JAPI Releases Dedicated Supplement Addressing Clinical Needs for Adult Vaccination in India

Recognizing this urgent need, the Journal of the Association of Physicians of India (JAPI) has released a dedicated supplementary issue (Vol. 73, Issue 5, Supplement 1) focusing exclusively on the clinical and public health requirements of adult pneumococcal vaccination in India. Edited by Prof. Dr. Mangesh Tiwaskar, the supplement brings together expert voices from across the country, to address the barriers, gaps, and opportunities in India's adult immunization strategy. The issue comprises seven articles, including one editorial, two original research studies, a review article, a narrative review, and two systematic literature reviews.

Pneumococcal Disease: A Growing Threat in India with Alarmingly Low Adult Vaccination Rates

Streptococcus pneumoniae, or pneumococcus, is a major global health concern, responsible for serious illnesses such as pneumonia, meningitis, and bloodstream infections, which affect hundreds of thousands of adults annually. The burden is particularly severe in the Indian subcontinent. Estimates suggest that pneumococcal disease causes nearly 1.6 million pneumonia cases each year in India, contributing to approximately 160,000 deaths. In their editorial, Dr. Agam Vora and Dr. Mangesh Tiwaskar emphasized even with a high disease burden, vaccination uptake among adults is shockingly low. They appeal for mandatory vaccination consideration in high-risk groups and also highlighted the potential of newer vaccines such as PCV20 to improve outcomes.(1)

High-Risk Groups Underserved Despite Available Vaccines

Although vaccines such as PCV13 and PPSV23 are available, adult vaccination rates continue to be disappointingly low. Key reasons include poor awareness, absence of dedicated adult immunization centers, and inconsistent recognition of comorbidities as risk factors. Pneumococcal vaccination is especially critical for high-risk and at-risk populations. A systematic review by Dr. Pankaj Bhardwaj and colleagues highlights the importance of increasing coverage in these groups to reduce disease burden, protect vulnerable individuals, and alleviate pressure on healthcare systems. The review also emphasized adherence to national guidelines and notes the expanded protection offered by newer, higher-valency vaccines such as PCV13 and PCV20. (2)

Low Adult Pneumococcal Vaccination Rates in Real-World Clinical Practice

Despite vaccines being safe, effective, and economical, a nationwide survey conducted by Dr. Namrata Kulkarni and Dr. Santosh Taur reveals a concerning gap between knowledge and practice. Surveying 1500 HCPs revealed that key factors influencing vaccine recommendations by HCPs were disease awareness, availability, and cost. Patient barriers included poor understanding of vaccine safety, affordability issues, and lack of mandatory vaccination, leading to low adult vaccination rates in India.(3)

Health Care Workers (HCWs) Themselves at Risk, Yet Not Prioritized for Vaccination

Despite their elevated risk and common comorbidities, HCWs in India are not universally prioritized for pneumococcal vaccination. A systematic review by Dr. Parvaiz Koul and colleagues sheds light on the vulnerability of this group, the impact of infections on healthcare delivery, and the benefits of routine immunization. The review emphasized that India’s estimated 5.7 million HCWs are the foundation of its health system; vaccinating this workforce not only protects providers but also reduces patient risk and strengthens healthcare infrastructure. Cost-effectiveness studies further support vaccination as a wise public health investment. With global guidelines now lowering vaccine eligibility age to 50, a growing number of HCWs qualify for immunization.(4)

Adult Vaccination Overlooked in Pediatric Clinics – A Missed Opportunity

Another missed opportunity lies within pediatric clinics. In a questionnaire-based study involving 500 pediatricians, only 39.6% recommended pneumococcal vaccination to adults over 60 accompanying children, while 33.2% vaccinated adults only upon another physician’s advice. Research by Dr. Sripriya Sathyanarayanan and colleagues reveals that most pediatricians in India do not routinely recommend pneumococcal vaccines to accompanying adults. This gap is attributed to unawareness, lack of clear guidelines, and insufficient understanding of the benefits of adult vaccination.(5)

Antimicrobial Resistance on the Rise

The challenges extend beyond low vaccination coverage. The emergence and spread of antimicrobial resistance (AMR) pose a grave concern. Streptococcus pneumoniae has developed resistance to multiple antibiotic classes, threatening the effectiveness of treatments. This escalating resistance leads to increased healthcare costs, prolonged hospital stays, and reduced productivity. A narrative review by Dr. Ravi Kumar and team highlights that pneumococcal infections are not only prevalent but increasingly difficult to treat due to rising resistance. The review stresses that vaccination serves as a powerful preventive tool to reduce disease incidence and curb unnecessary antibiotic use. Unfortunately, adult vaccine coverage remains dismally low.(6)

Call for a Dedicated Adult Vaccination System

The true burden of vaccine-preventable diseases (VPDs) in adults is likely underestimated due to limited surveillance and inadequate infrastructure. Dr. V. Ramasubramanian and colleagues highlight the urgent need for a structured adult vaccination ecosystem in India. The current absence of dedicated vaccination clinics, coupled with insufficient public awareness and unclear guidelines, hinders vaccine access and uptake. Establishing adult vaccination clinics could transform this scenario by offering accessible services, targeted outreach, and improved public education. By prioritizing high-risk groups and integrating community-based strategies, India can bolster its public health resilience. Such dedicated centers, supported by trained staff, clear guidelines, and awareness campaigns, would be instrumental in increasing adult vaccine coverage and reducing the long-term burden of VPDs.(7)

Integrating Pneumococcal Vaccination into Adult Immunization Strategy

The supplement stresses an urgent call to action for integrating pneumococcal vaccination into India’s adult immunization strategy through focused education, infrastructure development, and supportive policy frameworks. In line with this, the Association of Physicians of India (API) had issued the country’s first-ever guidelines on adult immunization last year, offering evidence-based recommendations on vaccine administration and preventive strategies for various vaccine-preventable diseases.(8)