API and Ipsos, supported by GSK, conducted a survey to understand the awareness and adoption of vaccination by adults above 50 years of age
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 per cent of adults aged ≥50 years are aware of adult vaccination, only 16 per cent have taken any adult vaccines. Patients and doctors have provided significantly different reasons for low adoption.
A majority of doctors surveyed (90 per cent) 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 per cent) and their caregivers (76 per cent) 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 per cent) and their caregivers (48 per cent) said that measures such as those implemented for COVID-19 vaccination awareness can increase the adoption of adult vaccination.
In Mumbai, 73 per cent of adults aged ≥50 are aware of adult vaccination, but only 11 per cent of adults have taken any adult vaccines. A significant number of adults aged ≥50 (50 per cent) and their caregivers (20 per cent) would trust their doctor’s word if advised to get vaccinated. Doctors in Mumbai have recommended adult vaccines to only 9 per cent of ageing adults and only to those who ask for them. More than half (53 per cent) of adults above the age of 50 say they will check with family or friends before taking an adult vaccine even if a doctor has recommended it. Doctors from the West zone have concerns about the lack of patient receptivity towards adult vaccination, affordability of adult vaccines, and lack of the information about adult vaccination available.
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. Many (50 per cent) believe that multiple doses of vaccines can make them dependent on vaccines. More than half of adults aged 50 years or older (58 per cent) and their caregivers (62 per cent) feel that there are better ways than vaccination to protect themselves or their parents/in-laws from diseases. In Mumbai, 52 per cent adults aged 50 years or older feel the same and 36% 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 per cent of adults aged 50 years or older.[i] It is an extremely painful condition where the pain can last for weeks or months[ii].
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 per cent of patients, and 72 per cent were unaware of shingles before they got it. Even after they got it, 73 per cent of patients were not aware that they can get shingles again. Chronic conditions such as diabetes and hypertension were reported by 66 per cent of patients surveyed which made them more vulnerable to getting shingles and reinforced the need for such patients to get vaccinated.
References:
[i] Indian Paediatrics | Seroprevalence in India above 40 years – 91% Lokeshwar MR, Agrawal A, Subbarao SD, Chakraborty MS, Ram Prasad AV, Weil J, Bock HL, Kanwal S, Shah RC, Shah N. Age related seroprevalence of antibodies to varicella in India. Indian Pediatr. 2000 Jul;37(7):714-9. PMID: 10906803
[ii] The impact of herpes zoster and post-herpetic neuralgia on quality-of-life – PMC (nih.gov)