13May25 Supporting our systems slides.pptx

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, immunosenescence itse lf 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: Fostering healthy ageing by addressing modifiable risk factors and encouraging healthier lifestyle choices. 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: Populations are healthier and more likely to elicit a stronger immune response to vaccines. 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)

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. 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.

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 L earning 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. L ifestyle factors like physical inactivity, smoking and excessive alcohol consumption are linked to CVD.

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%).

18. 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. 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

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. * 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 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; 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; 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 ; National Health Service. Children’s flu vaccine. Available at: https://www.nhs.uk/conditions/vaccinations/child-flu-vaccine/ . Accessed December 2023; 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; 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