Knowledge and perception regarding influenza and its vaccine among the elderly population in India: a multicentric study on the drivers of vaccine uptake

Older adults experience a high risk of severe influenza, yet vaccine uptake in India is low. There is no government funded influenza vaccination program in India. Understanding the drivers of uptake is essential to guide policy and practice. We conducted a multicentre, cross-sectional survey among 4,998 adults aged ≥ 60 years enrolled in the I ndian N etwork of Population-Based S urveillance P latforms for I nfluenza and Other R espiratory Viruses among the E lderly (INSPIRE) cohort across Chennai ( n = 1274), Ballabgarh ( n = 1330), Kolkata ( n = 1384), and Pune ( n = 1010) between May and August 2023. Data on knowledge, attitudes, and practices regarding influenza and vaccination were collected via in-person interviews. Free influenza vaccination was offered at community health camps, and uptake was recorded. Multilevel logistic regression accounting for clustering by study site was used to identify the factors associated with vaccine uptake. Only 984 (19.7%) participants had heard of influenza, and 72 (1.4%) reported previous influenza vaccination. Only 35.9% agreed vaccines are safe, 39% supported vaccination for adults aged more than sixty, and, 65.3% were unwilling to pay for vaccination. Following the vaccination campaign, influenza vaccine uptake increased to 1485 (29.7%), varying across sites (2.7% in Pune to 48.3% in Ballabgarh). Participants aged 60–64 years were more likely to take the vaccine than those aged ≥ 70 years (aOR = 1.76, 95% CI 1.05,2.94), while self-employed participants had higher odds of vaccination than employed participants (aOR = 2.07, 95% CI: 1.14, 3.77). Influenza vaccination uptake among older adults in India is low, highlighting the need to improve awareness, access and strengthen healthcare provider recommendations.