• More than 90% of doctors state that a lack of adult immunisation guidelines results in a lack of interest and adoption of vaccination
• The primary reason for 83% of ageing adults to get vaccinated is a doctor’s recommendation
• Doctors recommend adult vaccination to only 16% of their patients aged 50+ years

A recently conducted survey by The Association of Physicians of India (API) and Ipsos, in 16 cities among adults aged 50 years and older, their caregivers and doctors has yielded compelling insights into why there is low adoption of adult immunisation in India. The survey shows that although 71% of adults aged ≥50 years are aware of adult vaccination, only 16% have taken any adult vaccines. Patients and doctors have provided significantly different reasons for low adoption.

A majority of doctors surveyed (90%) state that a lack of formal guidelines results in a lack of interest and adoption of vaccination by patients. Doctors also hesitate to discuss adult vaccination with their patients because they have limitations of time, and they also feel patients are less receptive to vaccination recommendations due to cost as well as prioritisation of treatment over prevention. Patients say that since they do not receive a firm recommendation from their doctors, they have not proactively taken adult vaccination. Many adults aged ≥50 (69%) and their caregivers (76%) do not ask doctors about adult vaccination because they believe that if they needed it, their doctors would recommend it. When asked about how to improve adult vaccination uptake, adult respondents (55%) and their caregivers (48%) said that measures such as those implemented for COVID-19 vaccination awareness can increase the adoption of adult vaccination.

In New Delhi, 63% of adults aged ≥50 are aware of adult vaccination, but only 2% of adults have taken any adult vaccines. A significant number of adults aged ≥50 (78%) and their caregivers (93%) would trust their doctor’s word if advised to get vaccinated. Doctors in New Delhi have recommended adult vaccines to only 10% of ageing adults and only to those who ask for them. Overall, in the North zone, doctors have recommended adult vaccination to more adults (25%) compared to the national average (16%).

Dr. Agam Vora, Secretary, The Association of Physicians of India said, “Measures need to be taken to increase the confidence of doctors in recommending vaccination for adults aged 50 years or older. This is possible if formal guidelines on adult immunisation are set and widely shared. Programmes that address concerns, debunk myths, and remind patients and their caregivers frequently to ask doctors about adult vaccines can also drive adoption. Our survey also reveals that awareness of vaccine preventable diseases such as shingles is very low in India. We believe that only when adults aged 50 years and above are given complete information about the negative impact of VPDs, will they take immunisation seriously. We should also acknowledge the role that caregivers can play in improving the uptake of adult vaccination and create awareness programs that target them.”

Certain misconceptions about adult vaccination also hold back adults from getting vaccinated. More than half of adults aged 50 years or older (58%) and their caregivers (62%) feel that there are better ways than vaccination to protect themselves or their parents/in-laws from diseases. Many (50%) also believe that multiple doses of vaccines can make them dependent on vaccines. In Delhi, 69% adults aged 50 years or older feel the same and 63% believe that diseases other than COVID are not severe enough to require vaccination.

Since shingles is an important vaccine-preventable disease (VPD) amongst adults aged 50 years or older and there is low awareness about its prevention through vaccination, the second part of the survey was conducted with shingles patients aged 50 years or older to understand the level of awareness and impact of this condition on patients. Shingles, or Herpes Zoster, is caused by the reactivation of the chickenpox virus that resides in 90% of adults aged 50 years or older. It is an extremely painful condition where the pain can last for weeks or months.

The shingles survey shows that awareness about the condition is low in the country. Shingles patients find it difficult to differentiate between shingles and other skin conditions, resulting in delays in diagnosis that make the treatment less effective. Pain was the most distressing symptom for 79% of patients, and 72% were unaware of shingles before they got it. Even after they got it, 73% of patients were not aware that they can get shingles again. Chronic conditions such as diabetes and hypertension were reported by 66% of patients surveyed which made them more vulnerable to getting shingles and reinforced the need for such patients to get vaccinated.

About the survey

API and Ipsos, supported by GSK, conducted a survey to understand the awareness and adoption of vaccination by adults above 50 years of age. The survey also covered awareness, beliefs, and recommendations of doctors about adult vaccination. The survey was conducted with 1950 adults above 50 years of age, 409 caregivers (children/ spouses of children) and 345 doctors from February to March 2023. The qualitative part of the survey was conducted with 30 adults above the age of 50 years and their caregivers and 30 doctors from January to February 2023.

The second part of the survey was conducted with shingles patients to understand the level of awareness and impact of this condition on the lives of patients. Those who were suffering or have suffered from shingles in the past 1 year and their caregivers were interviewed. The qualitative part of the survey was conducted online with 10 shingles patients (50+ years)/ caregivers across cities between January to February 2023. The quantitative part was conducted online with 216 (50+ years) shingles patients/caregivers. This was conducted from February to March 2023.

The cities in which the survey was conducted were Delhi, Kolkata, Mumbai, Ahmedabad, Bengaluru, Chennai, Hyderabad, Lucknow, Jaipur, Chandigarh, Varanasi, Surat, Bhopal, Vijayawada, Thiruvananthapuram, and Raigarh. The city/zone-wise classification is listed below:

• North: Delhi, Lucknow, Chandigarh, Varanasi, Jaipur
• West: Bhopal, Raigarh, Mumbai, Ahmedabad, Surat
• East: Kolkata
• South: Bengaluru, Chennai, Hyderabad, Vijayawada, Thiruvananthapuram

 About API:

The Association of Physicians of India is a professional body of consultant physicians formed in 1944.

The vision of a few stalwart Physicians of India gave birth to the idea of forming the Association of Physicians of India, mainly to provide a common forum for the Physicians of India to meet and share experiences and research observations in the field of Medicine.