So near, yet so far: Uptake of vaccination in older patients with cancer remains elusive in India

We recently read the article titled, “Uptake of vaccination in older Indian patients with cancer: A cross-sectional observational study,” by Sabu et al.,[1] published in Cancer Research, Statistics, and Treatment. The authors evaluated the proportion of older patients with cancer who had received routine pneumococcal, influenza, and coronavirus disease (COVID-19) vaccinations and identified factors associated with vaccine uptake. We found this study to be a valuable contribution to the literature on vaccine uptake in older adults with cancer in India. The authors reported that the uptake of pneumococcal and influenza vaccines was extremely low, with only 0.68% and 0.7% of patients receiving these vaccines, respectively. This is consistent with previous studies that have shown low vaccine uptake rates in older adults with cancer in India.[2,3] It is important to address this issue as older adults with cancer are at a higher risk of invasive infections and vaccination is an effective approach to decrease morbidity and mortality associated with infections.[4,5] However, the study found that the uptake of the COVID-19 vaccine in older patients with cancer was over 80%, which is heartening. This may be due to the global recognition of the importance of COVID-19 vaccination during the pandemic. According to a report from the Indian Ministry of Health and Family Welfare, over 156 crore doses of COVID-19 vaccines had been administered in India as of April 26, 2021.[6] It is worth noting that older individuals and those with underlying health conditions, including patients with cancer, were prioritized for vaccination in India. However, the exact uptake rate among older Indian patients with cancer is not known. Initial reports from March 2021 indicated that the COVID-19 vaccination rate in India was low, with only about 4% of the population having received at least one dose of the vaccine. While vaccination efforts have been ongoing, factors such as vaccine availability, accessibility, and vaccine hesitancy may have impacted the uptake rate. Several studies have highlighted the low COVID-19 vaccine uptake rates among patients with cancer in India, particularly during the early stages of the vaccination drive.[7,8] A review article published in the Journal of Global Oncology in August 2021 reported that only 29.1% of Indian patients with cancer had received at least one vaccine dose.[9] The study also found that vaccine uptake was lower among patients with hematological malignancies (22.4%) compared to those with solid tumors (32.3%). Similarly, a study published in Vaccines in May 2022 found that only 47.7% of Indian patients with cancer had received the vaccine, with lower uptake rates among patients from rural areas and those with lower levels of education.[10] These findings suggest that there is a need for increased efforts to promote vaccine uptake among older Indian patients with cancer. Possible interventions include education and awareness campaigns, improved access to vaccination sites, and addressing concerns and misinformation about the vaccines.[11-13] It is essential to prioritize the vaccination of this vulnerable population to reduce the morbidity and mortality associated with COVID-19 infections. The study by Sabu et al.[1] identifies several factors associated with vaccine uptake, including education, marital status, primary tumor site, and place of residence. These findings highlight the need for targeted interventions to increase vaccine uptake in specific patient populations. One potential limitation of the study is that it was conducted at a single center, and the findings may not be generalizable to other settings. Additionally, the study did not assess the reasons for low vaccine uptake, which would be valuable information for designing interventions to improve vaccine uptake in this population. Overall, we believe that this study provides important insights into the low vaccine uptake rates among older patients with cancer in India and highlights the need for targeted interventions to increase vaccine uptake in this vulnerable population. We look forward to seeing future research that addresses the reasons for low vaccine uptake and evaluates the effectiveness of interventions to improve vaccine uptake. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.