Home » Not just children and the elderly: the challenge of immunization in adults for healthy aging

Not just children and the elderly: the challenge of immunization in adults for healthy aging

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Not just children and the elderly: the challenge of immunization in adults for healthy aging

Europe, and Italy in particular, is colored gray because people are living longer and it is estimated that by 2030 the population over 60 will increase by 34%, reaching 2.1 billion by 2050. Good news as long as you age in good health, an objective that can be achieved with prevention, a not at all abstract word which includes – in addition to healthy lifestyles – also the vaccinations currently available for preventable diseases. On the occasion of World Vaccination Week promoted by the World Health Organization from 24 to 30 April (the European one is from 21 to 27 April), the pharmaceutical company GSK organized an event entitled “Unlocking the power of prevention: making adult immunization a standard of care in an aging world” which took place in Wavre in Belgium one of the largest vaccine production sites in the world with a total size of 550,000 meters, more than 70 football pitches.

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Vaccinations cornerstone of prevention

Precisely in these days, in World Immunization Week which marks 50 years since the introduction of the extended immunization programme, Stella Kyriakides, Commissioner for Health and Food Safety, recalled how in 1974 only 5% of children in the world he had been vaccinated against diphtheria, tetanus and whooping cough. Today this figure has risen to almost 85% of children worldwide and 94% in the WHO European Region. But in recent years there has been a decline in vaccinations in much of Europe and in the last three years, more than 1.8 million children have not been able to be vaccinated against measles. The consequence of this is a 60-fold increase in the number of cases in 2023 compared to 2022. “We live in a very challenging context and we seem to have forgotten the experience of Covid,” explains Sibilia Quilici, Executive Director of Vaccines of the European Federation of Pharmaceutical Industries and Associations (EPFIA). “The emergence of new infections, climate change, an aging population and antibiotic resistance put global health and healthcare systems at risk: vaccinations are a cornerstone of prevention”.

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The foundations of healthy longevity

It is estimated that over ten years, from 2021 to 2030, the population over 60 will increase by 34% and that by 2050 there will be 2.1 billion adults over 60. Although many infectious diseases are preventable, they still represent a high healthcare cost in adults who tend not to be vaccinated. Yet, as we age our immune system weakens and makes us more vulnerable to diseases with consequences also on work productivity and social costs. “Most people – explains Jane Barratt, Global Advisor of the International Federation on Aging (Ifa) – understand the importance of a healthy diet and regular exercise to improve and maintain their functionality, including mobility, but they are much less aware that as we age, there is a natural weakening of our immune system, making it increasingly difficult to fight infections and recover from illnesses.”

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L’immunosenescenza

From age 20 onwards, the immune system begins to gradually change in a process known as age-related immune decline or immunosenescence. The resilience acquired in youth gradually wears off until around age 50, when the risk of infections and more serious outcomes begins to become increasingly evident. “As people live longer, it is vital that they are well informed and understand the risks of infectious diseases, such as shingles, influenza and pneumonia, and that they support themselves to age healthily,” Barratt added. enjoy and accomplish more in our more mature years when we take steps to maintain and improve our functionality and quality of life.” In short, vaccines can also help to age in good health: “We must go beyond the idea that vaccination is a one-off event for children or frail elderly people and encourage governments and the population to adopt vaccination throughout the span of life. This strategy can not only prevent individual infections, but lead to a healthier aging population and further protect against the effects of comorbidity with other diseases.”

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L’effetto ‘win win’

This creates a ‘win-win’ effect as vaccines, by reducing infections, limit the need for antibiotics and thus protect future generations from the spread of antimicrobial resistance. “Furthermore – adds Barratt – immunization programs have a unique ability to reach hard-to-reach populations and can be used as a basis for strengthening primary health systems throughout the lifespan and, therefore, also to promote coverage universal healthcare and the health of the population in general”.

The economic impact of an unprotected population

An estimated $1 trillion per year in productivity is lost due to preventable diseases among people aged 50 to 64 in G20 countries. For example, there are 330,000 hospitalizations of older adults worldwide each year due to respiratory syncytial virus (RSV) alone. Adult patients hospitalized with RSV may experience significant long-term problems. Up to 24.5% require professional home care, 26.6% required readmission within 3 months of hospital discharge, and the mortality rate is nearly 33% within one year of hospitalization. 8% of patients aged ≥60 years admitted to hospital with confirmed RSV reported continued loss of independence 6 months after hospital discharge.

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The Italian study on the costs of missed vaccinations

Recently one studio Italian published in the International Journal of Technology assessment in health care evaluated the fiscal impact and potential savings resulting from three vaccines in adults: influenza, herpes zoster and pneumococcal. For influenza, with an estimated number of 2.1 million people infected, the total economic impact was almost 1 billion euros. Of this figure, 160 million euros represents the fiscal impact, highlighting considerable pressure on the healthcare system and work productivity. Pneumococcal diseases, although less widespread with an estimated 90,000 cases, had a significant economic impact of approximately 148 million euros, with a fiscal impact of 24 million. Finally, herpes zoster, with an estimated 6,400 cases, generated a total impact of 4,777,200 euros. Of this sum, 630,000 euros derive from the decrease in tax collection, which underlines the direct impact of this less prevalent but no less serious disease on economic resources.

Data on savings generated by vaccinations

These data highlight not only the economic burden of infectious diseases in Italy, but also the need for effective health policies to mitigate their impact. The Italian study, however, also evaluated the potential effect of vaccination programs for adults aged between 30 and 60 against these three diseases, estimating it on the basis of the annual reduction of 200,000 cases of influenza, 400 cases of herpes zoster and of 9,000 cases of pneumococcal infection. It has been calculated that it would be possible to achieve savings of 129 million euros for influenza, 299,000 euros for herpes zoster and 14 million for pneumococcus.

Not enough is invested in vaccinations

During the meeting organized by GSK, data relating to a study conducted in the Netherlands was also presented which demonstrated that every euro invested in the vaccination of adults aged 50 and over would produce over 4 euros in economic income for the rest of their lives. through its effects on growth, productivity, tax and pension systems. Despite this scientific evidence, vaccination does not have priority over government funding. “The inadequate allocation of budgets for vaccines and vaccination campaigns, together with reimbursement practices that are often too long, are a problem,” underlines Quilici. “77% of EU and UK countries spend less than 0.5% of their health budget on immunisation. 58% of EU countries do not fund flu vaccination and experienced lower coverage rates than countries with public funding. Furthermore, in 30% of member states, the reimbursement process for new vaccines often extends beyond a long six-year horizon. The fact is that health ministers do not speak the same language as finance ministers who aim to save resources. But it is necessary to change our approach and consider these costs not as an expense but as an investment that allows health systems to save money.”

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How to overcome vaccine hesitancy

Having established that prevention through immunization brings benefits to everyone, a far from negligible obstacle is the vaccination hesitancy that spreads among many segments of the population. What can be done? “We need to change the narrative and focus on Health Literacy”, replies Barratt who adds: “We need to get the right information directly to people rather than waiting for them to look for it, perhaps stumbling upon fake news, therefore not just articles in traditional media, on the radio, on TV or on social media but also posters on buses, on the street, in pharmacies and even in supermarkets.”

How a vaccine is born

Spreading Health Literacy also means making people aware of how much work goes into a vaccine: “It is a highly complex and highly regulated process that can take up to 30 years from the first initial stages to when it reaches the patient,” explains Emmanuel Felix, GSK vice-president, Belgium Operations, Vaccines Manufacturing. “We have many steps to comply with and high quality controls, but we are also starting to work with Artificial Intelligence using digital twin technology to create detailed models of the human immune system or specific pathogens.” And Sibilia Quilici concludes: “To inspire trust and make people understand the importance of immunization, I believe it is essential to explain not only to the population but also to the institutions how much science there is behind the development of a vaccine.”

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