“Longevity has been one of the greatest achievements of recent decades but has implications for social, economic and health systems,” says Professor Carlo Signorelli, President of the Italian Society of Hygiene, Preventive Medicine and Public Health (SITI).
Speaking at a session on the Role of Adult Vaccination as Part of Healthy Ageing at the European Public Health Conference in Milan, he said keeping this section of the population healthy is essential. Adult vaccination, he noted, would play an increasingly important role in safeguarding healthy ageing.
The demographic figures can be stark. Globally, the number of people aged over 60 has tripled over the last 50 years and will double against by 2050. In Europe, the proportion of people of ‘working age’ is said to be shrinking.
Dr Lale Ozisik, Hacettepe University Faculty of Medicine in Ankara, Turkey, told the conference that older populations tend to have higher rates of hospitalisation. This translates into misery – as well as lost independence and dignity – for the people affected while also implying higher health spending.
Because immunity wanes with increasing age, adult immunisation is especially important. Older people, especially the many who already suffer from an underlying chronic disease, are also hit harder than others when they catch the flu, pneumonia or shingles so vaccination needs to be a routine part of healthcare throughout life.
Flick through a newspaper or listen to a radio debate and there is a good chance you’ll find worried words about Europe’s demographic ‘crisis’.
We are getting older and living longer, they remind us. But before you have time to celebrate, talk turns swiftly to the ‘burden’ of an ageing society; to the pressure this will put on health and social services.
If a time-traveller from a few centuries ago arrived in 2015 she would laugh enviously at what passes as a problem these days. That is not to say that demographic changes do not require us to adapt but all this talk of burdensome older people seems like a negative spin on a hugely positive story. It is also based on outdated notions of what it means to be an older person.
Yes, our 18th century time-traveller would expect a 65-year-old to be frail, unproductive and, well, elderly.
But that’s not the case today. It’s not at all uncommon for people in their 60s and 70s to be doing paid work, not to mention the many hours of unpaid work they do in our communities and families. So by all means let’s reinvent our systems and services to meet the needs of today’s population. Let’s make it easy to stay healthy by eating well, exercising, socialising – and immunising.
And let’s do it in a positive and proactive well. Remember: you’ll be older one day – if you’re lucky.
Figures from the US show that around 400,000 people are hospitalised due to pneumococcal pneumonia every year and that the risk of dying from the disease is much higher for older people. Add to this the 6,000 cases of pneumococcal meningitis – which carries a 22% fatality rate in adults – and you begin to get a sense of the scale of the problem.
Shingles too is a deeply unpleasant infection with potentially long-lasting pain that affects around half of all people living to the age of 85.
Time for action?
Despite these startling statistics, vaccination rates for older Europeans are too low. Most European countries are not hitting their 75% target for vaccinating people over 65 against flu. With the laudable exceptions of the Netherlands and the UK, this is a political promise not kept. Uptake rates are much higher in the US where flu vaccination is universally recommended and more easily accessible.
It’s a similar story for pneumococcal vaccination. The European Centre for Disease Prevention and Control reports that over 65s are at the highest risk of catching pneumococcal disease. And, when infections occur, older people are more likely than any other age group to die.
But pneumococcal vaccination coverage for older people is lower in the EU than in the US. Around 60% of Americans have had the pneumococcal vaccine. In Europe, the figure is 10%.
What are we doing wrong?
“Europe is way behind the US on pneumococcal vaccination and is also well behind on flu,” said Dr Ozisik, adding that data on adult vaccine uptake is not available from some countries. “If something is not measured and reported, it is impossible for the community to be aware of it.”
Other obstacles, she says, include lack of awareness among health professionals and patients, as well as financial barriers and underdeveloped healthcare systems.
“One of the reasons adult vaccination rates remain low is because many adults simply don’t know that they need vaccines throughout their lives,” she added.
Finally, she said, research on flu vaccine uptake suggests that the rates are best where the vaccine is clearly recommended, easily accessible and reimbursed. The Netherlands, which has a stellar record for flu vaccination, offers the jab for free, reimburses GPs, invites people at risk to attend for vaccination, and runs large nationwide information campaigns.
Dr Jane Barratt, Secretary General of the International Federation on Ageing, said it was high time that adult immunisation was put on the healthy ageing agenda. “We are encouraged to have screenings for prostate and breast cancer but are we encouraged to have vaccines?” she asked.
She said that diseases such as community-acquired pneumonia (CAP) get scant public attention despite their social and economic impact. Around 9,000 people die from CAP in Europe every year, making it the most frequent cause of death from an infection.
“That’s 9,000 lives. It could be your mother or father, sister or brother,” she said.
In addition to the high mortality rate, people who catch CAP typically spend around 10 days in hospital. This comes at a direct economic cost of €5.7 billion but the full impact is harder to measure.
“We don’t talk about the indirect costs; about how the person’s partner or children take care of them. We don’t talk about the impact of losing the contribution that person would normally make to the economy or to their family,” said Dr Barratt.
However, she said international organisations and civil society are playing their part in turning the tide. The WHO has published its first report on Ageing and Health which calls for “A world in which everyone experiences healthy ageing”. The report, she said, is an opportunity to bring immunisation into discussions about healthy and active ageing.
“It’s time that those who are committed to this field across all sectors to join together and ensure that older adults of today – and those that come after us – have the benefits of adult vaccination,” she said.
The conference session on the Role of Adult Vaccination as Part of Healthy Ageing at the European Public Health Conference in Milan was sponsored by Pfizer.