. As a result, adult vaccination has received limited research attention and policy focus.

Healthcare workers remain one of the few groups where adult vaccination is more common. Due to occupational risks, medical professionals are often advised to receive vaccines such as hepatitis B, as they regularly interact with patients and clinical procedures.

Cost and Accessibility Challenges

Cost remains another significant obstacle to adult immunisation in India. Most adult vaccines are available primarily through the private healthcare sector, making them expensive for many people, particularly those from low-income or marginalised communities.

Dr. Marbate emphasises that the price of vaccines can be a major deterrent, especially when they are not covered under government programmes.

Even large public health schemes such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which provides health insurance coverage for inpatient care, currently do not include adult vaccines under their benefits.

Important Vaccines Recommended for Adults

To address this gap, the Association of Physicians of India released the Indian Consensus Guidelines on Adult Immunisation, which provide recommendations for 25 vaccines across different age groups and risk conditions.

These guidelines include tailored recommendations for individuals with specific health conditions, such as pregnancy, heart disease, lung disorders, or weakened immune systems.

Some of the key vaccines recommended for adults include:

• Influenza vaccine
  
  

• Pneumococcal vaccine
  
  

• Hepatitis B vaccine
  
  

• Herpes zoster (shingles) vaccine
  
  

• Human papillomavirus (HPV) vaccine
  
  

• Typhoid vaccine
  
  

• COVID-19 vaccine
  
  

These vaccines help prevent infections that can lead to severe complications, especially among people with underlying health conditions.

However, Dr. Marbate notes that while the vaccines exist, the dosing schedules, eligibility criteria, and recommendations are not always clearly stated in national guidelines.

Steps Needed to Improve Adult Vaccination

Experts believe that improving adult immunisation coverage in India will require a multi-pronged approach involving awareness, policy reforms, and improved access.

The ORF report highlights several strategies that could help increase vaccination uptake. One approach is to involve paediatricians more actively in spreading awareness. Since adults often accompany children during vaccination visits, paediatricians could educate them about the importance of adult immunisation.

Public health campaigns are also essential. Increasing awareness about vaccine-preventable diseases and the importance of lifelong vaccination could help shift public attitudes.

Another recommendation is the establishment of dedicated adult vaccination centres, which could make vaccines more accessible and streamline immunisation services.

Dr. Marbate also emphasises the need for clear national guidelines and a structured adult immunisation programme supported by adequate funding, trained personnel, and logistical infrastructure.

She notes that socio-economic factors and political priorities have so far limited the focus on adult vaccination in India. However, initiatives such as the HPV vaccination programme demonstrate that the government has the capacity to implement large-scale immunisation campaigns.

Moving Towards a Lifelong Vaccination Culture

India has already demonstrated its ability to lead global vaccine production and deliver large-scale childhood immunisation programmes. Extending this success to adult vaccination could significantly reduce preventable illnesses and improve long-term public health outcomes.

As the country’s population ages and chronic diseases become more common, lifelong vaccination will become increasingly important. Building awareness, strengthening policies, and improving affordability could help India close the adult immunisation gap and create a culture where vaccination protects people throughout their lives not just during childhood.