On World Immunization Week, a leading neonatologist speaks out on India’s immunization divide  and why adults are the missing piece

Dr. Babu S Madarkar

Clinical Director Consultant Neonatologist & Paediatrician

KIMS Cuddles, Secunderabad

Every year during the last week of April, the world pauses to reflect on one of medicine’s greatest gifts  the vaccine. World Immunization Week (April 24–30) is not merely a public health calendar event. It is an urgent, annual reminder that millions of lives hang in the balance of a single decision: to vaccinate, or not. As a neonatologist who has spent years at the bedside of the most fragile newborns this world produces, I write this not from a textbook  but from the wards, the incubators, and the grief of preventable loss.

A MIRACLE WE TAKE FOR GRANTED

Imagine a world without vaccines. Polio crippling children before their second birthday. Measles sweeping through schools and leaving behind blindness, brain damage, and empty chairs. Tetanus claiming newborns in their very first days of life. These are not distant nightmares from history books  they were everyday realities just decades ago, and they remain threats wherever immunization coverage falls short.

The World Health Organization estimates that immunization prevents 3.5 to 5 million deaths every year from diseases such as diphtheria, tetanus, pertussis, influenza, and measles. Yet millions of children  and equally, millions of adults  still do not receive the vaccines they need and deserve. Vaccines are arguably the single greatest public health achievement in human history. And yet, in 2026, we still argue about them.

THE STATE OF VACCINATION IN INDIA  WHERE DO WE STAND?

India’s immunization story is one of remarkable progress shadowed by stubborn and dangerous gaps. India runs the Universal Immunization Programme (UIP), one of the largest public health programmes in the world, covering 12 vaccine-preventable diseases. The progress has been real:

• India’s DTP-1 coverage has reached 93% meaning 2.47 crore out of 2.65 crore infants are vaccinated, significantly ahead of comparable nations like Nigeria (70%)
• The percentage of zero-dose children has dropped from 0.11% in 2023 to 0.06% in 2024, a landmark achievement
• Mission Indradhanush has delivered an 18.5 percentage point increase in full immunization coverage in targeted districts

Yet the gaps are deeply concerning:

• Per NFHS-5 (2020–21), only 76.4% of Indian children aged 12–23 months received all basic vaccinations nearly 1 in 4 children remains incompletely protected
• India still accounts for 6.4% of all zero-dose children globally in 2024, and 49.2% of zero-dose children in South Asia
• In 2024, 909,000 children remained entirely unvaccinated, with a further 454,000 only partially protected
• Gaps are concentrated in urban slums, remote tribal areas, migratory populations  and increasingly, educated urban households misled by social media misinformation

THE ADULT VACCINATION CRISIS  A NATIONAL BLIND SPOT

If child vaccination in India is a glass three-quarters full, adult vaccination is a glass that has barely been touched. The numbers are stark and sobering:

• In a multi-centric study of older adults across four Indian states, influenza vaccination uptake was a shocking 0.1–0.4%
• In a national survey of 72,250 adults aged ≥45 years, uptake of influenza, pneumococcal, typhoid, and hepatitis B vaccines was less than 2% each
• India currently has no national adult immunization programme  no government-funded, systematic effort to vaccinate adults the way UIP protects children
• The Global Atlas on Adult Vaccination notes India has no vaccination coverage targets for at-risk adult populations

THE STARK DIVIDE: CHILD vs. ADULT VACCINATION IN INDIA

Metric   Child Vaccination              Adult Vaccination

National Programme       ✅ UIP since 1978           ❌ None

DTP Coverage     ~93% first dose  Not measured

Full Schedule Completion              ~76.4% (NFHS-5)              Data unavailable

Influenza Vaccine Uptake              Part of UIP          0.1–0.4% (elderly)

Pneumococcal Vaccine   Available under UIP         <2% in adults ≥45 yrs

Typhoid Vaccine               Childhood schedule         Severely underutilised

Government Funding       Fully funded        Largely out-of-pocket

Public Awareness             High       Very low

WHY NEWBORNS ARE MOST VULNERABLE — A NEONATOLOGIST’S PERSPECTIVE

As a neonatologist, my deepest concern lies with the youngest members of our society. A newborn enters the world with an immune system that is still learning, still building its defenses. In those first weeks and months of life, the gap between a protected child and an unprotected one can mean the difference between life and death.

The hepatitis B vaccine given within 24 hours of birth can prevent a lifelong infection that silently progresses to liver cirrhosis and cancer. The BCG vaccine at birth protects against tubercular meningitis and miliary TB — diseases that devastate the developing brain. The pentavalent vaccine, oral polio drops, rotavirus vaccine, and pneumococcal vaccine that follow build a fortress of immunity during the most vulnerable period of life.

ADULT VACCINES EVERY INDIAN SHOULD KNOW

💉 Influenza — Every Single Year

Influenza is far more dangerous than a bad cold. It kills hundreds of thousands globally each year, hitting the elderly, pregnant women, healthcare workers, and those with diabetes or heart disease hardest. Because the influenza virus mutates rapidly, a new dose is needed every year without exception. If you are over 50, have a chronic illness, or are pregnant  this vaccine is non-negotiable.

💉 Typhoid  The Forgotten Adult Vaccine

Typhoid fever, caused by Salmonella typhi, affects an estimated 4.5 million Indians annually. Most people think of typhoid as a childhood disease  adults are equally at risk, especially frequent travellers, food handlers, and healthcare workers. Two vaccines are available: the Vi polysaccharide vaccine (effective 2–3 years) and the newer Typhoid Conjugate Vaccine (TCV). A booster is required every 2–3 years. Drug-resistant and XDR typhoid strains are a growing threat in South Asia, making vaccination even more critical as treatment options become limited.

💉 Pneumococcal Vaccine  Adults Over 60

Streptococcus pneumoniae causes pneumonia, meningitis, and bloodstream infections. Adults over 60 and those with diabetes, heart disease, or immunosuppression must receive this vaccine. Pneumonia is a leading cause of death in the elderly  and it is largely preventable.

💉 Tdap / Td Booster — Every 10 Years

Tetanus, diphtheria, and pertussis immunity fades. A booster every 10 years is essential for all adults. Pregnant women must receive Tdap in every pregnancy  the antibodies cross the placenta and protect the newborn in the critical first weeks before their own vaccination journey begins.

💉 Hepatitis B  For All Unvaccinated Adults

If you were not vaccinated as a child, get the 3-dose series now. Hepatitis B destroys the liver silently over years and is a leading cause of liver cancer. Healthcare workers must confirm documented immunity  no exceptions.

💉 HPV Vaccine  Up to Age 45

HPV causes virtually all cervical cancers and contributes to cancers of the throat, mouth, and genitals. Over 77,000 Indian women die of cervical cancer every year  nearly all preventable. Recommended for girls and boys from age 9, available for adults up to 45 years.

💉 Herpes Zoster (Shingles)  Adults Over 60

Shingles causes excruciating nerve pain that can last months  post herpetic neuralgia. The shingles vaccine dramatically reduces risk and severity in those over 60.

💉 COVID-19  Stay Updated

Stay current with national booster recommendations, especially if elderly, immunocompromised, or managing chronic disease.

THE COCOON STRATEGY  ADULTS PROTECTING NEWBORNS

One of the most powerful concepts in modern immunology is the ‘cocoon strategy’  vaccinating everyone around a newborn to create a protective shield of immunity. Newborns are too young for many vaccines in their first weeks of life. When parents, grandparents, siblings, and caregivers are vaccinated against whooping cough, influenza, and typhoid, they cannot transmit these deadly infections to the baby. Vaccinating yourself is, quite literally, protecting your newborn.

BUSTING THE MYTHS

MYTH: “I am healthy  I don’t need vaccines.”

FACT: Vaccines are not for the sick  they keep the healthy from becoming sick. Your good health is precisely what you are trying to preserve.

MYTH: “Vaccines are only important in childhood.”

FACT: Immunity wanes. Bodies change. New risks emerge with age, pregnancy, and chronic disease. Vaccination is a lifelong commitment not a childhood checkbox.

MYTH: “I had typhoid before  I am immune.”

FACT: Natural infection with typhoid does not guarantee lasting immunity. Re-infection is well-documented, particularly with emerging drug-resistant strains.

MYTH: “I had the vaccine years ago  I am still protected.”

FACT: Many vaccines require boosters. Tetanus, typhoid, and influenza protection fades. Check with your doctor about what you may be due for.

WHAT INDIA MUST DO

1. Launch a National Adult Immunization Programme with government funding for high-priority vaccines in at-risk adults
2. Integrate adult vaccination into primary healthcare  every government clinic visit should include an adult vaccination review
3. Include typhoid, influenza, and pneumococcal vaccines in all occupational health mandates for healthcare workers and food handlers
4. Train ASHA workers and community health volunteers to counsel adults, not just mothers of young children
5. Create a national adult immunization registry to track coverage with the same rigour applied to childhood vaccination

THIS WORLD IMMUNIZATION WEEK  ACT TODAY

• ✅ Check your child’s immunization card  are all vaccines up to date?
• ✅ Check your own history  when was your last tetanus or typhoid booster?
• ✅ Adults over 60: ask your doctor about flu, pneumococcal, and shingles vaccines
• ✅ Pregnant mothers: ensure Tdap and influenza vaccines during this pregnancy
• ✅ Frequent travellers & food handlers: update your typhoid vaccine
• ✅ Healthcare workers: confirm hepatitis B immunity and annual flu shot
• ✅ Young adults: discuss the HPV vaccine with your doctor if not yet received
• ✅ Share verified information  not fear  on your social media this week

“We built a wall to protect our children and forgot to finish it. Adult vaccination is not a new wall  it is completing the one we already started.”