The global population is ageing, and with it, the burden of infectious disease is set to grow. Innovative health policies are needed to make adult immunisation a standard of care – in the same way child vaccinations are – in order to strengthen economies, bolster health services, and ensure people are able to live healthy lives.
Adults raised in the years before video games – when phones were still attached to a cord in the home, and only a few TV channels were available – likely belong to the first generation of children protected by vaccines developed against measles (1963), mumps (1967), and rubella (1969) - and the combined vaccine (1971). Prior to mass vaccinations for measles, a major epidemic would take place every 2-3 years, causing around 2.6 million deaths per year.
Paediatric vaccinations were developed to protect children from suffering the effects of these severe infectious diseases. Innovative health policies were introduced alongside this in the form of national immunisation programmes in many countries to ensure most children would benefit.
These programmes included standardised vaccination schedules with clarity on what was needed when, easy access via healthcare professionals, updates to programmes when new vaccines were made available, and adequate funding.
Because of these efforts, the measles, mumps and rubella vaccines that brought such relief to the parents of that first generation of children to receive them are now a mainstay of paediatric vaccination programmes around the world – and the kids who benefitted from them are now aged 50, 60 and above.
Now, as adults over 60 outnumber children under five for the first time in human history, the burden of vaccine-preventable disease among adults is increasing. Therefore, adult immunisation rates, which are generally low, need to improve. To do this, innovative health policy is once again needed – this time to make adult immunisation programmes a routine practice.
Professor Roberto Bernabei is the President of Italia Longeva, a national association established by the Italian Ministry of Health with a mission to make older people central to health and welfare policies.
“In past years throughout Europe, older adults’ vaccinations, unlike paediatric childhood ones, have not been considered a routine health intervention, nor perceived as such by the public,” he says.
“Vaccination for adults has been an underutilised public health strategy compared to the vaccination of children, despite its key role in promoting healthy ageing. This has negatively affected adherence rates to vaccination campaigns, including influenza, and the implementation of coordinated programs for vaccination in older adults.”
The COVID-19 pandemic, Prof. Bernabei continues, changed this bringing the issue of fragility and “the importance of protecting the most vulnerable population groups – in this case senior patients and those with chronic diseases – from severe and potentially fatal infectious diseases through vaccination to the forefront.
The economic argument
The economic contribution of older adults in Europe is estimated to be around €9,700 ($11,565/£9233.50) per person, and in the US, this is even higher at €17,200 ($16375.98/£13074.58) per person. In Europe this adds up to 8% of gross domestic product (GDP), while for the US the contributions are equivalent to 7% of GDP, based on data collected in 2015.
Sibilia Quilici is the executive director of Vaccines Europe, a specialised vaccines group within the European Federation of Pharmaceutical Industries and Associations (EFPIA).
“It is estimated that every €1 invested in adult vaccination starting at age 50 would yield over €4 economic revenue for the government for the remaining lifetime of the cohort through its effects on growth, productivity, and workforce participation, as well as on tax and pension system,” she says.
The socio-economic impact of adult immunisation is clear, but this knowledge needs to be better recognised and acted on as the global population continues to age.
“By 2030, the number of people aged 60 plus globally is expected to increase to 1.4 billion people,” Dr. Piyali Mukherjee, Vice President and head of Global Medical Affairs for GSK Vaccines, says.
“This is an enormous number of people, who are at increasing risk of infectious disease as their immune system declines in function and becomes less effective with age. The medical need is clear, and for this reason over 80% of vaccines in development by Vaccines Europe members are targeting adults.
“GSK has the broadest vaccine portfolio in the industry, delivering over 1.5 million vaccine doses every day to protect people from childhood, right through their adult lives.”
However, she says, “vaccines will only work to help prevent diseases when they are effectively used, and people are able to easily access immunisation programmes.”
Quality of life
Adult vaccination coverage is still far below optimal, and to meet this challenge it is necessary to focus on the importance of vaccine prevention for the most vulnerable individuals.
“Many common infectious diseases represent a threat to older adults, including influenza and shingles,” Prof. Bernabei continues. “Indeed, the progressive loss of immune system efficiency and the presence of concurrent chronic diseases expose the individual to an enhanced risk of infections and severe complications damaging overall health.”
“Reducing the burden of infectious diseases means decreasing hospitalisations, ER admissions and investing in people's health, gaining years towards healthy ageing.”
Concerted effort and investment will be needed in order to change this. But what is required to get the job done?
Much like the foundations built all those years ago for paediatric vaccinations, new and adaptable processes that account for the requirements of older adults need to be put in place.
These include timely recommendations when new vaccines are available. Adult vaccination schedules that simplify timings for adults to receive vaccinations are key too. An example of this could be spreading vaccinations over the course of a year to limit missed opportunities to protect adults.
Adequate investment with funding to implement equitable and accessible vaccination programmes is also important, as is expanding the number of vaccinators able to administer immunisations beyond doctors. Additional access points for patients to receive vaccinations, beyond clinical settings, are also needed to improve health equity.
“We are at the forefront of a potential golden age of vaccination,” says Dr. Mukherjee.
“One that sees people throughout the various ages and stages of their lives protected against an increasing number of infectious diseases.
“Scientists are hard at work developing vaccines for diseases impacting older adults, designing them to trigger a response in the declining immunity that comes with age. But as always, these vaccines will only make a difference if they are used when they become available.
“It is becoming clear which policies are needed to start bringing adult immunisation rates on par with those for children, so let’s get to work and start making this potential golden age a reality.”