Including Adults in the Vaccine Conversation

By Michael Hodin

At the Global Vaccination Summit in Brussels last week, the European Commission and the WHO convened global policymakers, national leaders, health leaders, private-sector representatives, and, of course, vaccine experts to take a key step towards fighting the growing misinformation and thereby regaining public trust in vaccines. It’s encouraging to see these leading organizations work towards the kind of concerted, sustained, and cross-sector effort that this issue demands. However, to truly drive progress, policymakers must expand the conversation to include adult vaccination — a key opportunity, yet one that was largely missing in Brussels.

Even as we redouble our efforts to ensure the centrality and huge value of childhood vaccines in our public health systems, we are now, in our 21st century, at a moment when we would all benefit from a parallel emphasis on adult vaccines. This emphasis aligns with the one billion of us over 60, doubling by mid-century, who — like the children last century when childhood immunization was launched — represent such a huge proportion of society as to demand public health attention. The time has come to recognize that vaccines for both adults and children — vaccines for all — is one of the most important health and economic goals of our time.

Indeed, as the global population continues to age, adult vaccination will become increasingly essential to health policy. This is one of the most effective and cost-efficient ways to support healthy, active aging and fight preventable diseases such as shingles, pneumococcal disease, influenza, HPV, and hepatitis B. And it is a way to keep adults healthier as they age through the core preventive strategy of vaccines, opening space for spending on children and others of need.

Even more, today’s support for adult vaccines will create an ecosystem in which innovation for tomorrow will then find incentive to emerge. This could even potentially include preventive vaccines for diseases like Alzheimer’s and cancer.

Adult vaccination should be front-and-center at convenings like the one last week. Forward-looking policymakers get it, such as Belgian Minister of Social Affairs and Public Health, Maggie De Block, who highlighted the need for vaccination measures targeting adults. Yet, overall, the Summit could have done far more to recognize the key role adult vaccination should play in topics like global vaccine responses and vaccine research and development. The convening should be applauded for addressing the tragic spread of vaccine misinformation and broadening the conversation to include private-sector leaders like Facebook and Mozilla, but these efforts will be most impactful only if they also include adult vaccination.

Indeed, if you’re talking about vaccines without talking about adult vaccines, you’re missing not just half of the equation, but the half that is growing more important each day, as populations age.

For example, Professor Laetitia Rispel, President of the World Federation of Public Health Associations, highlighted that caregivers and parents should be given the opportunity to come back to their doctor with additional questions about vaccinations. However, caregivers of older adults were never clearly called out during the Summit, even though it is absolutely crucial that they are included in this conversation. Dr. Katherine O’Brien, Director of Immunization, Vaccines and Biologicals at the World Health Organization, rightly pointed out that parents are influenced at a hyper-local level when it comes to vaccination decisions for their children, and therefore we have to adopt a people-centered approach. The same is true for older adults and their caregivers: an essential piece of all our communities, who shouldn’t be left behind.

Moving forward, our world needs to expand the policy conversation about vaccines to include adult vaccination, which is key to our health and wealth for a number of reasons:

· Adult vaccines are vital for aging populations. Populations are rapidly aging around the world, yet adult vaccination rates remain low in many countries. More than 40% of adults in the European Union are not covered for most recommended vaccinations, and in Japan and Canada, more than 40% have not received even the flu vaccine. Furthermore, while nearly all G20 nations collect and provide extensive data on childhood vaccinations, most have not begun compiling data for the most common adult vaccines.

· Adult vaccines enhance global health security. Vaccine preventable diseases are deadly. For example, more than 30,000 Americans die each year due to these diseases, and more than 95% of these are adults. However, like the Europeans, Japanese, Canadians, and millions of others around the globe, many American adults have not received recommended vaccines. We have the tools to save lives — we’re simply not using them. And, as we begin to use them, more will be invented as the system recognizes the rewards of new innovation.

· Adult vaccines are a best buy. Vaccine-preventable diseases also generate an enormous economic burden. Vaccination (essential prevention strategy) is considered a public health “best buy” — estimated to deliver a huge $44 ROI for every $1 invested by avoiding direct medical costs and the indirect costs of missed work, lost productivity, and caregiving. Governments, businesses, and other stakeholders could realize even greater savings and ROI by tapping into the full economic potential of adult vaccination.

· Adult vaccines help prevent anti-microbial resistance (AMR). The WHO has declared anti-microbial resistance (AMR) a “global health emergency.” Adult vaccines can — and must — play a key role in the fight against this grave public health threat. Higher rates of vaccination keep more people healthier, reducing their risk for infection and the number who have to take antibiotics — the driver of AMR. For example, when the US introduced the pneumococcal vaccine in 2004, there was a 49% reduction in antibiotic resistance.

· Adult vaccines improve wellness, quality of life, and community well-being. Adult vaccines lead to cascading benefits for individuals and communities by reducing the risks for morbidity and disability, as well as the effects and severity of other diseases. Those who have received adult vaccines are more likely to be healthy and, therefore, also active, productive, independent, and engaged. As a result, vaccines help to avoid caregiver burden, reduce the stigma of ageism, and contribute to higher quality of life for older adults and healthier communities overall.

We can’t afford to continue treating adult vaccines as a mere footnote in public health prevention strategies. The benefits of adult vaccines — and, sadly, the human and economic costs of vaccine-preventable diseases — are simply too large to ignore. And the urgency of this effort will only continue to grow, in step with the rapid aging of populations around the world.

We need leaders from across sectors and geographies to champion this issue, using the tools we already have to reach the next great public health achievement of our time. While the WHO-EU Summit might have missed this opportunity last week, as they prepare the report following the Summit, surely they could still make certain adult vaccines are a recognized strategy for 21st century public health.