Cost, societal impact and relevance of reduced vaccine responses in the elderly

Vaccinations have undoubtedly been one of the most significant medical improvements in human history, saving countless lives and preventing the spread of many deadly diseases. While vaccines have played a crucial role in protecting people of all ages, the impact and relevance of vaccines are especially critical for the elderly population. Aging leads to a decline in the functioning of the immune system, making the elderly more vulnerable to infections and less responsive to vaccines. In this article, we will explore the societal impact and relevance, as well as the cost and burden, of reduced vaccine responses in the elderly. [1]

(Illustration image ANP)

The Growing Elderly Population

The global population is aging at an unprecedented rate. According to the World Health Organization, by 2050, over 2 billion people will be aged 60 or older, accounting for more than 20% of the world's population. This demographic shift brings challenges, particularly in healthcare. [2]

One of the key factors contributing to the growing elderly population is increased life expectancy. Medical breakthroughs, improved nutrition, and better living conditions have led to people living longer, healthier lives. [3]

One of the biggest concerns is the increased vulnerability of the elderly to infectious diseases. Due to their weakened immune systems and multiple age-related comorbidities, such as heart disease, diabetes, and respiratory issues, older individuals face higher risks of severe illness and death when infected with pathogens like influenza, pneumonia, and most recently, the COVID-19 virus [4]. As an example, adults over the age of 65 are eight times more likely to be hospitalized if they contract pneumonia from a pneumococcal infection, compared to people aged 50 and younger. [5]

Cost and burden 

The economic cost of reduced vaccine responses in the elderly is substantial and a multifaceted issue. It has consequences for both individuals and the society as a whole. Due to the aging of the population, healthcare costs will increase significantly in the coming years.

These expenses will rise even more when older adults suffer from diseases which could have been prevented by vaccinations. These expenses for example include the costs of hospitalization, medication, and long-term care. [6] In 2018, an estimated 92.8 billion euros was spent on healthcare in the Netherlands and these costs are predicted to amount to 129.4 billion euro annually by 2030 in
the Netherlands alone. [7]

(Healthcare costs in billion euros per year in the Netherlands, SBO 2018 [7])

(Average healthcare costs of basic insurance by age per year in the Netherlands, SBO 2018 [7])

Additionally, lost productivity due to illness or death among older workers causes even more economic losses. Reduced vaccine responses can also affect the family members and caregivers of elderly individuals. They may need to provide additional care and support, which can be emotionally and financially taxing. [8]

To address the cost of reduced vaccine responses in the elderly, several strategies can be considered. For example tailoring vaccine formulations or schedules to better suit the needs of older adults can improve their immune responses. Research into adjuvanted vaccines, higher-dose formulations, and new vaccine technologies is ongoing. There could also be more education, for example public health campaigns can raise awareness about the importance of vaccination. Especially with certain religious beliefs the vaccination rate is low. Therefore more focus could be placed on these groups. Encouraging regular vaccinations and addressing vaccination doubts can help protect the elderly.  [9] 

So, the cost of reduced vaccine responses in the elderly is not limited to healthcare expenses but extends to the overall well-being of individuals and society. Addressing this issue through research, education, and healthcare access can help diminish the adverse consequences and improve the health and quality of life for older adults.

Societal Impact and Relevance

The reduced vaccine responses are not only a problem for individuals, but for society as whole. More elderly individuals contracting preventable diseases causes increased hospitalizations, medical interventions, and longer recovery times. These additional demands cause an added burden on healthcare systems, affecting not only the elderly but also potentially delaying care for others in need. [10]

Besides economic costs there are also public health concerns as the elderly are more likely to serve as an intermediary agent for infectious diseases, potentially spreading these diseases to vulnerable populations, like those with a compromised immune system or other elderly individuals. This increased disease burden can strain healthcare resources, potentially leading to overwhelmed hospitals and clinics during disease outbreaks. An example of this is from the COVID pandemic. Entire nursing homes became infected with the virus because one or a few caregivers were infected. This was primarily because old people were significantly more vulnerable to the virus. The infection spread swiftly among the old residents, leading to entire nursing home populations becoming infected in a short period. [11]

Besides these fears of contracting diseases may lead to self-imposed isolation, reducing social interactions and negatively affecting mental and emotional well-being. This can contribute to social isolation among the elderly. [9]

Importance of Vaccination in the Elderly

Vaccines have proven to protect individuals and communities from infectious diseases. They work by stimulating the immune system to recognize and remember specific pathogens, making it more effective at fighting off infections. Vaccines have played a crucial role in reducing the burden of diseases like polio, measles, and hepatitis, leading to a significant increase in life expectancy over the last century. [12]

Especially for the elderly, vaccines are a crucial tool in maintaining their health and preventing severe illnesses. Contracting preventable diseases can significantly reduce the quality of life for the elderly. This is because of the increased risk of severe illness, but also because severe illness leads to mental and physical decline, and people can really become frailer after serious infections. [9]

However, as people age, their immune response becomes weaker, and the effectiveness of vaccines can decrease. This is known as immunosenescence, and it is a key factor in understanding the reduced vaccine responses in the elderly. Immunosenescence, the age-related decline in immune function, affects the ability of older individuals to generate strong immune responses to vaccines. This decline is influenced by factors such as changes in T-cell and B-cell function, decreased production of antibodies, and alterations in the inflammatory response. [13] Further on in this weblog there is more information about this in the articles “Alterations in immune system that predispose to infection in old” and “Effect of inflammaging and senescence on vaccine responses”. 

Conclusion

The reduced response in the elderly causes a significant societal challenge with far-reaching consequences. As the world population continues to age, addressing this issue becomes increasingly important. 

Vaccines are crucial for maintaining the health and quality of life of the elderly, despite weakened immune responses due to aging. This issue involves healthcare challenges, economic costs, and public health risks. To address these challenges, we need to focus on developing better vaccines for older adults, raising awareness about the importance of vaccinations and investing in research. By taking these actions, we can improve the health of older individuals and strengthen society as a whole.

Literature

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2. Aging and health [Internet]. Who.int. [cited 2023 Sep 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
3. Lunenfeld B, Stratton P. The clinical consequences of an ageing world and preventive strategies. Best Pract Res Clin Obstet Gynaecol. 2013 Oct;27.
4. Benksim A, Ait Addi R, Cherkaoui M. Vulnerability and Fragility Expose Older Adults to the Potential Dangers of COVID-19 Pandemic. Iran J Public Health. 2020 Oct;49
5. Ook vaccins nodig als je ouder bent [Internet]. Pfizer. [cited 2023 Sep 30]. Available from: https://www.pfizer.nl/je-goed-voelen/ook-vaccins-nodig-als-je-ouder-bent
6. Institute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. Retooling for an Aging America: Building the Health Care Workforce. Washington (DC): National Academies Press (US); 2008. 2, Health Status and Health Care Service Utilization. Available from: https://www.ncbi.nlm.nih.gov/books/NBK215400/
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8. Largeron N, Lévy P, Wasem J, Bresse X. Role of vaccination in the sustainability of healthcare systems. J Mark Access Health Policy. 2015 Aug 12;3.
9. Soegiarto G, Purnomosari D. Challenges in the vaccination of the elderly and strategies for improvement. Pathophysiology [Internet]. 2023 [cited 2023 Sep 24];30(2):155–73. Available from: https://www.mdpi.com/1873-149X/30/2/14
10. Rodrigues CMC, Plotkin SA. Impact of Vaccines; Health, Economic and Social Perspectives. Front Microbiol. 2020 Jul 14;11:1526. 
11. Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses. Eur Geriatr Med. 2021 Dec;12(6):1127-1136
12. Vaccines and immunization [Internet]. Who.int. [cited 2023 Sep 21]. Available from: https://www.who.int/health-topics/vaccines-and-immunization
13. Tran Van Hoi, E. et al. Biomarkers of the aging immune system and their association with frailty - A systematic review. Exp Gerontol 176, 112163, doi:10.1016/j.exger.2023.112163 (2023).