Adult Vaccines, the Children and the Rest of Us
By Michael Hodin
As the global vaccine community convenes for its World Vaccine Congress next week in D.C., there is one topic barely noticeable on the agenda, but which should be prominent, namely adult vaccines. While there is and should be huge interest in childhood vaccination, as well as innovation areas such as TB that continue to plague low- and middle-income countries, the exploding mega-trend of aging means adult vaccination deserves an equally important place on the agenda.
It’s not just the huge global population of older adults — 2 billion over 60 by midcentury — but also the fact that every society around the world has or will soon have more old than young as it modernizes. In other words, the number of older adults who need vaccines for a range of conditions — from flu and pneumococcal pneumonia to shingles, RSV, and Covid-19 — is at least as much as what we, 100% appropriately, do for vaccinating our babies. But if our childhood immunization begun in the 1950s was a pillar of 20th-century longevity, reducing childhood mortality, surely our current age demographic construction should be prompting a parallel effort for healthy longevity now in our 21st century.
Yet, the leaders of the World Vaccine Conference seem not to notice, much. And if it is not high on their agenda, how can we expect others to put adult vaccines high on their respective agendas?
The principles for why we care about vaccine development — new innovations — and broader and deeper access globally for those already in play for children and LMICs is at least as powerful for the older adult community:
First is the sheer number — that 2 billion over 60 — who are at risk at a time in their lives when promoting prevention and healthy aging supports ethical as well as practical economic interests. Preventing flu, shingles, RSV, or pneumococcal pneumonia is cost-effective and perfectly aligned with healthier aging. For example, researchers estimate that vaccine-preventable diseases cost the United States approximately $9 billion per year in productivity losses and healthcare costs. At the same time, numerous studies have found adult vaccination to be extremely cost-effective, increasing lifespans for low investments. And this approach also helps to support sustainable health systems, at a time when they are already strained for capacity.
Second, market incentives and public policy for adult vaccines will drive ongoing innovation for multiple other disease states that might find scientific linkages to vaccination strategies. Attention to adult vaccines for today’s well-known communicable diseases can generate further incentives for innovative development of vaccines for non-communicable diseases, such as cancer or even Alzheimer’s. There are hundreds of vaccines now in active development around the world, with many targeting diseases for which we have never had vaccines before.
However, this activity is only sustainable in a healthy research ecosystem. We need to approach prevention as an investment rather than a cost, with volume usage of these new vaccines to yield yet more innovation in a positive feedback loop. And so more serious attention to adult vaccines at a conference such as the one commencing Monday will surely have positive implications that we may not even be able to imagine yet.
Third, it is no surprise that the adult vaccine theme is central to the Decade of Healthy Ageing platform, including the pillar to Combat Ageism and increasingly also the pillar of Integrated Care for Older Persons. Vaccines for older adults is also prominent in the World Health Organization Immunization Agenda 2030. The United Nations and World Health Organization have recognized a key truth, that adult immunization is crucial to the achievement of a world in which all people have equal access to good health as they age. All of public health should reframe its strategies from this guidance.
While next week’s official conference agenda may be set, it’s not too late for the vaccine community to give adult vaccination the attention it deserves. Those who will convene in D.C. can have thousands of conversations that acknowledge the centrality of adult vaccines to their collective community. Moreover, they might realize that as Nigerian, Thai, and Brazilian societies join the Japanese, Italians, Germans, and Americans in this aging mega-trend, they all have the same health challenges, including the impact on their growing number of at-risk older adults. And, moreover, that usage of, access to, and innovation in adult vaccines is also good for the children.
In fact, it’s good for everyone. Fewer older adults in hospitals means more resources that can be put toward children’s health needs, alongside ongoing health innovations, stronger economies, and more productive workforces and organizations. Let’s put that on the agenda.
