Published Sep 13, 2026 | 7:00 AM ⚊ Updated Sep 13, 2026 | 7:00 AM
The clinical value of vaccination lay in reducing the severity and consequences of illness.
Synopsis: A multicentric study found that only 29.7% of nearly 5,000 older adults accepted a free influenza vaccine, despite cost being removed as a barrier. Low awareness, doubts about vaccine necessity and safety, and limited doctor recommendations emerged as key challenges, highlighting gaps in India’s approach to influenza prevention.
The vaccine was free. There was no pharmacy bill and no consultation fee standing between an older person and a flu shot.
Yet, when researchers offered influenza vaccination free of cost to nearly 5,000 adults aged 60 and above across four Indian locations, fewer than three in 10 accepted it.
A study published in BMC Public Health found that 1,485 of 4,998 participants received the influenza vaccine after it was offered for free through community health camps. The study was conducted in Chennai, Ballabgarh, Kolkata and Pune between May and August 2023.
The finding was striking because cost had been removed at the point of vaccination. Yet uptake remained low and varied sharply between locations, from 2.7% in Pune to 48.3% in Ballabgarh. The researchers noted that the vaccination was provided as part of a research intervention, not through a government vaccination programme.
The study also found that influenza itself remained unfamiliar to many older adults. Only 19.7% of participants had heard of influenza, while just 72 people, or 1.4%, reported having received an influenza vaccine previously. Among participants who had heard of influenza, 65.3% said they were unwilling to pay for vaccination and 32% said they would pay up to ₹500.
But the responses after the free vaccine was offered showed that affordability was only one part of the problem.
Among those who hesitated or refused vaccination, 74.9% said they did not believe vaccination was necessary. Another 71.3% said nobody had recommended or advised them to take it. More than half, 55.9%, said they lacked sufficient information about vaccine safety or effectiveness. Lack of awareness was reported by 45.7%, while 40.7% cited concerns about side effects.
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Dr Sweatha Kumar, Infectious Disease Consultant at Rela Hospitals, Chennai, said she had repeatedly encountered a misconception in her clinical practice: patients often treated the influenza vaccine as a one-time intervention.
“To be honest, the awareness regarding the vaccination was less. That’s the sad truth and reality. What they generally did was, whenever they had one episode of flu, they took the vaccine that year and then they did not take the annual vaccination,” Dr Sweatha told South First.
She said patients often assumed that a previous flu shot meant they were protected in subsequent years.
“Every year WHO released a newer strain, but people are not aware of it. I have come across that scenario quite often, where people say they had already taken the vaccine as they were not aware it has to be taken annually,” Dr Sweatha said.
Dr Sowmya Sridharan, Consultant Infectious Disease at Kauvery Hospital Alwarpet, Chennai, also shared similar experience.
“When asked, many patients said that their doctors had not told them that they needed to return the following year. There was therefore a gap in educating patients that they needed an annual flu vaccine,” she said.
The study, meanwhile, found that only 72 of the 4,998 participants reported having previously received an influenza vaccine.
Dr Shankar V, Internal Medicine Physician at Apollo Hospitals, Seshadripuram, Bengaluru, said influenza vaccines were updated because the virus underwent continuous antigenic drift.
He noted that the influenza viruses circulating in India included H1N1, H3N2 and influenza B, with H3N2 often causing more severe disease among older adults. He also explained that the vaccine composition changed as the virus accumulated mutations.
“Influenza vaccines are updated every year because the virus undergoes continuous antigenic drift, mutations,” Dr Shankar told South First.
This means that a person who had received a flu vaccine in an earlier year cannot assume that the same formulation remained appropriate for the following season.
Dr Sweatha noted that considering influenza a self-limiting disease and failing to take adequate precautions could have severe consequences, particularly for elderly people.
“As we grow older, the immune response becomes less robust and influenza can be much more than a self-limiting respiratory infection. It can precipitate pneumonia, worsen heart or lung disease, result in hospitalisation and, in vulnerable individuals, can even be fatal,” she said.
Dr K. Vinodini, Senior Consultant Microbiologist at Neuberg Diagnostics described influenza as a virus whose consequences could vary according to the circulating strain, immunity and underlying health conditions.
“Influenza is certainly not a virus that should be dismissed as just another seasonal infection. Influenza viruses are highly transmissible respiratory viruses, and their behaviour can vary considerably depending on the circulating strain and the individual’s immunity and underlying health status,” Dr Vinodini told South First.
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Dr Sowmya said patients could still develop influenza after vaccination. She said the clinical value of vaccination lay in reducing the severity and consequences of illness.
“The flu vaccine may not reduce the number of infections, but it will definitely reduce the severity of the infections and the mortality and morbidity associated with influenza. As I said, these complications can definitely be avoided, and hospitalisation is going to cost you much more,” Dr Sowmya told South First.
She said vaccination could still be worthwhile even when influenza was already circulating.
“Infections could still happen despite vaccination, but the severity of the infection and the complication rates, including ICU admissions, would be reduced if a person took the flu vaccine,” Dr Sowmya said.
“So, if a patient came to our OPD and was a candidate for the flu vaccine, we typically vaccinated them rather than waiting for the current wave to subside,” she said.
Dr Vinodini said vaccination and treatment served different purposes.
“Vaccination and treatment serve two very different purposes. Medicines are used after infection has occurred, whereas vaccination prepares the immune system in advance to recognise and respond to the virus,” she said.
“Another common misconception is that getting vaccinated means you can never get influenza. That is not the promise of the vaccine. The objective is to reduce the risk of infection and, importantly, reduce the risk of severe disease and complications,” Dr Vinodini said.
The study recorded a substantial difference between the four locations. Ballabgarh had the highest uptake at 48.3%, while Pune had the lowest at 2.7%. Chennai and Kolkata fell between the two.
The researchers said the differences pointed to site-specific factors involving vaccine delivery, healthcare infrastructure and community mobilisation. They also found that adults aged 60 to 64 had 1.76 times the adjusted odds of receiving the vaccine compared with those aged 70 and above. Self-employed participants had 2.07 times the adjusted odds compared with employed participants.
Interestingly, knowledge and attitude scores were not independently associated with vaccine uptake after adjustment. In other words, knowing more about influenza did not automatically translate into accepting vaccination.
The study also found uncertainty around the vaccine itself. Among participants who had heard of influenza, only 35.9% agreed that influenza vaccines were safe and 39% supported vaccination for adults above 60. Nearly half, 49.8%, believed immunity acquired through natural infection was better than vaccine-induced immunity. At the same time, 40.1% agreed that influenza vaccination could prevent severe symptoms and hospitalisation.
No serious adverse events were reported during post-vaccination follow-up.
India does not have a national routine influenza vaccination programme. Influenza vaccination is not part of the Universal Immunization Programme, and there is no national policy recommending routine influenza vaccination for the general population or specifically for older adults, although the Ministry of Health and Family Welfare consider older adults a desirable group for influenza vaccination.
The researchers recommended stronger public awareness, greater involvement of healthcare providers, improved primary healthcare delivery and reliable annual vaccine availability, particularly for high-risk groups.
Dr Sowmya suggested that doctors needed to make vaccination part of routine conversations with eligible patients.
“Doctors should recommend and offer flu vaccines to all patients who are eligible. This needs to be done proactively by physicians, primary healthcare physicians and other healthcare providers who come in contact with patients,” she said.
“Only through such proactive recommendations and counselling can the uptake of flu vaccines be increased in India. We should proactively offer flu vaccines and educate patients about the availability and importance of the vaccine,” she added.
The study showed that half of the participants who accepted vaccination cited a doctor’s recommendation as one of their reasons for taking it. Self-protection was the strongest motivation, reported by 71.4%, followed by the desire to protect family and friends at 28.5%.
The study did not show that making influenza vaccination free was enough to make older adults accept it. Instead, it revealed how several decisions stood between an older person and a vaccine: whether they knew about influenza, whether they believed vaccination was necessary, whether they trusted the vaccine and whether a healthcare professional had made the recommendation.
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