AIIMS Study Makes Strong Case for Government-Funded Annual Flu Vaccination for India's Senior Citizens

India may be a step closer to introducing its first government-funded annual influenza vaccination programme for older adults following a landmark study led by researchers at the All India Institute of Medical Sciences (AIIMS), New Delhi. The study concludes that providing free seasonal influenza vaccines to senior citizens would be a cost-effective public health intervention, with the greatest benefits achieved by initially targeting older adults living with chronic illnesses such as diabetes, cardiovascular disease, and chronic respiratory conditions.

The findings arrive at a crucial time for India's healthcare system. The country's population is ageing rapidly, and the burden of non-communicable diseases continues to rise. While childhood immunisation programmes have achieved remarkable success over the past several decades, adult vaccination has received relatively little attention in public health policy. Influenza vaccination, in particular, remains largely unavailable through publicly funded programmes despite the disease causing thousands of preventable hospitalisations and deaths every year.

Researchers estimate that seasonal influenza causes approximately 5.3 million illnesses, more than 36,000 hospitalisations, and nearly 85,000 deaths annually among Indians aged 60 years and above. These figures indicate that influenza represents a far greater public health challenge than commonly recognised, especially for older adults and individuals with underlying medical conditions.

The research, published in the journal Influenza and Other Respiratory Viruses, analysed data collected through the INSPIRE surveillance network, which followed more than 7,200 elderly individuals across multiple locations in India between 2018 and 2023. By combining real-world disease surveillance with economic modelling, researchers evaluated whether introducing a publicly funded influenza vaccination programme would represent good value for government healthcare spending.

One of the study's most important findings is that a phased vaccination strategy would offer the best balance between health outcomes and affordability. Instead of vaccinating every citizen aged 60 years and above immediately, researchers recommend prioritising seniors with chronic diseases such as diabetes, heart disease, and chronic lung disorders. These individuals face the highest risk of severe influenza complications, prolonged hospitalisation, intensive care admission, and death.

According to the economic analysis, vaccinating all senior citizens would require government spending of approximately ₹1,514 crore annually. A targeted programme focusing on high-risk older adults would cost about ₹817 crore per year while delivering a significant proportion of the potential health benefits. This targeted approach could reduce pressure on hospitals, prevent avoidable deaths, and make more efficient use of limited public healthcare resources.

The study also highlights India's exceptionally low adult vaccination coverage. Previous research has shown that fewer than 2% of elderly Indians receive seasonal influenza vaccines, while vaccination rates for pneumococcal disease and other recommended adult vaccines remain similarly low. Limited public awareness, vaccine hesitancy, out-of-pocket costs, and the absence of a national adult immunisation policy have all contributed to poor uptake.

Healthcare experts argue that improving adult immunisation should become an important component of India's preventive healthcare strategy. Influenza often causes serious complications among older adults because age-related decline in immune function makes them more vulnerable to severe respiratory infections. Individuals with diabetes, hypertension, chronic kidney disease, heart failure, and chronic obstructive pulmonary disease are particularly susceptible to influenza-related complications, frequently requiring hospitalisation during seasonal outbreaks.

Beyond protecting individual patients, wider influenza vaccination could also ease the burden on India's healthcare infrastructure. Seasonal influenza contributes to increased hospital admissions, emergency department visits, and demand for intensive care beds each year. Preventing infections through vaccination could reduce healthcare expenditure while allowing hospitals to focus resources on patients with other critical illnesses.

The findings may also influence future discussions within India's National Technical Advisory Group on Immunization (NTAGI), which advises the government on vaccination policy. Until now, the absence of India-specific cost-effectiveness data has been one of the major barriers to introducing publicly funded influenza vaccination for older adults. The AIIMS study provides policymakers with domestic evidence rather than relying on international research conducted under different healthcare conditions.

India's broader healthcare strategy has increasingly shifted towards preventive care, early disease detection, and healthy ageing. Programmes aimed at controlling diabetes, hypertension, cardiovascular disease, and cancer screening have expanded significantly over the past decade. Adult vaccination could become another important pillar of this preventive health approach, particularly as life expectancy continues to increase and the elderly population grows.

Implementation, however, would require careful planning. Vaccine procurement, cold-chain logistics, public awareness campaigns, healthcare worker training, and integration with existing primary healthcare services would all be essential for a successful nationwide programme. Experts suggest that beginning with high-risk elderly populations would allow health systems to build capacity before considering broader universal coverage.

The AIIMS study represents one of the strongest pieces of Indian evidence supporting adult influenza vaccination. While policymakers have yet to announce any changes to the national immunisation programme, the research provides a compelling case that preventive vaccination could save thousands of lives each year while remaining financially sustainable. As India prepares for the healthcare challenges associated with an ageing population, adult immunisation may soon become a far more prominent part of the country's public health agenda.