By Michael Hodin, Javier Garau, and Alexandre Kalache
May 22, 2013 | Health Affairs Blog
As life spans increase and birth-rates decrease, the world’s population is aging. From 2000 to 2025, the over-60 demographic segment will double from 600 million to almost 1.2 billion. By 2050, it will nearly double again, surpassing two billion and accounting for an incredible 22% of the total global population. A society this “old” has never before existed, and it is a social, ethical, and economic imperative to keep older adults healthy and engaged. It is timely for the global public health community to re-align its thinking, policies and activities to this new demographic reality.
Organizations at national and global levels have begun to pursue initiatives to promote healthy aging, and these efforts are going to intensify in the coming years. Thus far, the progress has been admirable, with the World Health Organization, the United Nations, the Organisation for Economic Co-operation and Development, and others taking leadership roles. Yet, despite many promising developments, the potential of “life-course immunization,” which stresses the administration of vaccines throughout all stages of life – including for adults – to prevent disease and promote health, has been largely overlooked, especially among adults.
This is a missed opportunity. There is a growing body of research and data to show that immunizations against some of the more specific age-related health challenges – such as pneumococcal disease, herpes zoster, and others – are economically feasible investments that can create large public health benefits.
Benefits of Immunizations in Adults
As adults age, they increase their risk of contracting vaccine-preventable diseases like pneumococcal disease, herpes zoster (shingles), and influenza, among others. Immunization in the adult years – and throughout the life-course – enables adults to age with reduced risk to such vaccine-preventable diseases. Disease-free, older adults can remain active, healthy participants in society while curtailing increases in healthcare expenses and more fully engaging in economic life. As researchers have argued before, this creates a multi-tiered win for individuals and societies. Health costs are contained, and economic productivity goes up. Vaccines are, ultimately, further evidence illustrating how good health policy can be great economic policy.
One example is influenza. There is a wealth of evidence to suggest the health and economic benefits of influenza vaccination in adult populations. An overview of influenza research by Kristin Nichol (2003) finds that there are “remarkably consistent” conclusions about the health and economic advantages of investing in influenza vaccines. Further research into the cost-effectiveness of robust society-wide vaccination programs is needed, but past studies suggest the value of integrating adult vaccination into core public health programs.
Similar research could and should also be done for other vaccine-preventable diseases – like herpes zoster (shingles), influenza, and hepatitis B – that older adults run increased risk of contracting. As we discuss below, this should be a major policy priority for policymakers and other stakeholders. Furthermore, with this data supporting the public health benefits of various adult immunizations, new vaccine innovations would be incentivized and, eventually, brought to market. This is also how childhood immunizations were developed, and the model of success should be brought to innovations in adult vaccines.
For all of the potential of life-course immunization programs, there do remain a number of barriers to implementation. Research by the Alliance for Health and the Future shows that, globally, the causes for the lack of uptake of life-course vaccination programs include complex vaccination schedules and inadequate physician knowledge. Patients, too, have limited awareness of the benefits of vaccinations for themselves and their families. There is a lack of vaccination recommendation alignment among national and global bodies, and this, in part, prevents patients from complying with recommendations.
Part of the problem is ideological. Embedded attitudes about vaccines would shift with increased understanding of their value as adult immunization becomes a central part of public health thinking. Throughout the industrialized world, it is common for people to get vaccines before they travel abroad in order to prevent disease, but they do not consider the disease risks they face while at home. In the developing world, there is often lack of awareness and resources. As we have seen over the past few decades with childhood vaccinations, access is only part of the equation. The other part is raising awareness and understanding of how vaccines can improve health. The GAVI Alliance has done a tremendous job of creating an appreciation for children’s vaccines in the developing world. A similar level of attention needs to be placed on the critical value of adult vaccines as the global population ages.
Policy Priorities to Promote Life-Course Immunization
A life-course approach to immunization can only become a reality for people around the world with the dedication of and coordinated follow-through by policymakers. The most essential first steps are:
Increase awareness regarding the health benefits of life-course immunization among health professionals, as well as employers, employee groups, and unions; to be led by local and national governments, as well as global organizations like the World Health Organization;
Establish or enhance existing surveillance systems to determine the burden of vaccine-preventable diseases in adults; to be accomplished through partnership between national and global bodies;
Create institutional alignment on adult vaccination schedules among leading organizations like the World Health Organization, the Centers for Disease Control and Prevention, the European Union, the Pan American Health Organization, and others willing to participate
Integrate adult immunizations into Personal Medical Records and create an adult immunization registry; to be accomplished through partnership between private and public organizations;
Integrate adult vaccination in public and private payer access programs;
Embed adult vaccination in core preventive services for adults; advocacy to be led by both public and private organizations with a stake in cost containment and improved health outcomes;
Bring adult immunization into global public health as a matter of course in our 21st century; led, for example, by the World Health Organization and other multi-governmental organizations and NGOs.
Over the last couple of years, health and aging experts have made significant strides in rolling out plans for healthy aging initiatives. From President Obama’s pledge to end Alzheimer’s by 2025 to the United Nations’ historic summit on non-communicable diseases, national and global health leaders have pioneered new paths for healthy aging. Conspicuously missing from these efforts is a campaign for life-course immunization. Policymakers around the world should put life-course immunization at the top of their agenda in order to enable healthy aging and support social and economic success in the 21st century.
The original posting can be found here: