Adult immunisation

It is estimated that in 2060, 30% of Europeans will be 65+ (nearly 130 million people)¹. This means that in some years, there would be more people prone to chronic health conditions generating a greater burden on healthcare systems, as well as higher healthcare costs. Older persons generally have greater susceptibility to infections than younger adults, and vaccination is an important tool that can help address the challenges posed by an ageing population.

The burden posed by vaccine-preventable diseases in adults is significant. For example, respiratory syncytial virus (RSV) causes an estimated 250,000 hospital admissions and 17,000 hospital deaths every year in people over 65², and herpes zoster-associated mortality increases with age³. In the case of seasonal influenza, vaccination can reduce hospitalisations and deaths by 45% and 38%, respectively, in older people with diabetes, and is also associated with reduced risk of cardiovascular death⁴ ⁵.

Vaccination brings high financial return too, e.g. every Euro invested in adult vaccination (starting at age 50) yields €4 of future economic revenue for government over the lifetime of the cohort⁶. Furthermore, the Office of Health Economics published a report on the socio-economic value of adult immunisation programmes, focussing on seasonal influenza, pneumococcal disease, herpes zoster and RSV in 10 countries. The report found that adult immunisation programmes return up to 19 times their initial investment, or up to $4,637 per individual full vaccination course.

Yet, adult immunisation schedules are not as well established as those for children and adolescents. For example, there’s a 75% target for flu vaccination coverage for people with chronic health conditions, but this hasn’t been achieved in any EU country. In 2018, the flu vaccine uptake across EU/EEA countries was only 45%⁷, while the uptake for pneumococcal vaccination varies between 20% and 30%⁸.

We urgently need to shift to a prevention-first mindset in our approach to health, to ensure adults are protected from vaccine-preventable diseases. We recommend implementing the following 4 actions to strengthen adult immunisation policies across Europe:

Prioritise and embed adult vaccination in national immunisation plans and ensure sufficient funding to improve access and uptake of existing vaccines, as well as faster inclusion of new vaccines.

Increase awareness and education of citizens and healthcare professionals on the overall burden of vaccine-preventable diseases and the benefits of adult immunisation.

Improve access and convenience to vaccination for adults.

Establish digital vaccination registries to improve vaccination coverage rates across the lifespan and enable recalls and reminders.

Taking these actions would help improve immunisation uptake for adults in Europe, but it would be vital to understand how uptake develops over time and for the different vaccinations offered to adults. Timely monitoring of coverage rates and disease surveillance across Europe are key ingredients for the success of adult immunisation programmes, and therefore better disease protections and healthcare resilience.

We need to work together to address the barriers to more widespread and effective immunisation schedules for adults. The pipeline review of our member companies we conducted in 2022 showed that 80% of the vaccine candidates in the pipeline are for adults. It’s paramount that countries are ready for these new vaccines, and are able to quickly and efficiently integrate them in their national immunisation programmes.

Closing the gaps in vaccine recommendations for all adults is essential. One cohort that is often underrepresented in adult immunisation programmes are pregnant women. Adult vaccination schedules include pregnant women in 37 European countries, with the majority of them recommending influenza and pertussis vaccines, but only a handful of countries are recommending vaccines for e.g. pneumococcal/meningococcal diseases or hepatitis A⁹. This discrepancy between European countries needs to be addressed, to ensure optimal protection for pregnant women and their babies.

Promoting adult vaccination to citizens is usually done by governments’ campaigns, with the support of healthcare professionals, including pharmacists , but there are other approaches that could be explored. For example, the Business Partners to CONVINCE initiative is creating a network of employers worldwide to tackle vaccine hesitancy in the workplace and improve vaccination uptake among employees.

Immunisation throughout adulthood is a key component of the life-course vaccination approach, to help protect people’s health.

[1] https://ec.europa.eu/eurostat/databrowser/view/PROJ_23NDBI__custom_5647092/bookmark/table?lang=en&bookmarkId=661767aa-bcd5-40f9-ba86-8419ff1bcae1
[2] https://www.bmj.com/content/381/bmj.p978
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435558/
[4] Pascale E et al (2020). Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases, Infectious Diseases and Therapy. 9: 467–480.
[5] Modin D et al (2020). Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study, Cardiovascular and Metabolic Risk. 43(9): 2226-2233. https://care.diabetesjournals.org/content/43/9/2226.long (Accessed September 2021).
[6] Supporting Active Ageing Through Immunisation (SAATI) Partnership (2018). Adult vaccination: a key component of healthy ageing. https://ilcuk.org.uk/wp-content/uploads/2018/11/Adult-vaccination_a-key-component-of-health-ageing.pdf (Accessed September 2021)
[7] Seasonal influenza vaccination and antiviral use in EU/EEA Member States (2018) ECDC https://www.ecdc.europa.eu/sites/default/files/documents/seasonal-influenza-antiviral-use-2018.pdf
[8] Fedson DS et al. (2011). Pneumococcal polysaccharide vaccination for adults: new perspectives for Europe. Expert Rev. Vaccines 10: 1143-1167.
[9] Maltezou HC et al. (2021) Vaccination programs for pregnant women in Europe, 2021. Vaccine 39: 6137-6143. https://pubmed.ncbi.nlm.nih.gov/34462162/