Young children and older adults are both at higher risk for potentially devastating and debilitating diseases, many of which are vaccine-preventable. Countries prioritize and routinely immunize infants, yet the same cannot be said for older adults, variably defined as 50, 60, 65, or 70+ years of age, with or without risk factors. There is no simple explanation of why countries looking at very similar data come to very different conclusions. Even experts and the global health community are divided on the role of adult immunization. As a result, a large portion of countries have failed to address vaccine-preventable diseases like influenza, pneumococcal disease, and herpes zoster (shingles), which affect this fast-growing demographic.
Why haven’t countries prioritized vaccinating adults?
Some reasons countries don’t prioritize vaccinating older adults include budgetary pressures and competing priorities. Vaccines also may be suboptimal for the elderly population. Countries may be unaware of the disease burden. As adults live longer and lead more productive lives, understanding opportunities for the prevention of premature death, disability, or serious economic consequences becomes increasingly important.
Photo Courtesy of AMRO/PAHO
What is the state of adult immunization globally?
As a starting point, the International Vaccine Access Center (IVAC) was commissioned by the World Health Organization to conduct a preliminary literature review and qualitative interviews to characterize the state of adult immunization globally, including in low- and middle-income countries. The findings demonstrated a significant burden of disease and a need for a robust life course approach to be taken by both countries and the global community.
Although evidence gaps exist, there is a major opportunity to address vaccine-preventable disease—through immunization and other preventive measures—in the older population. However, there is a significant need for global technical consensus and more unified global guidance, as well as action at both the country and global level. The vaccine community can be alone in taking action: Diverse voices, representing the healthy aging community, must also be sitting at the table.
Photo courtesy of Gavi
Reviewing policy across 30 countries to build a policy roadmap
To build political priority, IVAC is first addressing basic criteria to develop a roadmap for policy decisions and increased uptake. This research, which includes both a desk review and in-country interviews, will contribute to:
Establishing a summary resource of key data describing the state of adult vaccine policies and uptake around the world
Highlighting key factors that influence and guide the introduction and use of adult vaccines
Developing a framework to assess country archetypes for adult immunization that could help inform data needs or approaches that support policy making, access, and uptake.
A global platform is needed and IVAC’s adult immunization project is poised to fill this need. There are many ongoing individual and regional efforts to fill gaps, but there is no coordinated, global platform that promotes awareness, facilitates technical consensus, provides leadership, and collaborates and coordinates with other key stakeholders. In addition to the creation of a database and framework, IVAC is convening a group of independent experts with specialties in infectious disease, immunization, economics, and healthy aging to create the International Council on Adult Immunization. This council will review the research, determine a technical consensus, and lead international collaboration around adult immunization.
Lois Privor-Dumm, IMBA, is the Director, Policy, Advocacy & Communications (PAC) at the International Vaccine Access Center (IVAC) at Johns Hopkins Bloomberg School of Public Health.She leads PAC team efforts on a variety of projects at country, regional, and global level, including advocacy and capacity building in low- and middle- income countries (with a strong focus on India), policy research and advocacy for adult vaccines, new vaccine introduction support for pneumococcal, rotavirus and HPV, advice and training on vaccine confidence, and communication of evidence to establish the broader value of vaccines through IVAC's new VoICE tool.
Nina Martin, PhD, is an expert in immunology and science communication at the International Vaccine Access Center (IVAC) at Johns Hopkins Bloomberg School of Public Health, where she also received a PhD in Molecular Microbiology and Immunology. At IVAC, Dr. Martin conducts research on how countries make decisions on adult vaccine recommendations, implementation and uptake and is leading a qualitative study on drivers of adult vaccination. She also supports activities and research for the International Council on Adult Immunization, a global group of diverse experts who will advocate for adult vaccine policies and help provide a roadmap for increasing action on prevention of adult infectious disease.
Prarthana Vasudevan, MS, MSPH, is a public health professional, with a scientific background in microbiology & immunology and global disease epidemiology. Prar serves as a research lead for IVAC’s new project on adult vaccine use and policy. Under that project, she is leading a research team of five to develop a database that summarizes the current landscape and the factors that influence adult vaccine introduction decision-making, access, and uptake.