Breaking Update: Here’s a clear explanation of the latest developments related to Breaking News:An Ambitious Beginning in Kerala– What Just Happened and why it matters right now.
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Kerala’s State Budget 2026–27 marked a modest but important beginning for adult immunisation in India. It set aside INR 50 crore for a pneumococcal vaccination programme that is explicitly designed for people aged 60 years and above from BPL families. It gives priority to those living with one or more comorbidities such as diabetes, chronic respiratory disease, cardiovascular disease, cancers, and other immune-compromised conditions. In the national context, this signifies a first: an adult vaccine treated as a routine public health responsibility with a defined target group and a stated budget line. That is where the longer journey must begin, from isolated state initiatives to a coherent life-course immunisation agenda that can be sustained at scale.
India’s immunisation architecture was built for a different demographic and disease profile. The global Expanded Programme on Immunisation (1974) and India’s adoption of it in 1978, later recast as the Universal Immunisation Programme in 1985, were designed for infants, children, and pregnant women. For many years, the only routine adult element within this frame was tetanus toxoid for pregnant women. Coverage remained uneven across states, and this slow consolidation is one reason the programme did not expand the vaccine basket until the late 2000s. In the interim, adult immunisation largely remained outside the remit of public systems, surfacing mainly as outbreak or exposure responses, as travel-related requirements, or as discretionary advice in clinical settings.
The global Expanded Programme on Immunisation (1974) and India’s adoption of it in 1978, later recast as the Universal Immunisation Programme in 1985, were designed for infants, children, and pregnant women.
From 2008 onwards, national and state efforts strengthened surveillance and AEFI reporting, cold chain, workforce capacity, institutional mechanisms such as the National Technical Advisory Group on Immunisation (NTAGI) and the Immunisation Technical Support Unit (ITSU), and demand-side communication. New vaccine introductions and catch-up campaigns followed in the last two decades, but the expansion began to widen the age lens in only limited ways, through adult Japanese encephalitis vaccination in endemic districts and adolescent cohorts reached through measles-rubella catch-up and Human Papilloma Virus (HPV) vaccine. Yet adult immunisation remained peripheral in national policy discussions, and the available service-use data underline the gap: even where an adult immunisation clinic exists, utilisation is dominated by post-exposure vaccines, with relatively small uptake for preventive adult vaccines such as pneumococcal, hepatitis B, and influenza.
Evidence on Adult Immunisation in India
Population-based evidence from the Longitudinal Ageing Study in India (2017–2018) shows that adult vaccine uptake among Indians aged 45 years and above is extremely low. Using self-reported immunisation status for 64,714 respondents, Rizvi and Singh (2022) estimate “ever vaccinated” coverage of 1.5 percent for influenza, 0.6 percent for pneumococcal disease, and 1.9 percent each for typhoid and hepatitis B. The overall picture was of negligible coverage with clear socio-economic gradients, suggesting that without systematic public recommendations and financing, adult immunisation will remain limited to a small, better-off minority.
Population-based evidence from the Longitudinal Ageing Study in India (2017–2018) shows that adult vaccine uptake among Indians aged 45 years and above is extremely low.
A second LASI-based analysis broadens the picture beyond older adults and shows how thin adult immunisation remains across the life course, with only a modest rural–urban gap. Using 68,463 adults (aged 18–116 years) from the same LASI wave 1 (2017–2018) and defining “immunised” as having received any of five adult vaccines recorded in the survey (influenza, pneumococcal, hepatitis B, diphtheria–tetanus, or “any other”), Irshad and Dash (2025) estimate overall coverage of 6.56 percent in rural India versus 6.89 percent in urban India. Their models also point to a “risk and contact” pattern, whereby people reporting recent exposure to endemic diseases and those with morbidity or functional limitations were more likely to be immunised.
The COVID-19 Opportunity
The irony is that India has already shown it can immunise adults at scale. COVID-19 became the country’s largest adult immunisation drive, with more than two billion doses by early 2023, delivered through a nationwide system that combined public provisioning with digital registration and certification. Yet when the emergency receded, the momentum did not convert into a normalised adult vaccine conversation in primary care. However, COVID-19 changed one thing that India had struggled to achieve for decades: it made immunisation a familiar adult behaviour, not a paediatric service confined to childhood.
There are persistent gaps in awareness among the public and, to some extent, among providers. A study showed that despite 66 percent of surveyed adults reporting at least one comorbidity, only 13 percent were advised pneumococcal vaccination, and only 6 percent actually received it. Another study among diabetes patients reported pneumococcal vaccination coverage of 0.7 percent, alongside low awareness of pneumococcal infection symptoms. Despite the disruption that COVID-19 caused in the system, the status quo remains, and adult immunisation has not been given the importance it deserves in policy conversations.
Existing Guidelines in the System
India does not yet have a single, official national adult immunisation schedule comparable to the UIP for children, so the practical guidance in routine care has largely come from professional, consensus-led recommendations. A recent review of Indian guidance summarises the Association of Physicians of India (API) 2024 consensus document as a harmonised set of recommendations across medical societies, offering dosing schedules and decision rules for a wide set of vaccines and explicitly tailoring advice for older adults, healthcare workers, and adults with chronic conditions and other high-risk states.
India does not yet have a single, official national adult immunisation schedule comparable to the UIP for children, so the practical guidance in routine care has largely come from professional, consensus-led recommendations.
The consensus document also sets a clear prioritisation logic by grouping vaccines into “vital”, “essential”, and “desirable” categories, and provides risk-based recommendations for specific clinical contexts such as HIV/immunocompromised states, hematopoietic stem cell transplant, pregnancy, and solid-organ transplant recipients and donors. Within this framing, the document repeatedly foregrounds adult protection against major preventable respiratory and systemic infections, with emphasis on vaccines such as influenza, pneumococcal, hepatitis B, and herpes zoster, alongside continued attention to COVID-19 immunisation and boosters.
Way Forward
India does not need to invent adult immunisation; it just needs to normalise it. The clinical rationale is already reflected in India’s consensus guidance, which treats adult immunisation as a risk-based intervention centred on older age, pregnancy, comorbidities, and occupational exposure, and not as an optional add-on. The LASI evidence strengthens the case for public design as uptake remains low, and the modest rural–urban gap sits atop deeper gradients of education and development that the market will not correct. The way forward is to convert the existing consensus into a single, widely used national reference so providers and patients are not left navigating competing schedules, and to embed this reference into routine adult-care touchpoints such as Ayushman Arogya Mandirs, NCD clinics, geriatric services, and discharge follow-up protocols.
India’s elderly population is rising, and older citizens are a major constituency in many states, with participation in elections typically steadier than that of younger cohorts.
The political economy also points in the same direction. India’s elderly population is rising, and older citizens are a major constituency in many states, with participation in elections typically steadier than that of younger cohorts. For states where the age structure is shifting faster, preventing vaccine-preventable hospitalisations is not only good public health, but also a fiscally sensible way to reduce avoidable spending for households and for state health budgets.
This logic becomes sharper after the move to extend PMJAY coverage to all adults aged 70 years and above. Now, every avoidable admission averted through adult immunisation can translate into real savings for the public exchequer, alongside reduced out-of-pocket costs and disability for families. Kerala’s decision to publicly fund pneumococcal vaccination for older adults is, therefore, a strong beginning, but the policy test is whether it expands into a larger, prioritised basket of adult vaccines linked to age and risk. In a society that is ageing rapidly, adult immunisation needs to move beyond a routine clinical recommendation; it is a policy imperative for healthy ageing and for realising the silver dividend.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Observer Research Foundation.
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