India’s Hidden Health Pandemic: Vitamin D Deficiency Affects One in Five

 

Meta-analysis reveals that 1) there is regional variation in the prevalence of Vitamin D deficiency, 2) children, adolescent, pregnant women and the elderly are the most vulnerable and 3) the indoor lifestyle of urban India is contributing to rising prevalence of Vitamin D deficiency.

The event was conducted in hybrid mode, and was attendant by over 300 participants globally. The event was attended by key dignitaries, policymakers, doctors, nutritionist, industry representatives and academicians.

Scale of Deficiency

A growing body of research indicates that India is facing a silent yet severe pandemic of Vitamin D deficiency. A meta-analysis by researchers in ICRIER and ANVKA Foundation found that one in five Indians suffer from this deficiency, with the Eastern region showing extreme levels of up to 38.81%. The issue is particularly alarming among adolescents, newborns, and the elderly. The women across all age groups are more vulnerable than men. The deficiency is higher in urban than in rural areas.

While sunlight is the most important source of Vitamin D, despite India's abundant sunlight, the deficiency continues to surge. This is due to factors such as increasing pollution levels, rapid urbanisation, use of sunscreen, and modern indoor lifestyles which have significantly reduced natural sun exposure.

Health Impact: A Cascade of Diseases

Vitamin D is essential for bone health, and its deficiency is linked to severe skeletal disorders such as rickets in children and osteomalacia in adults. Inadequate levels can also lead to muscle weakness, fatigue, and depression. Beyond bone health, Vitamin D deficiency is associated with an increased risk of cardiovascular diseases, type 2 diabetes, and cancers such as breast and prostate cancer. “Vitamin D deficiency is a silent epidemic affecting millions, yet it remains largely overlooked. Its impact extends beyond weak bones—it weakens immunity, increases the risk of chronic diseases, and imposes a significant economic burden on families and the healthcare system. Tackling this crisis requires a unified effort from policymakers, healthcare professionals, industry leaders, and society as a whole. Through fortified nutrition, awareness campaigns, and proactive health strategies, we can build a ‘Vitamin D Kuposhan Mukt Bharat.’ This is not just a public health mission but a vital step toward a healthier, stronger, and more productive India as we progress toward Viksit Bharat 2047”, remarked Dr Aashish Chaudhry, Managing Director, Aakash Healthcare, co-author of the study.

Several factors contribute to the growing deficiency:

• Lifestyle & Environment: High pollution levels in cities block UVB rays, reducing natural Vitamin D synthesis. Dense urban areas limit sun exposure. Work-from-Home culture and screen-based activities restrict outdoor time, affecting Vitamin D production.
• Dietary Deficiency & High Costs: Vitamin D-rich food, like fish, eggs, and fortified dairy, remain unaffordable for many due to high costs. Traditional diets and lactose intolerance further reduce intake. Only 8-14% of Indians meet the recommended dairy consumption.
• Skin Tone & Cultural Practices: Darker skin tones require longer sun exposure to produce Vitamin D. The preference for fair skin, use of sunscreen, and full-body coverings reduce natural absorption. Darker skin (high melanin) requires 3–6x longer sun exposure for adequate Vitamin D.
• Affordability Barriers: Private laboratory tests cost over Rs. 1,500, and supplements range from Rs. 48–130 for 10 tablets, remain unaffordable for many. GST of 18% on supplements further limits access.
• Obesity and Chronic Diseases: Obesity impairs Vitamin D metabolism, making supplementation less effective. Rising metabolic disorders worsen the problem.
• Policy Gaps: No national program targets deficiency. Food fortification is voluntary; staples like rice/wheat aren’t fortified. Mid-day meals in most states exclude Vitamin D-rich items like eggs or fortified milk.

Roadblocks in Addressing the Deficiency

Despite the alarming prevalence, India lacks a clear national policy to address Vitamin D deficiency. Testing remains expensive, with private laboratories charging over Rs.1,500/-, which discourages early diagnosis. Although Vitamin D supplements are included in the National List of Essential Medicines (NLEM), only D₃ is covered. The prices of supplements remain high due to 18% GST and regulatory gaps. Food fortification initiatives are also limited, with fortification restricted to only milk and oil.

Push for Change

Experts stress the need for a comprehensive vision document and a multi-sectoral strategy to address Vitamin D deficiency, which should include:

• Expanding mandatory Vitamin D fortification to staple foods distributed through the Public Distribution System (PDS).
• Improving accessibility and affordability by including Vitamin D₂ supplements in the National List of Essential Medicines (NLEM) to accommodate diverse dietary preferences, and reducing the 18% GST on supplements.
• Launching large-scale awareness campaigns to highlight the importance of sun exposure and Vitamin D-rich diets, particularly for high-risk individuals.
• Promoting outdoor physical activity, such as yoga, especially in schools and workplaces.

Recommendations

The reports suggested nine targeted policy interventions to address the Deficiency.

• Enhance Inter-Ministerial Partnerships and Coordination: India’s fragmented governance requires stronger collaboration across ministries. The Ministry of Health and Family Welfare should lead a coordinated approach involving key ministries like Ministry of Finance (for funding), Ministry of Consumer Affairs, Food and Public Distribution (for PDS distribution), Ministry of Ayush (to integrate traditional health practices), and Ministry of Food Processing and Industries (for food reformulation and fortification).
• Develop a Comprehensive Vision Document: Develop a national strategy with clear goals for high-risk groups. Define roles for all stakeholders, adopt a phased rollout starting with pilots, include monitoring mechanisms, and allocate dedicated funding.
• Launch a Nationwide “Vitamin D Kuposhan Mukt Bharat” Campaign: Launch a nationwide campaign to raise public awareness about Vitamin D, promote sun exposure and dietary intake, and educate at-risk groups through schools, media, and frontline health workers.
• Bridge the Gaps in Food Fortification: Mandate fortification of milk and oil.  Fortify cereals and expand distribution through the PDS. Incentivise industry to reformulate and support MSMEs.
• Focus on Supplementation as a Targeted Intervention: Provide free or subsidised Vitamin D supplements to children, pregnant women, and elderly through health centres, ASHAs, Anganwadis, and immunisation drives. Align this with the Free Drugs Scheme and ‘Make in India’.
• Reduce the Cost of Treatment and Testing: Produce low-cost test kits under ‘Make in India’; reduce GST and integrate Vitamin D screening with anaemia programmes.
• Strengthen Funding and Research to Combat Vitamin D Deficiency: Allocate dedicated funds for Vitamin D research, like low-cost testing kits, food bio-addition, cooking stability, and integrating Vitamin D with child vaccinations for sustainable delivery.
• Strengthen the Data Infrastructure: Establish a national, regularly updated database covering all age groups to track Vitamin D levels, monitor progress, and guide interventions.
• Foster Multistakeholder Partnerships: Create a national platform involving government, WHO, UNICEF, GAIN, academia, and industry to align policies, share knowledge, and coordinate efforts.

"This analysis is a wake-up call. The report aims to highlight the urgent need for coordinated action against Vitamin D deficiency. By addressing policy gaps, funding research, and implementing large-scale interventions, India can work towards the UN Sustainable Development Goals of eliminating malnutrition and ensuring good health by 2030. Without data-driven interventions, India’s SDG goals on health and malnutrition will remain out of reach," said Dr Arpita Mukherjee, Professor, ICRIER.

"India needs a roadmap akin to its iodized salt success—mandatory fortification, subsidies, and awareness campaigns. Voluntary measures won’t curb this crisis. Without immediate intervention, the country risks a surge in preventable illnesses, placing further strain on an already overburdened healthcare system," said Deepak Mishra, Director & Chief Executive, ICRIER.