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Prioritizing Routine Adult Vaccinations to Promote Healthy Ageing

Immunisation is one of the most cost-effective public health interventions of modern times and key to maintaining well-being in older age. Every year, thousands of people have serious complications from vaccine preventable diseases (VPDs), often resulting in hospitalization or even deathi. Older people are at a higher risk of infections such as influenza, pneumonia, and shingles due to a decline in immune system function. This decline is manifested in high rates of VPDs amongst older people, with one in five hospitalizations directly related to influenza and pneumoniaii. Despite evidence supporting the benefits of adult vaccination, vaccine uptake rates remain suboptimal among older persons and those with chronic comorbidities. During the COVID-19 pandemic, the rates have further continued to fall behind. A recent article entitled ‘Adults need to take seriously vaccines for other diseases besides COVID-19 and the flu’ highlights the barriers to routine adult vaccination in the United States and the alarming drop in coverage during the pandemic. In the article, public health experts highlight factors that contribute to poor uptake, such as limited accessibility, vaccine hesitancy, lack of awareness and understanding about vaccines and how they prevent diseases. In the recent Seventy-fourth Regional Committee Session of the World Health Organization South-East Asia, Regional Director Dr. Poonam Khetrapal Singh described the escalating vulnerability of older people to VPDs as a result of disruption of essential immunization services and surveillance for VPDs during the pandemic. The dangerous disruption in routine immunization for VPDs constitutes a serious and growing public health concern. There is an urgent need to repair the damage caused by the pandemic and to protect the health and well-being of older people through upscaling routine immunization against VPDs. At a time when the United Nations Decade of Healthy Ageing 2021-2030 (the Decade) calls for a whole-of-society response to improve the lives of older people and re-think ageing, adult immunization must be at the top of global agendas. Aligned with the Decade and the WHO Immunization Agenda 2030, programs and policies should focus on the principles of prevention, access, and equity in the context of adult vaccination to support healthy ageing. It is imperative that global leaders in public health continue to refine strategies to improve vaccine accessibility, ensure equitable vaccine distribution, reduce vaccine hesitancy, and engage global stakeholders to develop integrated, evidence-informed strategies and policies on adult vaccination. To learn more about the importance of life-course vaccination to support healthy ageing, please contact Dr. Enrique Vega García an IFA Expert and United Chief for the Healthy Life Course, PAHO. To contribute to the crucial dialogue on adult vaccination through the key pillars of prevention, equity, and access, please contact Ms. Anusheh Khan (akhan@ifa.ngo). i CDC. (2020). 3 Important Reasons for Adults to get Vaccinated. Retrieved from: https://www.cdc.gov/vaccines/hcp/adults/downloads/fs-three-reasons.pdf ii Schaffner, W., Chen, W. H., Hopkins, R. H., & Neuzil, K. (2018). Effective immunization of older adults against seasonal influenza. The American journal of medicine, 131(8), 865-873.

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Fighting for COVID-19 Vaccine Equity Amongst Older People

A recent article by Dr. Peter Lloyd-Sherlock, entitled “Does vaccine ageism amount to gerontocide?”, considers a critical question on vaccine distribution amongst older people. The article describes the nature of ageism which has characterized the ongoing COVID-19 pandemic and the global failure of governments to protect the rights of older people. The pandemic has only furthered the inequities and ageism experienced by older people globally. As Dr. Lloyd Sherlock highlights, the first year of the pandemic was marked by a narrative of “intergenerational injustice” in which younger people felt that protective public health measures meant sacrificing economic and social opportunity to protect the well-being of older people. In countries where the pandemic was most dire, COVID-19 treatment was prioritized based on age to ration healthcare resources, leaving many older people left behind and diminishing the value of older people in society. Now, as COVID-19 vaccines are distributed, some countries are continuing to leave older people behind in their national strategies. India and the Philippines, for example, are failing to prioritize vaccination amongst older adults, despite the known increased risk of fatality due to COVID-19 in this age group. In India, many over 60 years of age have not yet received a single dose of the COVID-19 vaccine. In the Philippines, the vaccination strategy was shifted to prioritize “so-called working age adults”. According to the authors “this vaccination policy will not save lives: it will contribute to thousands, potentially millions of avertable deaths.” Correspondent at Reuters Ms. Patpicha Tanakasempipat, reports that older people in Thailand are one of the least vaccinated groups in the country. Government data showed an estimated 6.7% of people aged 60 years and older were vaccinated, compared with 15% of those 18 to 59 years. Despite initially announcing that older adults would be prioritized, regional outbreaks and plans to resume international tourism led to a shift in vaccination priorities. As a result, younger people were able to be vaccinated more easily than older age groups. The situation in Thailand, and countries in this region demonstrates the urgent need to have consistent vaccination policies based on science and implemented with a sound comprehensive set of action that accommodates the needs of older people and other marginalized groups. At a time when the United Nations Decade of Healthy Ageing 2021-2030 (the Decade) calls for a whole-of-society response to improve the lives of older people and re-think ageing, vaccine equity amongst all groups must be at the top of global agendas. In alignment with the Decade and World Health Organization’s Immunization Agenda 2030, global action is needed to ensure that older people can fulfill their potential in dignity and equality. Currently, much work is needed globally to ensure that the rights and well-being of older people are protected and respected, and no more older people are left behind in receiving life-saving vaccinations. The International Federation on Ageing (IFA)’s 15th Global Conference on Ageing entitled “Rights Matter” brings together global leaders fighting to protect the rights of older people. The Vaccines4Life Summit, a full-day pre-conference event entitled “Driving Policy to End Immunisation Inequity: The Future of Adult Vaccination and Lessons Learned from the Coronavirus Pandemic”, is a critical point of connection to be informed, to share learnings and take collective action on ensuring immunization equity. As part of this event, Dr. Peter Lloyd Sherlock will speak in a session entitled “Health is a right not a question of income: Vaccinating hard to reach groups” and share his expertise on fostering equity in adult immunization as a key action in reaching universal health coverage. Visit the conference website to register for this pre-conference event and explore the conference theme “older people and pandemics”. To learn more about achieving immunization equity, contact these experts. Prof. Peter Lloyd-Sherlock, Professor of Social Policy and International Development, University of East Anglia Dr. Ida Berenice Molina Aguilera, Head of Honduras’ Extended Program for Immunization (EPI) Dr. Isabella Ballalai, Vice President, Brazilian Immunization Society

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Racial Disparities in Adult Vaccine Uptake

Marginalized groups especially older people and those with chronic health conditions not only have a higher risk of contracting infections but are also disproportionately impacted -especially among communities of colour. Patterns of health inequity have shown a long history of Individuals from underserved racial communities as having undiagnosed chronic medical conditions including diabetes, and kidney disease. The devasting impact of COVID-19 pandemic is clear, with social and racial injustice and inequity being the forefront of public health measures. Long standing health disparities continue to encompass the care system and vaccination services and require urgent action to protect the rights of underserved communities. Researchers, Dr. Kosuke Kawai, Harvard Medical School, and Dr. Alison Tse Kawai, Health Solutions, observe lower adult vaccination (e.g., influenza, pneumococcal, shingles, and Tdap) uptake rates particularly among racial and ethnic minorities. According to their findings, these disparities have persisted for decades and continues to become a pressing issue. Furthermore, observations show immunization programs that solidify relationships with diverse community members lead to probable results of eliminating communication and trust barriers between authorities and minorities. However, it is imperative to signal the need to reduce cost barriers as a key piece of ensuring immunisation equity among these groups. Although there is more public health attention to improve access to COVID-19 vaccines for marginalized groups, it is still equally important to consider vaccine preventable diseases. More than 42,000 adults die from vaccine-preventable diseases in the US every year, majority can be seen among minority communities who experience a multitude of delays to access the immunizations they need. Vaccines4Life’s study entitled Towards Ending Immunization Inequity is an innovative project aimed to understand the effects of social determinants on vaccination campaigns as a policy lever to improve uptake rates within the most at-risk communities. Stay tuned for its release over the coming months to provide evidence on the need to address health disparities through recommendations from immunization bodies (e.g., NITAGs), vaccination gateways, and access to vaccines for specific populations. Follow Vaccines4Life Twitter for more updates on the findings of this study. To learn more about the barriers to immunization in under studied and special risk populations, please contact Prof. Raina MacIntyre. As the Head of the School of Public Health and Community Medicine at UNSW and Professor of Infectious Diseases Epidemiology, Raina leads innovative research on advancing health equity through immunization programs. For more information on the social determinants of health in racialized older adult populations, please contact Dr. Isabella Aboderin. Isabella is the Regional Chair for Africa of the International Association of Gerontology and Geriatrics (IAGG), Technical Advisor to the Global Commission on Aging in Developing Countries, Member of the World Economic Forum Global Agenda Council on Ageing, and Board Member of HelpAge International and the United Nations International Institute on Ageing (INIA).

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Working Together to Defeat Invasive Meningococcal Disease

April 24 is World Meningitis Day, and on this day, the International Federation on Ageing (IFA) together with the Confederation of Meningitis Organisations (CoMO) and Immunize Canada want to remind you that meningococcal disease is a health risk you should not take.

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