Inequalities in Healthcare for Older Adults: Why lifetime immunization is important

By: Jane Barratt, General Secretary, International Federation on Ageing (IFA) and Isabelle Deschamps, Head of Global Vaccines Public Affairs, Sanofi Pasteur.

 

By 2020, the number of people aged 60 and older will outnumber children under 5^[1] for the first time in history.

 

We live in an ageing society in which older people are increasingly playing an active role. As life expectancy around the world increases, people aged 60 and above are extending their careers, pursuing new hobbies, and supporting families and our communities through volunteering, caregiving and mentoring. All these roles represent great value to our society and economy.^[1],[2]

On this United Nations International Day of Older Persons, which celebrates the “Journey to Age Equality,” we ask: How can we collectively do more to reduce inequalities, specifically in relation to immunization? With the start of the influenza season in the northern hemisphere, now is a prime opportunity to discuss how a life-course approach to influenza immunization can help people as they grow older.

What does Healthy Ageing mean? The World Health Organization (WHO) defines healthy ageing as “the process of developing and maintaining the functional ability that enables well-being in older age.”^[3]

To help older people live not only longer but healthier lives, the World Health Assembly adopted a Global strategy and action plan on ageing and health (2016-2020) that informs the Decade of Healthy Ageing (2020-2030) to be launched on October 1, 2020. This strategy focuses on sustained action to achieve a world where everyone can live a long and healthy life. It includes the need to ensure the availability of vaccines, which are increasingly recognised as a priority to achieve healthy ageing. Vaccination remains one of the most powerful and cost-effective preventions available to protect against a number of diseases, including influenza.^[4],[5]

Why is influenza a problem for older adults? Our immune systems weaken as we age, so it becomes more difficult to fight off infections. From the age of 50, the number of white blood cells (the cells that target and kill viruses and other germs) decreases, and those cells that remain in circulation become less effective.[6] Therefore, every influenza season, older people are among the most at risk of an influenza infection and serious outcomes.^[7],[8]

While many think of influenza as a “bad cold” that passes in a week, it can be much more serious. Influenza is a respiratory disease that can lead to pneumonia, heart attack and stroke.^[9] It can also contribute to an older person’s inability to recover fully once the infection has passed.^[10],[11]

What can we do to better protect older adults against the risks of influenza? The WHO advises annual vaccination against influenza for people aged 65 and over^[12] and it has declared influenza vaccination as one of the top three priorities to achieve healthy ageing in Europe.^[12] And yet, less than half of the countries around the world have a national immunization program targeted at older people.^[14] In most countries, influenza vaccine coverage rates for older people remain under the global target of 75%.^[15] Furthermore, there are influenza vaccines that have been specially designed for older people, and yet, in some countries where the vaccines are licensed, not all older people have access.

Adopting a life-course approach to vaccination, or ensuring vaccination across the life span, is increasingly recognised by leading global health^[16] and economic organizations^[17] as a solution that would benefit both individuals and cash-strapped health systems in an ageing world. This calls for investing in health care that strengthens individuals’ ability to maintain good health over the course of their lives.^[4] While this approach is gaining momentum at the national and international level, more work still needs to be done, particularly for diseases like influenza that disproportionately affect older adults and for whom tailored vaccines are available.

A true life-course approach to immunization, including ensuring access to vaccines designed for older people, is particularly instrumental now as the world undergoes a major demographic shift. Supporting the well-being of a growing population is critical to the health of future generations while recognising our older community members’ pivotal social and economic contributions.

• Asking healthcare professionals about the vaccinations you or your older family members may need to stay healthy and active over the life-course.

Join the “Journey To Age Equality.” For more information, visit International Day of Older Persons,

 

References

[1] World Health Organization. Ageing and health. Available at: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed September 2019.

[2] United Nations. Global Issues. Ageing. Available at: https://www.un.org/en/sections/issues-depth/ageing/ Accessed September 2019.

[3] World Health Organization. What is Healthy Ageing? Available at: https://www.who.int/ageing/healthy-ageing/en/. Accessed September 2019.

[4] Health Policy Partnership. A life-course approach to vaccination: adapting European policies. Available at: https://www.healthpolicypartnership.com/wp-content/uploads/vaccination/life_course_vacc_policy_report_interactive.pdf. Accessed September 2019.

[5] Shields GE, et al. A systematic review of economic evaluations of seasonal influenza vaccination for the elderly population in the European Union. BMJ Open 2017;7:e01484.

[6] Weyand CM and Goronzy JJ. Aging of the Immune System. Mechanisms and Therapeutic Targets. Annals ATS 2016;13:Supp5.

[7] Center for Disease Control and Prevention (CDC). People 65 years and older & influenza. Available at: https://www.cdc.gov/flu/about/disease/65over.htm. Accessed September 2019.

[8] Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002;2(11):659-66.

[9] Center for Disease Control and Prevention (CDC). Flu symptoms and complications. Available at: https://www.cdc.gov/flu/symptoms/symptoms.htm. Accessed September 2019.

[10] Gonzalo PL et al. The effect of influenza on functional decline. J Amer Geriatr Soc. 2012;60(7):1260-7.

[11] Andrew MK et al. Impact of frailty on influenza vaccine effectiveness and clinical outcomes: Experience from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network 2011/12 Season Canadian Immunization Conference, Ottawa, Ontario, Canada. Available at: https://academic.oup.com/ofid/article/3/suppl_1/710/2637095. Accessed September 2019.

[12] World Health Organization (WHO). Weekly epidemiological record. Vaccines against influenza WHO position paper 87(47):461–476. Available at: http://www.who.int/wer/2012/wer8747.pdf.  Accessed September 2019.

[13] World Health Organization (WHO). Policies and priority interventions for healthy ageing. World Health Organization Regional Office for Europe. Available at: http://www.euro.who.int/__data/assets/pdf_file/0006/161637/WHD-Policies-and-Priority-Interventions-for-Healthy-Ageing.pdf. Last accessed September 2019.

[14] Ortiz JR, et al. A global review of national influenza immunization policies: Analysis of the 2014 WHO/UNICEF Joint Reporting Form on immunization. NCBI [online] 2016;34(45):5400-5405.

[15] Jorgensen P, et al. How close are countries of the WHO European Region to achieving the goal of vaccinating 75% of key risk groups against influenza? Results from national surveys on seasonal influenza vaccination programmes, 2008/2009 to 2014/2015. Vaccine. 2018;36(4):442–52.

[16] World Health Organization (WHO). Immunization Agenda 2030. Draft One. Available at: https://www.who.int/immunization/ia2030_Draft_One_English.pdf?ua=1. Accessed September 2019.

[17] G20 Osaka Leaders’ Declaration of June 2019. Available at: https://www.consilium.europa.eu/media/40124/final_g20_osaka_leaders_declaration.pdf. Accessed September 2019.