Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion

Abstract

As the global population ages, there is concern about the effect of an increased proportion of older individuals on the economic sustainability of healthcare systems and the social effects of an older society. Health authorities and advocacy groups in countries at the forefront of this trend are now developing strategies to ameliorate the social and financial effects of an ageing population. There is broad agreement that for both society and for the individuals, it is important to ensure that increasing lifespans are matched with increased "healthspans"the number of years spent in good health. There is also growing consensus that vaccination is one of the tools that can play an important role in improving adult healththough currently vaccination coverage is often poor. This review focuses on two issues that consistently appear to be associated with under-vaccination: the low awareness of risk (and potential consequences) for vaccine-preventable diseases and a poor understanding of the value of improved vaccination coverage for adults. We suggest that understanding of vaccination as a health-promoting activity, rather than a medical intervention designed to prevent the spread of a specific pathogenis a crucial step to improve vaccination uptake among adults (see Supplementary video abstract). KEY MESSAGES As populations age globally, we are seeing an increasing burden of vaccine-preventable disease in adults. Adult vaccination against some common diseases has been shown to dramatically improve health and quality of life for older people. Despite the attested benefits, vaccination coverage is almost always poor in adults, even in countries where access is free at point of care. In this article, we discuss what appears to a neglected issue in adult vaccination, that of personal autonomy. We argue that adult vaccination will only be successful if it respects individual autonomy and that this requires treating the choice to vaccinate as a public health issue akin to smoking cessation, exercise and healthy diet.

Precision Medicine and Vaccination of Older Adults: From Reactive to Proactive (A Mini-Review)

“…However, preventative actions of this nature require the active participation of the individual, since they involve changes in behavioural patterns that are then sustained over a period of years or decades. Thus, while preventive medicine may be simple in theory, in practice considerable resources for education to encourage healthy behaviour are often required [21]. Furthermore, despite the potential benefits, spending on preventive medicine is typically a very small part of most health budgets.…”

“…The first steps in this direction are already in evidence, with (for example) screening programs to attempt to catch cancers in their earliest (and most easily treated) stages, chemoprophylaxis to reduce the risk of myocardial infarction or hyperlipidemia, etc. [21]. These activities need to be carried out in the context of successful public health education campaigns, e.g., decreasing the incidence of lung cancer and cardiovascular disease by reducing smoking.…”

“…The concept of life-course vaccination [25] is based on the recognition that, due to an age-related decline in immunity, vaccination in later life is unlikely to be completely effective at reducing the health burden of VPDs, and that effective immunity in later life builds on the immunity developed earlier in life. There is already good data available to support that adult mortality and morbidity can be greatly improved by childhood vaccination programs both through "herd" immunity, or by preventing childhood infections such as varicella or hepatitis that can cause serious disease in later life [21,26]. Beyond this, however, vaccination programs have been associated with decreases in mortality beyond that attributable to the specific pathogen targeted, presumably because the loss in resilience caused by infection renders those infected more susceptible to illness or death from other causes [27].…”

“…This is based on the observed elevated risk for severe outcomes in this cohort as a whole. However, immunocompetence and biological age do not always correlate with chronological age [21]. Some individuals (e.g., those with an elevated risk of developing cardiovascular disease) may benefit from vaccination earlier in life [47].…”

“…While supporting data are not conclusive, there are reasons to believe that "personalizing" vaccine recommendations may help improve compliance with universal vaccination recommendations. The first reason is our experience with existing public health campaigns, where a desire to protect/ improve personal health appears to be a driver of compliance with recommendations [21], e.g., cervical cancer screening (where, typically, participation in screening programs far exceeds the vaccination rate in adults [64] despite the fact that it requires more effort on the part of the patient). The second reason is the existing evidence that health-seeking behaviour is, in many cases, associated with improved vaccination coverage.…”