13May25 Supporting our systems slides.pdf

Slides from the Supporting our systems expert roundtable.

1. Supporting our systems
Expert roundtable discussion
Tuesday, 13 May 2025 | 2.00pm –3.15pm BST

2. Project overview and
findings so far
Patrick Swain, Research and Development Manager, ILC

3. Acknowledgements
This project has been sponsored by CSL Seqirus.
ILC has retained editorial control of all written outputs.

4. What is immunosenescence?
•Immunosenescence is the decline of immune functions due
to ageing, making older adults more susceptible to disease.
•Immunosenescence occurs naturally as people age, but
certain risk factors can accelerate the ageing process.
•Lifestyle choices and NCDs can weaken people’s immune
function, exacerbating the impact of immunosenescence.
•Healthy lifestyles and preventive health interventions such
as vaccination can support people as they age.

5. Why does vaccination matter in the
context of immunosenescence?
•While vaccination can help prevent severe disease and
protect older populations, immunosenescenceitself poses
a risk to the effectiveness of immunisation–it reduces
older adults’ immune system response to vaccination.
•Vaccine effectiveness in older age groups is generally
lower than in younger age groups, hence the need for
enhanced vaccine technology as well as healthier lifestyles
that can support immune responses to vaccination.

6. Prioritising prevention: Addressing poor
health to mitigate immunosenescence
To mitigate the impact of
immunosenescence, there should be a
greater focus on preventing ill health by:
1.Fostering healthy ageing by addressing
modifiable risk factors and encouraging
healthier lifestyle choices.
2.Promoting preventive health
interventions that support people’s
immunity, such as routine immunisation
with enhanced vaccine technology
where appropriate and available.

7. Healthier ageing means healthier
responses to vaccination
Keeping people healthier for longer not
only helps to slow immunosenescence,
but it also builds health resilience and
immune response.
Healthy ageing, therefore, works in
tandem with immunisation – vaccination
programmes are more effective when:
1.Populations are healthier and more
likely to elicit a stronger immune
response to vaccines.
2.Vaccine technology that enhances
protection against infectious disease is
made available to older adults.

8. What does healthy ageing
look like in Europe?
Data analysis

9. Healthy ageing in Europe
Looking at Healthy Ageing
and Prevention Index data
for EU/EEA + UK, there is an
uneven picture when it
comes to healthy ageing in
Europe. Disparities exist
between Eastern and
Western Europe, while
Scandinavian countries
perform the best.
Countries not shown:
Cyprus (21), Luxembourg
(10), Malta (14), Slovenia (26)
© GeoNames, Microsoft, Open Places, OpenStreetMap, TomTom
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1
3
5
7
9
11
12
14
16
22
23
25
27
28
29
30
34
35
36
38
40
42
45
48
54
71
Global Healthy Ageing and Prevention Index position (out of 153), ILC

10. Healthy life expectancy in older
European adults
Healthy life expectancy allows
us to see the number of years
someone can expect to live in
good health. In the context of
immunosenescence, this is
important because it highlights
how well people are ageing.
Healthy life expectancy at the
age of 60 varies considerably
across the EU/EEA + UK: there
is a clear East-West divide,
with a gap of over six years
between Iceland and Bulgaria.
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Healthy life expectancy at 60 (years), WHO, 2021
12.7515.9219.08
HLE (years)
Someone aged
60 in Iceland
can expect to
live in good
health until 79
…but in Bulgaria,
it’s around 73.

11. COVID-19’s impact on healthy ageing
Healthy life expectancy
across Europe has changed
significantly since COVID-19.
The differences between
Eastern and Western
Europe are most stark when
considering the shift in
healthy life expectancy at
60. While Western Europe
has seen a slight drop since
COVID-19, the average 60-
year-old in Eastern Europe
now lives 429 days less in
good health than in 2017.
-1.4
-1.2
-1.0
-0.8
-0.6
-0.4
-0.2
0.0
0.2
0.4
2017 2018 2019 2020 2021
Year-on-year change in healthy life expectancy at 60 (years) versus 2017
Europe Eastern Europe Western Europe

12. COVID-19’s impact on healthy ageing
In many ways, this fall in healthy life
expectancy in Eastern Europe can be
attributed to COVID-19 morbidity and
mortality rates.
The graph on the left highlights that
after nearly a year into the EU’s COVID-
19 vaccination programme, Eastern
Member States had much lower
coverage rates. At the same time, the
death rate in these countries was much
greater than in Western European
countries.
Previous ILC research has highlighted
issues with vaccine hesitancy and
delivery in a number of Eastern
European countries.

13. What else affects healthy ageing?
While immunosenescence is a
natural process, and aside from
COVID-19, lifestyle choices and
health-related risk factors can
have a negative impact on
healthy ageing.
Poor diet, a lack of exercise,
smoking and social isolation are
just a few examples that can
lead to comorbidities and non-
communicable diseases, which
reduce our ability to age well for
longer.

14. Health issues affecting Europeans
Chronic physical
conditions affect millions
of Europeans, putting
them at greater risk from
vaccine-preventable
diseases and infections.
Mental health conditions
also impact people’s
ability to age well for
longer: around 150 million
Europeans live with a
mental health condition.
CVD
prevalence
7 in 100
people
COPD
1 in 50 people
Mental health
conditions
150 million
Overweight
and obesity
60% of
European
adults
Sources:
Mental health
CVD prevalence
Prevalence rate chronic respiratory diseases
WHO European Regional Obesity Report 2022

15. Risk factors for severe influenza outcomes
include advancing age and comorbidities
Pregnancy
1–4,6,7
Renal disease
1–4,6,7
All children
aged 6–59 months
1–6†
Marginalised groups
1–3
Respiratory
conditions
1–4,6,7
Learning disabilities
7
Older adults
6‡
aged
≥65 years
1,3,4
or ≥50 years
in some countries
2,7
Cardiovascular
disease
1–4,6,7
Neurological
conditions
1–4,6,7
Immunocompromising
conditions (including
cancer)
1–4,6,7
Diabetes and other
metabolic disorders
1–4,6,7
Liver disease
2,4,6,7 Haematological
disorders
1–4,6,7 Obesity
2–4,6,7
Residents of long-term
care
2,3,7
Long-term aspirin
therapy in children
1–4
Advancing age or
comorbidity related
Other risk factors
†
In the UK this is specified as all children aged 2 to 11 years and those aged 6 months to 2 years in a clinical risk
group,
5
and in Europe, this is specified as young children and those aged >6 months with chronic conditions
6
;
‡
In
Europe, many countries adopt a threshold of 65 years, but some use a younger threshold
6
See the final slide for all references.

16. Cardiovascular disease in Europe
Cardiovascular disease (CVD) is
the leading cause of death in
the EU, with 343.4 deaths per
100,000 inhabitants in 2021.
East-West disparities are
evident: standardised death
rates in Bulgaria are 7.1 times
higher than in France.
CVD is considered a risk factor
for severe influenza outcomes
by the WHO and ECDC.
Lifestyle factors like physical
inactivity, smoking and
excessive alcohol consumption
are linked to CVD.
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CVD incidence, male and female: number of new cases of CVD per
100,000 population, age-standardised, ESC, 2020
435 7281021
CVD incidence

17. Obesity in Europe
Obesity rates in adults vary
across Europe. While there is a
higher prevalence in Eastern
Europe, some Western
European countries face high
levels of obesity that impact
healthy ageing.
A lack of exercise and poor diet
are the main drivers of obesity.
In Romania, for example, the
percentage of adults who are
physically inactive matches
that of the obesity rate (35%).
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Prevalence of obesity (BMI ≥ 30kg/m²) in adults, NCD-RisC, 2022
10% 23% 35%
Obesity prevalence

18. 0
2
4
6
8
10
Prevalence of chronic respiratory diseases per 100 people, WHO and Our World In Data
Asthma (2021)COPD (2019)
Chronic respiratory diseases in Europe
The prevalence of chronic respiratory diseases in Europe varies. While figures suggest a
better picture in Eastern Europe, modifiable risk factors such as smoking are much higher
in this region: adult smoking rates in Bulgaria (39%) and Latvia (37%) are much higher than
in Germany (22%) and the UK (15%).

19. Iceland (1
st
, 7.56)
Slovenia (26
th
, 6.75)
Spain (27
th
, 6.46)
Bulgaria (71
st
, 5.59)
0
2
4
6
8
10
0 25 50 75
Happiness score
Index position
Healthy Ageing & Prevention Index position vs happiness score, ILC, 2022
Happiness and wellbeing in Europe
In addition to physical
wellbeing, it is important to
explore the impact of
mental wellbeing on
healthy ageing.
There is a clear correlation
between countries that
perform better on the ILC’s
Prevention Index and their
happiness levels.
The happier the country, the
better the healthy ageing
outcomes.

20. What does adult
immunisation look like in
Europe?
Data analysis

21. Flu vaccination in older European adults
There are large disparities in
flu vaccination coverage in
over-65s across Europe. In
2022, only four countries met
the WHO target of 75%:
England (82.3%), Denmark
(78%), Portugal (75.8%) and
Ireland (75.4%).
With an over-65 population of
~108 million, ~52 million older
adults were unvaccinated
against the flu across these 30
countries in 2022.
*Austria = 2019; Iceland = 2021
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Flu vaccination coverage in over-65s, Eurostat and UKHSA, 2022*
5.644.082.3
Coverage (%)

22. Healthy life expectancy vs flu vaccination
The average healthy life
expectancy at 60 is 16.92
years, and the average flu
vaccination coverage rate
is 45.88%. Most countries
with a higher-than-
average HLE have a
higher-than-average
vaccination rate. While
HLE is not explicitly linked
to vaccination, with other
external factors impacting
people’s health, it is
notable that most Eastern
European countries fall
below both figures.
0
10
20
30
40
50
60
70
80
90
100
Flu vaccination coverage in over-65s vs healthy life expectancy at 60, 2021*
Flu vaccination coverage, 2021 (%)* Healthy life expectancy at 60, 2021 (years)
Flu vaccination coverage (average) Healthy life expectancy at 60 (average)
*Austria = 2019; UK flu
coverage = England
Data from Eurostat, WHO
and UKHSA

23. Healthy life expectancy vs flu vaccination
While correlation does not
equal causation, these
maps show an overlap
between flu vaccination
coverage and healthy life
expectancy: older adults in
Eastern Europe live longer
in poor health. They are
less likely to take up a flu
vaccine. More broadly
speaking, healthcare
systems and health
outcomes across Europe
remain unequal, raising
questions about structural
barriers and accessibility
to vaccination.
*Austria = 2019; Iceland = 2021
Flu vaccination coverage in
over-65s (2022)*
Healthy life expectancy at
the age of 60 (2021)

24. Healthcare access and delivery matters
While 83% of Europeans live within a
15-minute drive from a hospital,
pockets of Europe, particularly in rural
communities, face difficulties
accessing healthcare services.
Furthermore, the average number of
physicians per 1,000 people in the EU is
4.1. Most Eastern European countries
fall below this figure; Hungary has the
second-lowest amount in the EU with
just 3.1 per 1,000.
Addressing these barriers could help to
improve healthy ageing outcomes and
the ability to deliver vaccination.

25. Conclusions
•To address immunosenescence effectively, we need to
address health inequalities in Europe.
•Improving access to healthcare and delivering prevention
can ensure healthy ageing and better, longer lives.
•Vaccination will also play a crucial role in keeping people
healthier for longer by preventing severe disease and
hospitalisations.
•But to improve efficacy, we must ensure people are living
healthier lifestyles and that new technologies are created
to respond to the health needs of an ageing population.

26. References
1.Australian Technical Advisory Group on Immunisation. Statement on the administration of seasonal influenza
vaccines in 2022. March 2022. Available at:
https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-
vaccines-in-2022.pdf. Accessed December 2023; Grohskopf LA, et al. MMWR Recomm Rep. 2022;71(1):1–28;
2.National Advisory Committee on Immunization. Canadian Immunization Guide Chapter on Influenza and Statement
on Seasonal Influenza Vaccine for 2022–2023. Available at: https://www.canada.ca/en/public-
health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-
influenza-vaccine-2022-2023.html#a3.1. Accessed December 2023;
3.World Health Organization. Guidelines for the clinical management of severe illness from influenza virus infections.
Available at: https://www.who.int/publications/i/item/9789240040816. Accessed December 2023;
4.National Health Service. Children’s flu vaccine. Available at: https://www.nhs.uk/conditions/vaccinations/child-
flu-vaccine/. Accessed December 2023;
5.European Centre for Disease Prevention and Control. Risk groups for severe influenza. Available at:
https://www.ecdc.europa.eu/en/seasonal-influenza/prevention-and-control/vaccines/risk-groups. Accessed
December 2023;
6.National Health Service. Flu vaccine (adults). Available at: https://www.nhs.uk/conditions/vaccinations/flu-
influenza-vaccine/. Accessed December 2023.

27. Expert roundtable
discussion
All attendees

28. Closing remarks
Patrick Swain, Research and Development Manager, ILC

29. Thank you