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Prioritizing Pneumococcal Vaccination for Older Adults to Foster Healthy Ageing

Pneumonia is a leading cause of morbidity and mortality amongst older adults. In fact, deaths due to pneumonia are increasing in older adults. The Global Burden of Disease Study finds that deaths due to pneumonia in this age group have increased by approximately 60% over the last two decades. Additionally, pneumonia regularly results in hospitalization and significant morbidity, such as frailty, exacerbation of pre-existing comorbidities and overall decline in health. There remains a misconception that pneumonia is a disease only affecting old people, when in fact many forms of pneumonia are preventable via vaccination. The bacterial pathogen Streptococcus pneumoniae is a leading cause of pneumonia and does disproportionally result in greater morbidity and mortality in older populations. Two types of vaccines are available to protect against pneumonia due to Streptococcus pneumoniae, yet there remains very little awareness of these which can prevent serious disease and death in older adults. Pneumococcal vaccination is almost always in routine childhood immunization programs and are considered a critical action in preventing deaths in children under 5 years of age. In contrast, recommendations for older adults vary globally and are lacking overall. Some countries provide pneumococcal vaccination to all adults considered “high-risk” due to pre-existing comorbidities, such as those with immunocompromising conditions or non-communicable diseases. In many countries, vaccine recommendations for older adults are specified by arbitrary age cut-offs, such as 60 or 65 years and older. Even in countries where pneumococcal vaccination is recommended for older adults in national programs and free, uptake in this group is consistently below target and there is low awareness amongst the general public. Poor vaccination policy and low awareness amongst the general public is particularly concerning as we learn about the process of immune decline which occurs with ageing. This process, termed immunosenescence, is a normal function of ageing and makes older adults more susceptible to contracting and experiencing adverse health effects from infectious diseases. A newly published article, co-authored by the International Federation on Ageing’s (IFA) Secretary General, Dr. Jane Barratt, proposes changes to pneumococcal vaccine policy for older adults, considering the decline in immune function which occurs with age. The article suggests a new approach for pneumococcal vaccination in adults which firstly, recognizes older adults as an immunocompromised group and, secondly, prioritizes a life course approach to vaccination. The epidemiological, biological and clinical evidence, as outlined in the article, supports a re-framing of pneumococcal vaccination as a response to the medical needs of older adults due to their immunocompromising condition. Additionally, it is critically important to prioritize a life-course approach to vaccination and recognize it as a key component of healthy ageing. This approach involves expanding vaccination programs beyond childhood to support immunization for all ages. The WHO defines healthy ageing as “developing and maintaining the functional ability that enables well-being in older age”. In alignment with its Immunization Agenda 2030 and the United Nations Decade of Healthy Ageing, pneumococcal vaccination should be considered a key prevention effort which enables older people to maintain good health and well-being and continue to do what they have reason to value. The IFA’s 15th Global Conference on Ageing entitled “Rights Matter” provides a global platform to mobilize action and advocate for immunization policies and practices, which consider factors such as immunosenescence and prioritize vaccination as a key component of healthy ageing. Visit the conference website to register for the pre-conference Vaccines4Life Summit “Driving Policy to End Immunisation Inequity: The Future of Adult Vaccination and Lessons Learned from the Coronavirus Pandemic” and the Presidential Symposium on Adult Vaccination “Together Towards Tomorrow: Post-pandemic Action on Adult Vaccination”. Additionally, this World Pneumonia Day, taking place on November 12, IFA calls for the recognition of the high-burden of pneumonia in older adults and a life-course approach to pneumococcal vaccination. To learn more about vaccination policy for older people and a life-course approach to vaccination, contact these experts. • Dr. Luis M. Gutierrez Robledo, Director General, National Institute of Geriatrics,        National Institute of Health • Dr. Mine Durusu-Tanriover, Professor of Internal Medicine, Hacettepe University • Dr. Gaëtan Gavazzi, Professor, Faculty of Medicine, Grenoble-Alpes University

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Vaccination Equity as the Backdrop for Universal Health Coverage

Although many lessons have been learned through COVID-19, one of most crucial is the urgent need for universal health coverage to advance protection against the threats of infectious diseases and consequences to the population and economy. As vaccination policies and programs move towards implementing a life course approach, health disparities continue to be ever present in all countries around the world. To ensure no one is left behind, especially those most at-risk, governments need to prioritize increasing their investment in health promotion and prevention programs including immunization. In the recently published article entitled ‘South Korea’s Health-Centered Development Model’, author Lee Jong- Wha, shares the success of South Korea in developing and sustaining a well-functioning and resilient universal health coverage program. It is important to acknowledge the decade of this work and effort that has made medical and health-care services more accessible and cost-effective since the 1960’s. As a result of strong government commitment and investment to universal health care, evidence shows high vaccination uptake rates and effective containment of communicable diseases in South Korea. The commitment to universal health coverage and public health investment in vaccines in South Korea has resulted in the success of protecting population groups including older people and those with chronic health conditions against infectious diseases. This investment is also associated with robust social and economic systems that continue to prosper. Although the UN Sustainable Development Goals brings together a common agenda to work towards achieving universal health coverage including access to safe, and affordable vaccines, inequities around the world pose several challenges. Still to this day, most than half of the world’s population does not have access to health coverage and vaccines that are a crucial pillar of expanded prevention strategies. To combat vaccination inequity and ensure universal health coverage, join the Vaccines4Life World Coalition on Adult Vaccination (WCAV). The WCAV brings together experts of non-governmental organizations and academia, clinicians, and public health worldwide collaborating on a common agenda around a life course approach to vaccination. Follow the #Vaccine4Life platform on twitter to learn more about good practices in public health investment and worldwide case studies of inequities that contribute to low uptake rates. To engage with an expert on the value of universal health care, connect with Dr. Xenia Scheil-Adlung. She has published various research particularly on health coverage, and inequalities in access to services among older persons. To learn more about building a business case to improve public health investment for immunizations, connect with Dr. Bryan Patenaude, economist and Assistant Professor of Economic Evaluation in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. He has extensive expertise analyzing the cost-effectiveness of public health interventions including the economic impact of infection prevention policies and programs.

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Bone Health in Later Life

One of the structural changes that occurs as people age is the loss of bone tissue. As the skeleton provides structure, balance, and support to the body, the loss of bone mass or density can cause joints to become stiffer and less flexible. The interior structure of a bone resembles a honeycomb. When the tiny holes become larger, the bone becomes less dense and more porous. This weakens bones, making them fragile, and more susceptible to breakage. Age-related bone loss involves a steady and progressive decline with lower rates of calcium absorption leading to brittle bones that fracture easily. Over 80% of all fractures in people aged over 50 years are caused by osteoporosis.1 Often called the ‘silent thief’, osteoporosis is a skeletal disorder that can cause bone loss without symptoms. Postmenopausal women are especially susceptible as the condition is closely related to estrogen deficiency. Alarmingly, at least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture in their lifetime, and 28% of women who suffer a hip fracture will die within one year. Men who suffer a hip fracture tend to have poorer outcomes and are more likely to die from the complications. Protecting bone health requires not just behavioural and lifestyle modifications but also regular screening. The intake of calcium, vitamin D, weight-bearing exercises such as walking, and resistance training such as lifting weights, all contribute to bone health. Experts recommend screening for osteoporosis with bone measurement testing as a tool to help prevent fractures in women 65 years and older, and postmenopausal women younger than 65 years. Early detection has been found to reduce the rate of hip fractures among the ageing population2. Pharmacologic therapies are effective for people with low bone density (BMD) or those with a prior fragility fracture as well as reducing fractures in postmenopausal women. Medications appear to either reduce the rate of bone deterioration or are active in stimulating the bone-building process. From a policy standpoint, an important prevention measure is removing the barriers to healthy ageing such as fall prevention programs and building age-friendly communities. According to Dr. Kristine Ensrud, a physician-researcher who studies aging-related disorders at the University of Minnesota and Minneapolis VA Health Care System, “To reduce the societal burden of fracture, it’s going to take a combined approach of not only focusing on the skeleton but focusing on fall prevention.” The external environment is of great significance when considering the bone health of older people. Studies have shown that those over the age of 65 years face problems moving outdoors3. This impacts the health benefits of daily physical activity and hinders healthy ageing. The physical design of a space is a crucial element of preventing osteoporotic fractures. For example, the Netherlands is exploring the adaptation of street furniture like fences, benches, and lampposts into public gym equipment through minor modifications4. The protection of bone health in later life and prevention of age-related conditions such as osteoporosis are aligned with the key messages of the UN Decade of Healthy Ageing which emphasizes the development of communities that foster the abilities of older people through integrated person-centred care. A proactive approach towards the health of older people must go hand-in-hand with the implementation of policies at country level. To learn more about osteoporosis in later life and protecting bone health to ensure healthy ageing, please contact Dr. Edward Leung, Chief of Service of Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong at the IFA Expert Centre, which is a unique resource for those interested or involved in the areas of ageing, vision health, human rights, vaccination and more. To contribute to the vital discourse on bone health and fall prevention, connect with Dr. Supriya Venigalla (svenigalla@ifa.ngo). 1 Fast facts: Osteoporosis Canada. Osteoporosis Canada. (2019, April 18). https://osteoporosis.ca/about-the-disease/fast-facts/ 2 US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(24):2521–2531. doi:10.1001/jama.2018.7498 3 Kerr, J., Marshall, S., Godbole, S., Neukam, S., Crist, K., Wasilenko, K., Golshan, S., & Buchner, D. (2012). The relationship between outdoor activity and health in older adults using GPS. International journal of environmental research and public health, 9(12), 4615–4625. https://doi.org/10.3390/ijerph9124615 4 Morris, K. (2016). (rep.). Making Cities Better for Ageing: Lessons from U.K. Age-Friendly Cities. The German Marshall Fund of the United States. Retrieved from https://www.gmfus.org/publications/making-cities-better-aging-lessons-uk-age-friendly-cities

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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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The IFA has a long established and wide-ranging network of member organizations around the world. The network extends to over 75 countries covering every region. Together these organizations represent over 80 million older people.

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