Vaccines aren’t just for children anymore. Adults, particularly older ones, are increasingly being encouraged to get vaccines, too.
In addition to the annual flu shot taken by about two-thirds of older Americans every fall and winter, older adults are now encouraged to get a vaccine against the pneumococcus bacteria and a two-dose regimen against shingles.
COVID boosters are considered particularly important for those in higher decades.
And with a sign-off expected this week, people 60 and older will be able to get a vaccine against respiratory syncytial virus or RSV, too.
“We have the opportunity as we never have before to prevent much more disease,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine, Nashville, Tennessee.
Although “vaccine fatigue” is common after COVID-19 shots and boosters, experts say many older adults are eager to get immunized – often so they can safely see or care for their grandchildren.
Diseases like flu and RSV are especially dangerous at each end of life – early childhood and older age, said William Hanage, an expert in the evolution of infectious diseases at the Harvard T. H. Chan School of Public Health.
The human immune system evolved to enable most young children to get mildly ill and then develop immunity when exposed to pathogens. The immune system weakens with advancing age, though, and older people often have a worse response to never-before-seen pathogens, like the SARS-CoV-2 virus that causes COVID-19, he said.
“There was never any evolutionary benefit to making old people who are good at fighting off viruses,” Hanage said “For most of our history, most of us didn’t live that long.”
Why older Americans want to get vaccinated
Americans over 65 are increasingly seeing the value in staying protected against diseases, as data shows they’re more likely to work and raise grandkids compared to previous generations.
This became more evident during the early days of the COVID-19 pandemic, when getting vaccinated was their ticket to escaping lockdown and seeing their loved ones, said Bob Blancato, executive director of the National Association of Nutrition and Aging Services.
“Older adults care about being vaccinated so they can maintain contact with their kids and grandkids,” he said. “There’s a greater focus on healthy aging, what constitutes healthy aging and what things are preventative.”
More than 7 million grandparents are living with grandchildren under 18, U.S. census data shows, with nearly half in the labor force and one-third saying they’re responsible for their grandkids.
While this older generation can’t afford to get sick, experts say they’re also more likely to have multiple medical conditions that put them at greater risk.
“Boomers who are turning 65 are more focused on a Medicare that prevent them from getting sick versus a Medicare that treats them when they get sick,” Blancato said.
Older adults are “receptive and eager to get vaccinations,” said Anita Patel, Walgreens vice president of pharmacy services development.
They come into the pharmacy more often than younger people, because they’re more likely to need prescription refills, she said, and they tend to have a strong relationship with their pharmacist.
Still, they are tired of getting shots and their hesitation often comes from confusion about what they need and when Patel said. Educating them about their risks and administering several shots at the same time can help, she said.
“These can be really life-saving conversations,” she said.
Changing minds and hearts
Health care providers and public health officials need to do more to “encourage, persuade, educate, support, make comfortable the population that should be vaccinated,” Schaffner said. “We’ve got a lot of work to do out there.”
In his own practice, he tells patients that he and his wife and all the workers in his office are vaccinated against flu and other pathogens and he wants his patients to have the same protection. “We personalize it,” he said.
If someone has other ailments, such as heart disease, he tells them it’s “doubly important” to get protected.
“Information is absolutely fundamental, but information alone rarely is sufficient to change behavior,” Schaffner said.
People have to be convinced by someone they trust, whether it’s a health care professional or a member of their own community, such as a religious leader, a barber or a fellow bridge club member. “Dr. Bill is not sufficient. I need a lot of help in doing this.”
More to come
As vaccine technology advances, adults can expect more vaccines to come their way.
Although companies certainly stand to make a profit as more older adults get shots, Schaffner said, other drugs are far more profitable than vaccines, which typically cost less than $150 a shot and often under $100.
The federal government started funding childhood vaccinations after a measles outbreak in the early 1990s and now half of all shots for children are paid for by the government.
The same is not true for adults, said Dr. Leonard Friedland, vice president and director of scientific affairs and public health for GSK Vaccines. Although insurers are required to cover approved vaccines, people without insurance have to pay out of pocket or go without.
“We still need a safety net for adults,” Friedland said. “We have the tools and everybody should benefit.”
Still, flu clinics and federally funded COVID-19 vaccine bridge programs can help provide vaccines for people without access, Patel said.
Already vaccines are available for adults who travel to countries with diseases that are largely unfamiliar in the United States, like dengue and hepatitis B.
GSK is developing a vaccine against gonorrhea, a sexually transmitted infection that causes an estimated 82 million cases globally per year.
Moderna and Pfizer-BioNTech are studying the possibility of combining their COVID-19 vaccines with flu and maybe RSV, so people would need one shot instead of three.
And mRNA vaccines, which proved effective during the pandemic, are now being developed to prevent cancer recurrences and other viruses. Those include cytomegalovirus, which can affect people across their lifespan, and Epstein-Barr virus, which causes mononucleosis and was recently implicated in multiple sclerosis — it may be behind chronic fatigue and some cases of long COVID as well.
Vaccines against more pathogens would be great, Hanage said. “But I would also love to see more people making use of the things that we have,” Hanage said. “That would be a great public health benefit and a reminder to us all of how much more we can do to help more people.
Here are the current vaccines available for older adults:
RSV
Respiratory syncytial virus, or RSV, infects nearly everyone by age 2 and typically causes cold symptoms.
It’s the leading cause of hospitalizations among newborns and younger children, but it also strikes later in life, causing more than 177,000 hospitalizations and 14,000 deaths among older adults each year.
The FDA approved the world’s first vaccine to combat RSV in May. Arexvy, the new vaccine developed by GSK, formerly known as GlaxoSmithKline, was approved for adults 60 and older. Later that month, the agency approved Pfizer’s vaccine for older adults, Abrysvo.
A federal advisory panel last week said all Americans 60 and older may receive an RSV shot in consultation with their doctor.
“Our immune system changes as we get older … we’re not able to be as efficient in fighting off infections,” said Dr. Tochi Iroku-Malize, president of the American Academy of Family Physicians. “The idea of getting an extra boost to help fight off infections is important.”
Shingles
Shingles, or herpes zoster, is a viral infection caused by the varicella zoster virus, the same virus that causes chickenpox, according to the Centers for Disease Control and Prevention. It causes a painful rash of blister-like sores, which can also be accompanied by a fever, headache, and chills.
People who have had chickenpox before are at risk of developing shingles. After a person recovers from the infection, the virus stays inactive in the body and can become reactive years later, causing shingles, Iroku-Malize said.
About 1 in 3 people in the U.S. will develop shingles in their lifetime, according to the CDC, with shingles rates increasing in the United States.
Data shows more than 99% of people who were born in the United States before 1980 have had chickenpox before, suggesting more people are entering ages that increase their risk of developing shingles.
The shingles vaccine – Shingrix – is recommended for all Americans over 50, regardless of whether they’ve had shingles before or received the chickenpox vaccine.
“As we have a growing geriatric population, this is an important process of ensuring health and preventive care,” Iroku-Malize said.
COVID-19
Older people will always be at highest risk from COVID-19, Hanage said.
It’s impossible to predict how well previous infections and vaccinations will protect people against whatever variant will circulate later this year when infection rates are expected to rise again, Hanage said.
“We just won’t know exactly what that looks like until we get to the fall or winter,” he said. “As a result of that, COVID boosters are still something which is likely to be very helpful for those older individuals.”
Hanage, who is far younger than 65, said he will get another booster in the fall, not because he’s worried about dying from COVID-19 or even having severe disease, but because he’s a professor and doesn’t want to miss his own classes. He hopes health care workers get boosted for the same reason ‒ so they’re not sick at the worst possible time.
Other coronaviruses, which circulate widely and cause the common cold in most people, can cause deadly outbreaks in nursing homes, suggesting that previous infections don’t provide long-term protection among older people.
“COVID is heading in that direction and we don’t know yet how serious it’s going to turn out to be in the older age group as a whole,” he said.
Pneumococcus
Streptococcus pneumoniae or pneumococcus bacteria can cause pneumonia, ear infections, meningitis and other infections. There are 100 known strains. The most recent vaccine, which older adults need only once, can protect against 20 of the most serious of them.
Unfortunately, each time the vaccine is introduced to protect against certain strains, other strains take over, Hanage said. Although cases have actually increased, overall there’s been a benefit, he said, because the newer strains are less dangerous.
The introduction of the first pneumococcus vaccine, which addressed seven strains, cut childhood infection rates in half between 2000 and 2001. Now there are only 9 cases of invasive pneumococcal disease out of every 100,000 American children, compared to 79 at the turn of the century.
This drop in childhood infections also protected their grandparents, Hanage said ‒ so much so that it’s unclear how important it is to vaccinate older adults. “It’s definitely worth vaccinating children, without any question,” he said. “The net additional benefit of vaccinating adults is pretty minimal.”
Flu
About two-thirds of people 65 and up get an annual flu vaccine, Schaffner said, which means one-third don’t, even though it’s usually free and potentially life-saving.
“They have to roll up their sleeve, they don’t have to reach for their wallet,” he said.
Sometimes people underestimate the seriousness of the flu, because the term is thrown around so much and because most people have caught and survived it earlier in their lives, said Nicole Creanza, who studies the evolution of behavior at Vanderbilt University.
Also, if someone’s annual physical is in the spring or summer, they might not think to get a flu shot months later when flu season rolls around, she said.
“The more positive people’s attitudes are towards vaccines, the more likely they are to be vaccinated,” she said. “But people don’t necessarily apply the same heuristic to every vaccine they’re offered.”
Contact Karen Weintraub at kweintraub@usatoday.com and Adrianna Rodriguez at adrodriguez@usatoday.com.
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