Add Adult Vaccines to National Immunization Programs
By Michael Hodin
As we turn to 2024, there is growing recognition of the immense, multi-faceted value of adult immunization — a healthcare “best buy,” enabler of economic productivity, and smart policy choice, all rolled into one. In fact, widespread uptake of adult vaccines can help to address many of the most pressing challenges that governments and aging societies face, from overburdened health systems and chronic disease to strained public budgets and slowing economic growth.
So why are systems for adult vaccination still largely fragmented, underfunded and not a joining the childhood vaccine value we enabled in the middle of the last century? While there is surely some degree of ageism — they’re old and will die anyway. It’s also about filling the research gaps, quantifying benefits, and marshaling all the evidence to win over policymakers and other stakeholders. With 2 billion of us over 60 very soon and more old than young, it is clear that this adult immunization program must “come of age”.
This makes a ground-breaking new report from the Office of Health Economics, The Socio-Economic Value of Adult Immunisation Programmes, such an important step forward. It reviews available research on adult vaccination in ten countries around the world and finds huge value across many dimensions, from directly preventing disease, to keeping people out of the hospital, to supporting productivity and reducing the burden on health systems, families, and communities. On the latter, it’s an especially “valuable buy” for employers who want to retain, attract, and keep healthy workers across the life course.
Speaking at the recent High-Level Forum on the Silver Economy, Lotte Steuten, Deputy Chief Executive, Office of Health Economics, summarized the main call-to-action from the report:
“We need more investment in prevention, and adult vaccination is one important building block. … We also need good, robust evidence about the full socioeconomic value of prevention and adult vaccination to go with that, in order to make better-informed decisions.”
This is exactly the kind of analysis required to win over policymakers — including not just health ministers, but finance, labor, and technology, too. Just consider pioneering, super-aging Japan: As Yosuke Kita, Counsellor, Permanent Mission of Japan to the United Nations, shared on the same panel, the Japanese government has prioritized immunization programs as part of the larger shift to preventive care. As one example, Japan embraced the pneumococcal pneumonia vaccine after a cost-effectiveness analysis found it significantly reduced hospital admissions.
Surely, a similar analysis for shingles, flu, or now RSV would likely yield similar outcomes.
And while reduced hospitalizations alone justify the investment, the OHE report suggests that the benefits go much further. Here’s how governments, the private sector, and other stakeholders can seize the enormous opportunity:
· Put vaccines on the agenda of finance ministers. It’s estimated that preventable conditions already cost G20 economies more than $1 trillion in lost productivity for those ages 50–64. Clearly, then, vaccines should be a primary focus for finance ministers, not to mention businesses, employers, and the economy as a whole. This is a key part of how we keep economies and workforces running strong even as populations age.
· Don’t forget the lessons of COVID-19. The unprecedented COVID-19 vaccination effort — reaching more than 70% of the world’s population — shows what’s possible, if we have the political willpower, smart strategy, and community engagement. Most importantly, decision-makers approached COVID-19 vaccination as an investment that had to be made in order to sustain societies and economies. We need a similar approach to all adult vaccination, especially since COVID-19 caused a slowdown in other kinds of vaccination, on the scale of 100 million missed doses.
· Prioritize a prevention-first mindset. Adult vaccination can be the cornerstone of a larger move towards a “predict-and-prevent” model of care, alongside programs like fracture liaison services to prevent costly and dangerous secondary fragility fractures. These efforts can reinforce each other as part of an overall focus on healthy aging: for example, the pneumococcal vaccine has been associated with a decrease in heart attacks, strokes, and cardiovascular disease mortality.
· Continue the research, momentum, and conversation. The initial OHE report makes an important contribution by surveying the existing evidence. Further research can continue to build the case by assessing specific vaccinations in different countries and communities, as well as exploring the full value across a wider set of benefits.
· Clarity and Power of Global and National Guidance. We know from the programs on Childhood Immunization that became a fundamental part of global and national public health strategies. It was one of the principal drivers to our 21st century longevity. Parallel pronouncements from the WHO and influential OECD Governments will be the basis for 21st century healthy longevity.
Looking ahead, the OHE expects to release a second report early next year with more detailed benefits analysis. This second report will add more evidence to what is becoming increasingly apparent and widely recognized. Adult immunization is an essential tool for public health — but it’s also far more: a boon to economies, a bulwark for aging communities, and a smart investment in the “prevention-first” model of care required for sustainable, healthy longevity. It can also be an advantage for all employers as they compete to attract and retain employees.
