Warning against the narrow scope of India’s dengue vaccine approval

While India’s first dengue vaccine represents a scientific milestone, the safety caveat attached to its approval raises serious practical concerns. Restricting the vaccine to seropositive individuals may leave the most vulnerable—young children and first-time travelers—without protection. Implementing mandatory pre-vaccination testing across a fragmented health system will be difficult, potentially leading to missed opportunities or improper screening. In low-resource settings, the added cost and complexity could deter uptake, limiting the vaccine’s public health impact. Moreover, the reliance on serological tests is not foolproof: false negatives could expose seronegative individuals to risk, while false positives might needlessly scare people. The caveat also creates confusion among the public, who may not understand why a ‘new’ vaccine is not for everyone. Without a massive awareness campaign, many eligible persons might not seek the vaccine due to misunderstandings. This narrow approval could inadvertently widen health inequities, as wealthier individuals with access to testing get protection while poorer populations remain at risk. A more comprehensive strategy—including investing in a universal vaccine—should accompany this limited rollout.