Why immunisation matters for healthy ageing

ILC is the UK’s leading authority on the impact of longevity on society, combining evidence, solutions and networks to make change happen. We hear from Senior Health Policy Lead Esther McNamara about the socioeconomic effects of immunisation

One of the greatest markers of our collective progress in recent generations is our increased longevity – more of us are able to live more years than ever before. According to the World Health Organization, the world’s population of over-60s will double between 2020 and 2050, to 2.1 billion people. At the societal level, the challenges and opportunities of longevity require sustained attention and action that short political cycles are unable to give. With more of us living for more years, we could each experience more years in good health, spent in paid work, caring for our loved ones, and doing the things that matter to us. Conversely, it could also mean more years in poor health, in receipt of social support and unpaid care, drawing on healthcare services, with illness acting as a barrier to work and social inclusion.

The role of preventative healthcare

The social policy and healthcare infrastructure to support healthy ageing are complex and require sustained investment and attention to maintain the interventions we need to keep us well. Specifically, the role and value of immunisation across the life course is of particular interest to ILC UK, the UK’s leading authority on longer lives and what they mean. More people living for more years and increased economic inactivity in the UK and other countries make preventative health paramount to economic outcomes and the sustainability of our public services.

Preventative services can be used to prevent a range of communicable and non-communicable diseases, as well as any secondary conditions and adverse economic impacts that might follow. During the COVID-19 pandemic, we all grasped the social and economic impacts of communicable disease – work, volunteering, social connections, paid and unpaid care, and community activities were disrupted or cancelled altogether. With each case of a vaccine-preventable disease today, similar disruptions can be seen at the individual and community levels. This has economic consequences, too – the COVID-19 pandemic was estimated to cost the global economy $12.5tr in the first two years alone.

The socioeconomics of immunisation

ILC research found that during a measles outbreak in Washington DC, US, in 2018, only 2% of total expenditure following the outbreak was attributed to healthcare costs. Two-thirds of the $3.4mn dollar cost of this outbreak was in the public health response, in containing and responding to the 72 confirmed cases. A $1mn of economic productivity (attendance at paid work) was lost due to the outbreak.

Too often, healthcare systems make simplistic cost-benefit analyses of immunisation programmes that fail to capture the full extent of what we lose when we fail to prevent disease. This is particularly true for adult immunisation, which currently does not have parity with childhood immunisation and will only become more necessary as our societies age. The Office of Health Economics has found that every $1 invested in adult immunisation programmes generates a $19 socioeconomic return. Yet, targets for adult immunisation uptake are often significantly lower than childhood uptake. ILC concluded a programme of work on the cost-effectiveness of life course immunisation with a report highlighting the opportunities available to countries that prioritised prevention and immunisation throughout our longer lives and making recommendations for action.

Disparities between age groups, between countries, and even between regions characterise investment in preventative interventions, which in turn dictates our access to resources such as immunisation. ILC UK’s report on vaccine confidence in Central and Eastern Europe highlighted the disparities in health spending overall across Europe. In 2020, the average expenditure per inhabitant across the EU was €2,110. The lowest levels of spending were in Bulgaria (€754) and Romania (€713), and spending was higher overall across Western European nations. This often means that limited resources are geared towards curative and emergency interventions; preventative programmes such as immunisation have historically not been prioritised for reasons which include but go beyond the funding available. The economic consequences of this are clear – in 2018 alone, there was a cumulated economic loss of €264bn across Central and Eastern Europe as a result of poor health. We cannot say how much of this economic loss was preventable, but transitioning to a prevention-first approach to healthcare (which goes way beyond the healthcare system and involves all sectors of society) will be crucial as we manage the challenges of an older population. The heightened clinical risks and decreased resilience amongst some older groups mean preventing infectious disease in older groups makes financial and economic sense.

Democratising access to preventative healthcare

Throughout ILC’s programmes of work on immunisation, we have made several practical yet bold recommendations for action to democratise access to preventative health across our longer lives. Some of these extend to data collection, investment, and inspiring and engaging stakeholders. Sufficient and sustainable investment in prevention underpins all interventions – ILC has been calling for 6% of health budgets to be ringfenced for preventative health, as is already the case in Canada. Collecting high-quality data on uptake, making it accessible, and sharing it swiftly so it can be used effectively is a crucial first step to improving uptake. Finally, inspiring and engaging stakeholders inside the health system and, more broadly, across society to ‘get on board’ requires communicating differently about immunisation. This requires improving health literacy around the importance of immunisation and understanding why stretched health budgets and busy healthcare practitioners should prioritise it. It requires tackling misinformation and disinformation across society and making education and reliable information about immunisation accessible to all communities, particularly those that have historically been excluded from conversations around health and immunisation.

We have much to gain from immunisation and preventative interventions more broadly. As we are living longer, but not necessarily healthier, lives, we have an obligation and an opportunity to prevent poor health where we can and unlock the demographic dividends that are available through increased longevity. Immunisation is a key piece of the puzzle that is often overlooked but increasingly appreciated for the value it brings to our experience of our health. We all know intuitively that prevention is better than cure – there is more that we can do to drive change and make prevention the default across our longer lives.