COVID-19 vaccination among older adults in India: a case of underrepresentation

Background: Older adults are known to experience higher mortality and hospitalisation when infected with COVID-19 due to their increased vulnerability. COVID-19 severely impacted Indian older adults during the first two waves of the pandemic. While Indias vaccine coverage is impressive in absolute numbers, the coverage proportion, particularly among older adults, was questioned during the deadly COVID Delta wave. Hence, the analysis seeks to study the policies concerning prioritisation, and vaccine coverage among older adults in India. Methods: Mapping of the COVID-19 policies with the COVID vaccine and mortality data published by the Government of India between December 2019 and December 2022 was carried out to explore the reasons behind the underrepresentation. Results: Nearly 2000 million doses of COVID-19 vaccines were provided to Indian citizens as of mid-December 2022. 92% of older adults aged 60 and above received the first dose of the COVID-19 vaccine. While 88% of older adults received the second dose, only 33% received the booster dose, known as the precaution dose. While the coverage until mid-December 2022 is impressive for the first and second doses, it was not remarkable in 2021. When the COVID pandemic mortality was at its peak until July 2021, only 50% and 19% of older adults received the first and second doses. This was because older people did not receive sufficient prioritisation during the pandemic. Conclusion: COVID-19 vaccination coverage among older adults looks promising based on recent data. However, due to a lack of prioritisation, the coverage was poorer among this vulnerable group during the peak stages of the pandemic. Future pandemic vaccination programmes must consider prioritisation of older adults to reduce overall as well as older adult specific mortality and hospitalisation in India.