Ageism in vaccination issue for older people

A leading Australian geriatrician is calling for the establishment of an immunisation program for older people and the subsidisation of a new shingles vaccination, as part of a whole-of-life approach to disease prevention.

Above: Associate Professor Michael Woodward

By Keryn Curtis

Head of aged and residential care services at Melbourne’s Austin Health, Associate Professor Michael Woodward, is urging policy makers and the government to ‘bite the bullet’ and create an national immunisation program for Australians, “from the day you are born to the day you die.”

In a paper published in the Journal of Pharmacy Practice and Research in December last year [Vol 42, No 4. 2012], Professor Woodward argues that prevention of common infections among older people via effective vaccines is an important approach to reducing the burden of infections in older age groups.

Speaking to Australian Ageing Agenda, he said that immunisation among people over the age of 50 is effective for several infectious diseases, notably what he refers to as the ‘big three’ – influenza, pneumococcal (which causes pneumonia, meningitis and middle ear infection) and shingles (herpes zoster).  

However, while society has achieved near universal vaccination rates in young people, a ‘whole-of-life’ approach to vaccination is yet to gain momentum and the lack of an adult vaccination registry in Australia and New Zealand is an example of the current emphasis on only childhood vaccination.

“The problem is that, while we have a really good program for childhood and also for younger years  – for example the cervical cancer vaccination for teenagers – once you hit your twenties, you are on your own,” said Professor Woodward.

He said there were good historical reasons for this emphasis because historically many infectious diseases would kill or harm large numbers of children. But with larger numbers of older people living longer in the coming decades, a properly structured and funded immunisation program that included this age group would have a significant impact on the burden of disease.

“Many other health professionals and bodies are singing the same song but there is a lack of emphasis and impetus from governments.  There is no rewarding of GPs for high rates of immunisation for older patients; and things like getting out public information messages, has been largely left to interested health professionals.

“I believe there is a bit of ageism involved,” said Professor Woodward. “Why spend a whole lot of money on 80 years olds, is the thinking.  And the political agenda emphasises cost saving rather than expenditure.”

Cost savings clear

However Professor Woodward said there was strong evidence supporting the cost effectiveness of older adult immunisation.

“Vaccines for influenza and pneumococcal infections are already subsidised because the PBAC [Pharmaceutical Benefits Advisory Committee] reviewed them thoroughly and found them to be cost effective.  Pertussis vaccine, for whooping cough, which is important for older people in contact with grandchildren, is also subsidised on the National Immunisation Program.”

However a specially developed vaccine for shingles in older people has yet to be listed on the program and is currently under review by the government.

Zostavax, manufactured by US pharmaceutical company, Merck & Co and distributed in Australia by CSL, was reviewed by the PBAC in 2008 and recommended for listing on the National Immunisation Program for people at age 60, with a ‘catch-up’ vaccination for people aged 61-79.

But problems with supply of the vaccine worldwide until recently, have delayed attempts at the listing.  Professor Woodward says the listing of the vaccine should now proceed.

“It needs to come out of the May budget.  The PBAC has looked at the direct costs – hospitalisation, pain medications, GP consultations etc – and concluded it was cost effective.  The only thing that has held it up is securing an adequate supply. 

“The other [big three and others such as pertussis, tetanus and travel vaccines] vaccines are already subsidised.  The real issue is getting shingles up.  

“The immunisation issue needs a government sanctioned and publically recognised ‘whole of life’ approach.  A lot of other diseases currently plaguing older people are likely be preventable with vaccines in the future, including for gastro and staphylococcus ,” Professor Woodward said.

Associate Professor Michael Woodward is head of aged and residential care services at Austin Health, and a geriatrician in private practice at Donvale Rehabilitation Hospital. He is director of the Austin’s wound management clinic, editor of Wound Practice and Research and a past president of the Australian Wound Management Association. He is director of the memory clinic at the Austin and sits on numerous boards for dementia organisations. He sit on several global and national immunisation boards and recently revised the position statement of the Australian and New Zealand Society for Geriatric Medicine for immunisation of older people.

Tags: austin-hospital, immunisation, michael-woodward, shingles, zostavax,

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