With Minor Policy Support, India is Ready to Address the Rising Demand for Vitamin D Supplements

With the rising cases of Vitamin D deficiency -- one in five Indians being Vitamin D deficient, there is a growing fear whether India is equipped to handle the deficiency.  A recent study by the authors found that the Indian pharmaceutical sector is well-equipped to meet the growing demand for supplements, if comprehensive policy measures are taken to address the deficiency. 

The Indian pharmaceutical sector, the third largest in the world by volume and 14th by production (in FY2023-24), is well-positioned to address this national health challenge. Despite this, there is a growing incidence of Vitamin D deficiency, misinformation, price and accessibility issues, along with a lack of package of practice. In the past, sun exposure was a solution, but today, with rising pollution, sun exposure alone cannot meet the body’s Vitamin D requirements and, therefore, supplementation is essential for a “Vitamin D Kuposhan Mukt Bharat”. 

Focusing on the market size and production, India’s Vitamin D supplement market is projected to grow from USD98.02 million in 2024 to USD157.81 million by 2030, reflecting an 8.22% CAGR. The large and growing market is an incentive for the manufacturers to produce the supplements, and Vitamin D supplements are now available in India in various forms, such as tablets, capsules, sachets, and injectables. India’s pharmaceutical industry, with over 3,000 companies and 10,500 manufacturing units, valued at USD50 billion in FY2023-24, is well-placed to address the growing demand. 

However, Vitamin D supplements are not taken by some patients as they are confused between vegetarian and non-vegetarian ingredients in the supplements. There are two forms of Vitamin D – D2 (ergocalciferol, derived from plant source) and Vitamin D3 (cholecalciferol, derived from animal source). Currently, Vitamin D3 holds a prominent global market share of 74.92%. With the growing trend of vegan/vegetarian diets, demand for Vitamin D2 is also increasing. Therefore, patients need not worry, and the doctors can prescribe medicines as per their diet and level of deficiency.

The cost of medicine is another concern. While Vitamin D3 is more effective and is included in India’s National List of Essential Medicines (NLEM), the list does not include D2 to cater to the vegetarian population. The World Health Organization (WHO) Model List of Essential Medicines includes both D2 and D3. Further, a GST rate of 18% is imposed on this essential medicine, which increases its price and reduces its affordability for the poor. 

Unlike many countries globally, India is yet to launch a targeted Vitamin D supplementation programme to protect high-risk groups. The UK, for example, introduced the “Healthy Start” scheme in 2006, providing free Vitamin D supplements to pregnant women, new mothers and young children. Iran, in 2014, introduced the “National Program of Vitamin D Supplementation”, targeting children. Turkey, in 2005, introduced “Vitamin D Prophylaxis Program”, providing free Vitamin D supplements to all infants. In 2011, New Zealand, as a part of the “National Falls Prevention Program”, provided free Vitamin D supplements for elderly (over 60 years). There are some issues in mass supplementation programmes. For example, without a package of practice, and clearly defined dosages, it can lead to Vitamin D toxicity. 

The ICRIER study makes five recommendations for nationwide Vitamin D supplements to help address the Vitamin D deficiency.  

First, there is a need to set up population-specific guidelines for Vitamin D supplementation, including dosages, frequency, and preferred formulations (D₂ vs. D₃) for capsules, tablets, powder, etc., to avoid inconsistent clinical practice, overuse or underuse in different settings, and confusion among healthcare providers and consumers.  

Second, foster multi-stakeholder partnerships between government agencies, private pharmaceutical companies, NGOs, and healthcare providers to strengthen and implement supplementation programmes for targeted vulnerable groups like children, pregnant women and elderly. Vitamin D supplementation can be easily integrated into existing healthcare programmes targeting high-risk groups—such as elderly, pregnant women, lactating mothers, and children. 

Third, include Vitamin D2 into NLEM to improve accessibility and affordability for all and reduce the GST. 

Fourth, to make it more accessible, frontline health workers (ASHAs, ANMs, and Anganwadi workers) can be asked to distribute supplements during VHNDs (Village Health and Nutrition Days), routine check-ups, and door-to-door visits. The study found that a well-laid out supplementation plan with multistakeholders engagement will help to reduce the spread of the deficiency. 

The study noted the rising incidence of deficiency-related diseases like rickets in children and bone fractures, in addition to weakness and loss of workforce productivity. The spread of the deficiency cannot be addressed without a targeted and planned nationwide supplementation drive.    

(Authors are Professor, (ICRIER), and Research Assistant (ICRIER) respectively. Authors can be connected at arpita@icrier.res.in and tkhanna@icrier.res.in. Views are personal.)