Issue 24 / 27 June 2016

IN the current climate of heated debate around childhood vaccination and “no jab no play” laws, it is easy to lose sight of society’s other disease-vulnerable group: the elderly.

In fact, with vaccination rates significantly higher in infants than in their grandparents – despite free vaccines being provided for both groups – it becomes painfully clear just how neglected this aspect of their health is.


The role of health providers is critical.

Provider attitudes are one of the most powerful determinants of immunisation. If a doctor doesn’t recommend it, it often doesn’t happen. The most common response given by elderly patients when asked why they haven’t been vaccinated is “because my doctor never told me”.

Why this is happening is complex. The lack of an adult immunisation register has certainly played an important part, and the roll out this year of the whole-of-life immunisation register is anticipated to remove some barriers, simply by making it easier for GPs to track whether their patients are vaccinated or not.

However, much of the poor uptake is simply down to negative health provider attitudes. Vaccines in patients over 65 just don’t work that well, so why bother, they may think.

While it is true that cell mediated immunity wanes exponentially after the age of 50 years, the real question is, does it really matter? A vaccine waning to unacceptably low levels in 10 years is important if you have 80 years ahead of you, but less so if you’re looking down the barrel of 10. Besides, most vaccines have acceptable efficacy in the elderly, and novel research and strategies can improve vaccine immunogenicity in the elderly.

We also need to rethink our understanding of vaccine efficacy.

Vaccinologists think of vaccines as poor if efficacy is less than 80% and totally unworthy if under 60%. But compared to other accepted preventive public health strategies, elderly vaccinations fare well. Statins have an efficacy as secondary prevention of approximately 25% and yet are accepted worldwide. Vaccines in the elderly are as good as statins in terms of public health impact.

Efficacy is also not the whole story. With so many of the elderly affected by vaccine-preventable diseases, even a vaccine of modest efficacy results in lives saved. Vaccines also may have additional benefits such as prevention of heart attacks (flu vaccine).

And there are so many reasons to keep our seniors in good health.

Around a third of working mothers have a grandparent helping with childcare, exposing them to a much higher risk of disease transmission from young to old. Infections like whooping cough can be lethal to infants, many of whom are cared for by grandparents. And it’s hard to care for a sick child when you’re sick yourself.

We also expect older Australians to stay in the work force a lot longer and have high expectations of their ability to perform. Vaccinations can significantly reduce the number of sick days. Better for employers and employees alike.

And finally, we get down to money. Being sick costs the economy. Being hospitalised cripples it. In the past year, Australia racked up tens of millions on vaccine-preventable hospitalisations. Older Australians made up a large proportion of these. Looked at in this way, vaccines should be seen as an investment, rather than a cost.

But the most important reason to vaccinate the elderly is because our seniors have a right to health and to be able to do what they value. They have a right to avoid getting sick when there are safe, cost effective ways of doing so. 

We should reflect on why there is an immunisation gap in rates of vaccination for free childhood and elderly vaccines.

That’s why the International Federation of Ageing is making vaccination of people over 65 one of its global priorities for 2016 and beyond, seeing it as one of the most essential, accessible tools to support healthy ageing.

So let’s pick up the challenge here in Australia and start setting some goals around improving vaccination rates in the elderly.

Dr Jane Barratt, Secretary General, International Federation on Ageing and Professor Raina MacIntyre, Head of the School of Public Health and Community Medicine, University of New South Wales.

5 thoughts on “Vaccines: don’t forget the elderly

  1. Nancy Gomez says:

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  2. Wendy Webb says:

    I agree with dianmari, that in the particular case of patients receiving an ADT after injury this should now be replaced with the vaccine containing pertussis as well, to provide full protection.

    My elderly mother was given an ADT in hospital recently after a fall, and I wished she could have had the one with pertussis, as she’s now more likely to react badly if we arrange for her to have another vaccine that duplicates the ADT components.

    Hospitals may not be the place for routine vaccination, but they are part of the system, and while they take the initiative in an opportunistic sense, they should be using the most appropriate vaccine for the circumstances.

    Maybe if we get a workable e-record, it will be easier for everyone to provide the right vaccine at the right time.


  3. Oliver Frank says:

    With respect to dianmari, it is not appropriate for public hospitals to be seeking to provide routine immunisations for people who are well.  This is partly because the person may already  have had the immunisation by her or his usual GP or general practice, but also because there may be other elements or preventive care that are indicated and due for the patient.  Offering and providing all indicated preventive care is appropriately a major role and task for GPs, who can also do this more cheaply and efficiently than public hospitals.

    The appropriate thing for public hospitals to do for people who are well is to advise them to attend their usual GP or general practice, and if the hospital wants to be really helpful, it can even make the appointment for the person with the person’s usual GP or general practice.

    Frank OR.  Hospitals are not an appropriate setting in which  to provide catch-up immunisations (letter).  J Paediatr Child Health. 2012 Dec;48:1107.

  4. Diane Campbell says:

    One easy start would be to ensure that public hospitals offer  pertussis  with  ADT for ALL patients.  I understand there was a shortliived supply problem at one stage,  but I have locumed at places where that has engendered a permanent policy that only children due for  triple vacc and parents  are allowed to have pertussis…..   We might not all have the luxury of belonging to extended families  but a lot of older people are grandmothers, aunts, uncles who spend a lot of time with children.    And patients have a right to be informed  and to choose which they want.


  5. Oliver Frank says:

    There is another important reason for older people not receiving indicated vaccines.

    In consultations GPs are intensely occupied in responding to the patient’s agenda for the consultation and in addressing their own agenda (following up on previous problems, monitoring known chronic health conditions, and so on).  This makes it very difficult to reliably, consistently and thoroughly offer all indicated preventive care, including indicated immunisations.

    In our research program, we have enhanced the freely available Doctors’ Control Panel software ( to automatically print information sheets for patients when they arrive for consultations, that tell them about preventive care that is due to be performed for them.  In our studies to date, patients have responded very positively to these information sheets and reported that in their consultations they addressed most or all of the items listed. 

    Our studies to date suggest that giving patients targeted education, information and advice based on current data in their electronic medical record at a time when they can act on that advice immediately with a minimum of extra time, cost or effort has a potential to significantly improve care including preventive care.

    Frank OR, Stocks NP, Aylward P.  Patient acceptance and perceived utility of pre-consultation prevention summaries and reminders in general practice: pilot study.  BMC Family Practice 2011, 12:40, 26 May 2011.  doi:10.1186/1471-2296-12-40

    Frank OR, Aylward P, Stocks NP.  Development of pre-consultation prevention summary and reminder sheets for patients: preliminary study of acceptability and sustainability. Aust Fam Physician. May 2014, 43(5):310-314.

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