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As India’s population ages, adult immunisation is vital for unlocking long-term health and economic gains, ensuring healthier, more productive lives through adulthood and ageing.
World Immunisation Day, celebrated annually on 10 November, aims to raise awareness about the importance of getting vaccinated. Earlier in the year, the World Immunisation Week’s theme for 2025, held from 24-30 April, was “Immunisation for all is humanly possible.” In this context, while India has one of the largest immunisation programmes globally, targeting pregnant women and children, efforts toward adult immunisation often fall behind.
India’s immunisation programmes have been the most effective and cost-efficient health interventions for controlling the spread of diseases, disease eradication, and saving millions of lives every year among children and pregnant women. A study found that India’s Universal Immunisation Programme (UIP) for children increased weekly wages by 13.8 percent, providing long-term benefits across health and economic outcomes. This study highlights that vaccination is not just a health intervention, but an investment in human capital that yields returns through multiple pathways throughout the life course.
However, for adults – the most productive age group – vaccine uptake is low. In most low- and middle-income countries, including India, national vaccination policies do not adequately address adult vaccination. While some recommendations exist, there is limited awareness among the general population and healthcare professionals on the need for adult vaccinations. In the United Nations (UN) Decade of Healthy Ageing (2021-2030) – an initiative that aligns with the final ten years of the Sustainable Development Goals (SDGs), focused on improving the lives of older people, their families and the communities they live in – life-course immunisation is paramount.
Over 95 percent of vaccine-preventable diseases (VPDs)-associated deaths in India occur among adults.
While India is viewed as a young country with a median age of 28 years, parallelly, its demography is transitioning, with the ageing population expected to reach 193 million by 2030 – comprising 13 percent of the total population (see Figure 1). The United Nations Population Fund (UNFPA) estimates that between 2022 and 2050, the number of people over 80 years of age will increase by 279 percent, highlighting the need for initiatives to promote healthy ageing in India.
An ageing population is more susceptible to infections due to age-related decline in immunity. This is exacerbated by comorbid conditions among the elderly, increasing their vulnerability to infectious diseases. As the proportion of the elderly continues to increase globally, the World Health Organization has reiterated the importance of vaccination throughout the life course to promote healthy ageing.
Figure 1: Estimates on the Share of the Indian Population by Age Group (in percentage)
Source: Statista
Over 95 percent of vaccine-preventable diseases (VPDs)-associated deaths in India occur among adults. Although the increase in childhood vaccination coverage has been commendable, with increased life expectancy, diseases are epidemiologically shifting to later stages of life. Outbreaks of VPDs are now increasingly reported among adults and are associated with high rates of morbidity and disability from diseases such as rubella, hepatitis A, chicken pox, and influenza, among others.
The availability of newer vaccines, combined with historically low vaccination rates has produced an adult population that was not administered several vaccines during their childhood. While a single booster shot may be sufficient for adults, the elderly may require more potent dosages as well. Additionally, vaccinations can also aid in addressing the challenge of multi-drug resistance by reducing the need for antibiotics, while also helping target drug-resistant variants of pathogens.
An analysis by the Office of Health Economics (OHE) of immunisation programmes across ten countries including Australia, Brazil, France, Germany, Italy, Japan, Poland, South Africa, and the United States, found that programmes for adult immunisation generate an economic return of up to 19 times the initial investment, equivalent to approximately US$4637 per individual receiving a full vaccination course. The analysis also suggests that adult immunisation can potentially yield similar socio-economic returns as childhood immunisation programmes.
Programmes for adult immunisation generate an economic return of up to 19 times the initial investment, equivalent to approximately US$4637 per individual receiving a full vaccination course.
Overall, the benefits of adult vaccines extend beyond improving public health. Economically, they contribute to reduced healthcare costs in the long term, reduce losses in labour productivity, and contribute to broader social and economic development. With a significant proportion of the population living in crowded conditions, with poor diets, limited access to healthcare services, and poor sanitation systems, the importance of vaccinations in safeguarding public health cannot be overstated.
Adult vaccination has not been given sufficient importance in India, leading to low uptake. Among diseases such as influenza, pneumococcal, typhoid and hepatitis B, adult vaccination coverage was found to be 1.5 percent, 0.6 percent, 1.9 percent and 1.9 percent, respectively. However, vaccine uptake was higher among those with cardiovascular disease, diabetes, lung disease, those residing in urban areas, men, and those with higher levels of education.
A 2022 study found that disparities existed across income groups, with the more affluent groups having the highest coverage as compared to other groups. This could be attributed to affordability concerns and a lack of awareness. However, overall, the study observed a low coverage of vaccines among all adults. Sample studies in India found that over 80 percent of adults were unaware of the need for adult vaccinations, and many continued to believe that vaccination was only for children. This belief also prevails within healthcare settings.
Inadequate infrastructure dedicated to adult vaccinations and inflexible frameworks that fail to accommodate a working adult population exacerbate the challenges. The COVID-19 pandemic, when the largest adult vaccination drive was undertaken, underscored these challenges for adult immunisation.
In 2024, the Association of Physicians released the Indian Consensus Guideline on Adult Immunisation, outlining guidelines for 25 vaccines, with specific advice for risk conditions such as pregnancy, heart and lung disease, and the immuno-compromised, among others, as well as across age groups.
Additionally, there was a lack of comprehensive and standardised national-level guidelines on the administration of adult vaccines. To address this, in 2024, the Association of Physicians released the Indian Consensus Guideline on Adult Immunisation, outlining guidelines for 25 vaccines, with specific advice for risk conditions such as pregnancy, heart and lung disease, and the immuno-compromised, among others, as well as across age groups.
However, resource constraints still pose a challenge. Procuring vaccines and the associated administrative costs may place a heavy burden not only on the healthcare system but also on individuals. While the government health insurance scheme – the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) – covers inpatient care for the disadvantaged, vaccines are not covered by this insurance, even though they may reduce healthcare costs in the long run. This could widen prevailing disparities in vaccine coverage across adults from different income groups.
Recognising the potential public health and economic gains from investing in adult vaccines, concerted efforts need to be made to increase adult vaccine uptake across the country.
First and foremost, raising awareness among the population and the healthcare providers is essential to improving adult vaccination uptake. A 2025 study in India indicated that by raising awareness among paediatricians on adult vaccinations, and having them educate the adults accompanying children, adult vaccination rates could be improved. The lack of public health campaigns for adult vaccinations also needs to be addressed. Public education campaigns should be undertaken to increase awareness of VPDs and the importance of adult vaccination.
Further, adult vaccination centres should be established to increase coverage. Parallelly, an ecosystem for adult vaccination needs to be developed to strategically tackle the low vaccination rates among adults. India’s success in improving vaccine rates among children and pregnant women demonstrates the ability of the healthcare system to implement a national-level adult vaccine rollout. By providing insurance coverage for vaccines, long-term healthcare costs can be reduced in a cost-effective manner.
While vaccinating early in life is more cost-effective, those who missed vaccine doses in childhood should be prioritised, alongside individuals with comorbid conditions, weakened immunity, and advanced age. Similarly, equity concerns should be addressed by prioritising economically vulnerable populations. Targeting can help enhance the efficiency of adult programmes and resource utilisation.
Overall, a life-course approach should be adopted with respect to vaccination to improve the quality of life for all, and reap the benefits of improved public health as well as the economic gains of lower healthcare expenditure and higher labour productivity. As India’s demography transitions, immunisation for all is fundamental to truly achieve a decade of healthy ageing.
Nimisha Chadha is a Research Assistant with the Centre for New Economic Diplomacy at the Observer Research Foundation.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Nimisha Chadha is a Research Assistant with ORF’s Centre for New Economic Diplomacy. She was previously an Associate at PATH (2023) and has a MSc ...
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