Opinion The falling vaccination rate that we don't hear about

Between 2008 and 2011, there were more than 700 deaths in older Australians due to vaccine-preventable diseases, writes Raina Macintyre.

vaccination elderly

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OPINION: When people think of vaccinations, many would picture an infant on the lap of a parent at their GP or perhaps an adult attending a travel clinic to get a jab before going on an overseas holiday.

And we are all familiar with the harrowing stories of babies with whooping cough. Yet we don't often hear about the hospitalisations and deaths of older Australians from vaccine preventable diseases such as herpes, influenza, shingles and even whooping cough.

Between 2008 and 2011, there were more than 700 deaths in older Australians due to vaccine-preventable diseases. A disease such as shingles, flu or pneumonia can be the trigger that pushes someone who lives independently into permanent disability. Vaccination is low hanging fruit for preventing disease in older people.

Australia's population is ageing, and by 2056 a quarter of our population will be over 65 years of age. Older age of retirement has already been flagged by the government, and we will rely increasingly on older people in the workforce for our economic sustainability.  So keeping older people healthy has benefits beyond individual health and wellbeing.

In Australia we are aiming for 95 per cent coverage rates for free childhood vaccination and valid public health concerns are often reported in the media when these rates fall below 90 per cent.

What is less well known are the vaccination rates among older Australians for free vaccines are much lower – as low as 50 to 60 per cent. Why? There are a number of significant barriers to the vaccination of older adults that are not present for younger age groups.

A lack of awareness about adult vaccines by both health care professionals and the public is a major barrier. In general, doctors and providers are also less convinced about vaccines for adults than they are for children. Other barriers include access to care, mobility, older people having multiple GPs, a lack of clinical trial data in the frail elderly, ageism and a culture focused on childhood immunisation.

You may have heard the saying "pneumonia is the old man's friend". This is a common mantra among health providers, and reflects ageism and value judgment. How are infections anyone's friend, when they results in suffering, may be contagious and be passed on to others, and are so easily preventable?

Outbreaks of preventable infections are common in nursing homes and hospitals, and often we find that people who were eligible for vaccination have missed out. When asked, the reason most often given by older people as to why they are not vaccinated is "my doctor never told me".  Older people have an equal right to available prevention and treatment as do children, and we need a shift in perspective to achieve this.

We need increased awareness in the community and among healthcare workers of the high burden of vaccine preventable diseases and their consequences. There is also low awareness of additional benefits of vaccines, such as prevention of cancer (HPV vaccine and hepatitis B vaccine), and prevention of heart attacks. There is strong evidence that flu can trigger a heart attack and that flu vaccine can prevent this.

There is a need for vaccine trials in the frail elderly and more research on new vaccine technologies to overcome the progressively weakening immunity that occurs with age. New vaccines and combinations show promise in overcoming this problem, with a new shingles vaccine showing better effectiveness than many infant vaccines.

While the recent establishment of an Australian whole-of-life immunisation register and funding for vaccines are positive steps, more needs to be done to remove these barriers to reduce death and disability in older Australians from vaccine-preventable diseases.

As the population continues to age, vaccination for promotion of healthy ageing is an available and low-cost intervention that compares very favourably to other accepted prevention strategies in public health. We could be doing much better and preventing infections in older people.

Raina MacIntyre is Professor of Infectious Diseases Epidemiology, head of the School of Public Health and Community Medicine, UNSW.

This opinion piece was first published in The Sydney Morning Herald.