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

Our manufacturing teams have just finished producing influenza vaccines in time for the upcoming flu season, which is about to start in the Northern Hemisphere, and they are about to start all over again to ensure they have the right vaccine ready for March, when flu season strikes in the Southern Hemisphere. Producing influenza vaccines is an all-year round activity that relies on monitoring the different influenza viruses around the world and predicting this year’s dominant strains to produce the most effective vaccine possible – a task devoted to the World Health Organization and its global surveillance network.

Influenza can affect everyone, but while it is sometimes mistaken a with a common cold, influenza or flu can lead to much more serious health problems and causes between 290,000 and 650,000 deaths worldwide a year. Having the flu vaccine can reduce these risks and is particularly important for people over the age of 65, children under 5, pregnant women and people with chronic diseases, who all run a greater risk of severe outcomes. Among the elderly population, the risk of having a heart attack in the week after being diagnosed with flu increases six fold.

To mark the United Nations International Day of Older Persons we worked with the International Federation of Ageing to better understand and address the inequality in immunization facing older people, who often fall through the cracks of immunization programs around the world.

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

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

 


Older people Day

BY 2020, THE NUMBER OF PEOPLE AGED 60 AND OLDER WILL OUTNUMBER CHILDREN UNDER 51FOR THE FIRST TIME IN HISTORY.


We live in an aging 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 Aging mean?

The World Health Organization (WHO) defines healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age.”

To help older people live not only longer but healthier lives, the World Health Assembly adopted a Global strategy and action plan on aging and health (2016-2020) that informs the Decade of Healthy Aging (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 recognized as a priority to achieve healthy aging. 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 over12  and it has declared influenza vaccination as one of the top three priorities to achieve healthy aging in Europe.13  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 recognized by leading global health16  and economic organizations17  as a solution that would benefit both individuals and cash-strapped health systems in an aging 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 recognizing our older community members’ pivotal social and economic contributions.

On this International Day of Older Persons, we are calling on you to join our efforts in reducing older age inequalities and achieving healthy aging by:

  • Promoting life-course immunization, including access to influenza vaccines tailored for older people. 
  • 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,

Find out more here "Understanding Influenza"
F
ind out more here "Don’t let influenza break your heart"

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.

 

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