Abstract
Background: Pneumococcal disease imposes a substantial public health burden in India, particularly among older adults and individuals with chronic or immunocompromising conditions. Although the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine are available, the emergence of non-PCV13 serotypes has highlighted the need for broader serotype coverage. The approval of the 20-valent pneumococcal conjugate vaccine (PCV20) offers expanded serotype coverage and the potential to simplify adult vaccination strategies. Methods: A multidisciplinary expert panel convened to develop evidence-informed expert opinions on PCV20 use in adults. A narrative literature review (2010–2025), a structured pre-meeting web-based survey, and structured discussions using the Nominal Group Technique were conducted. Expert opinions were refined, reviewed, and approved by all panel members. Results: Based on the available evidence and expert deliberations, the panel supported single-dose PCV20 for adults aged ≥50 years and at-risk individuals aged 18–49 years. The panel also provided specialty-specific recommendations to facilitate the implementation of PCV20 in routine clinical practice across diverse adult populations in India. Conclusions: These multidisciplinary expert opinions provide practical guidance for PCV20 use in Indian adults and are intended to complement, not replace, the formal national recommendations and to support informed clinical decision-making for adult pneumococcal vaccination in India, while acknowledging remaining uncertainty regarding effectiveness, implementation, affordability, and the need for further India-specific evidence.