The winter season in Delhi usually results in poor air quality, outbreaks of seasonal influenza, a heavy burden on hospitals and increasing medical expenses. Hidden within the yearly air quality reports is a health problem that is preventable, and yet costs the city’s citizens lakhs. Among the elderly, especially those who have diabetes, chronic obstructive pulmonary disease, heart disease or a suppressed immune system, a viral infection can develop into bacterial pneumonia and require hospitalization. A single such incident can erase months’ worth of income and cause households relying on pensions and daily wages to slip down the income scale.
Industry estimates suggest that the average cost of a hospital stay is about ₹50,000, while intensive care can amount to ₹1 lakh.
These figures do not reflect the full extent of the problem, as they exclude people treated in private clinics, those who take medication on their own, infections that have never been confirmed by a laboratory test, and cases recorded as pneumonia rather than influenza. What makes the number of hospitalisations and their resultant expenditure tragic, is that a a significant portion of this could perhaps be avoided with a vaccine that is already available. The guidelines also include adults who have immunosuppression and chronic diseases. For residents of Delhi, in winter when pollution makes the air toxic, this could mean the difference between a minor ailment an episode of hospitalisation. Even this figure is an under estimate since the system covers only about one fifth to one quarter of all registered deaths nationally, and older people who die at home rather than in a hospital where certification takes place almost never get included at all.
India has achieved real advances in the fight against pneumonia, mainly as a result of introducing the pneumococcal conjugate vaccine (PCV) as part of the Universal Immunisation Programme in 2017 and through Mission Indradhanush. India has no National Adult Immunisation Policy, and as a result, vaccination rates rely on individual awareness, access to a doctor, and the ability to pay out of pocket, a situation that systematically excludes older people in lower-income families. The figure for deaths due to pneumonia recorded by India’s Medical Certification of Cause of Death in 2024 was 35,987, making it the leading cause of respiratory deaths, although it remains relatively out of the spotlight compared to other causes.
Free three-dose vaccinations are provided to infants, and by 2023, vaccination rates among infants in India had reached 83%, according to the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) . The 2026 Indian consensus guidelines concerning immunisation in adults recommend pneumococcal vaccination based on age and level of risk. It recommends the PCV20 vaccine for all adults between the ages of 18-49 years with chronic medical conditions or those considered at risk based on their health and lifestyle, or a single dose of the vaccine for all adults aged 50 and above. it is not merely a Delhi problem: in 2022, India was estimated to whom were 149 million people aged 60 and over, a large number of whom are still economically active and support households.The Longitudinal Ageing Study in India (2017-18) showed that of Indians aged 45 and over, only around 0.6% had received a pneumococcal vaccine, a figure that has not changed much since then While this a critical problem ahead of winter in Delhi.
Government records show that there were more than 2,00,000 cases of acute respiratory illness and 30,000 hospital admissions in just six Delhi government hospitals between 2022 and 2024. When the pollution lasted throughout December 2025 , doctors reportedly noted a 20% to 30% increase in the number of patients with respiratory problems, including some who had never before had such a condition.
