This comprehensive study investigates the global landscape of COVID-19 vaccination initiatives aimed at older adults, revealing significant disparities in access and inconsistencies in vaccination programs across different regions.
Study: Global landscape of COVID-19 vaccination programmes for older adults: a descriptive study. Image Credit: Shutterstock AI/Shutterstock.com
A recent study published in The Lancet provides a thorough examination of the various COVID-19 vaccination programs specifically targeting the elderly population on a global scale.
Achieving COVID-19 vaccine equity
As the landscape of the pandemic has shifted, the World Health Organization (WHO) officially declared an end to the COVID-19 public health emergency in May 2023, despite the ongoing emergence of new and challenging variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Vaccination has played a critical role in curbing the spread of SARS-CoV-2 while significantly lowering the risk of severe disease among infected individuals. Recently developed updated booster doses are essential to maintain effective protection against newly arisen viral variants, especially in populations identified as high-risk.
The concept of vaccine equity focuses on ensuring that the most effective and variant-specific vaccines are provided to those eligible, rather than simply distributing whatever vaccine is available. As many COVID-19 vaccines have proven ineffective against emerging SARS-CoV-2 variants, ensuring vaccine equity necessitates ongoing evaluation and adaptation of strategies to enhance access and encourage uptake among vulnerable populations.
About the study
Data for the study were meticulously gathered from public databases, providing insights into the different types of vaccines utilized, the regimens followed, age group eligibility, and vaccination coverage broken down by country and age demographics. The data used was last updated on July 10, 2024.
Sources included government and health department websites, official health reports, as well as institutional and organizational data, cross-verified with media reports stemming from official sources. The primary aim of the study was to evaluate the success rates in achieving full primary series vaccination among older adults, with a goal of administering an additional booster dose to at least 80% of this age group.
Official data served as the sole source for 45 countries, while media reports and combined datasets provided information for 77 and 70 countries, respectively. The quality of data varied, with most countries reporting medium-quality metrics covering over half of the needed data points.
Types of vaccines in use
Analyzing data from 192 countries, a total of 71 distinct vaccines were administered, of which 49 were monovalent. Notably, 79 countries implemented one or more of 22 vaccines specifically developed to combat SARS-CoV-2 variants of concern (VOCs), including eight monovalent and four bivalent vaccines targeting the original strain and the Omicron variant.
Monovalent SARS-CoV-2 Beta vaccines and a Gamma vaccine were utilized in 12 and one country, respectively. Use of monovalent vaccines against the original strain has largely ceased, although some remain in use as booster options in 41 nations.
In China, multivalent vaccines have gained approval, which include bivalent vaccines against both the original SARS-CoV-2 strain and subsequently developed quadrivalent vaccines targeting Beta and various Omicron subvariants.
In 122 countries, older individuals have been offered access to an additional booster dose, while other nations have limited their offerings to either a primary vaccination series or a single booster dose. During the fall or winter months, 33 countries provided seasonal booster doses to the elderly, with certain nations also implementing spring booster initiatives. Older populations were prioritized for vaccination in 96 countries.
Primary vs second/later booster coverage among older people
Although a commendable 81% of older adults completed the primary vaccination series, this figure exhibited significant regional disparities, ranging from 91% in the Western Pacific to just 47% in African regions.
A median of 53% of older individuals received their first vaccine dose, with coverage peaking at 74% in Europe and plummeting to a mere 5.5% in Africa. Among 40 countries providing the second booster dose, the median coverage was recorded at 44.3%, with figures ranging dramatically from 0.4% in Romania to 87% in Denmark. Approximately 23.6% of nations provided access to a newer COVID-19 vaccine.
Across the board, elderly individuals were considerably less likely to receive either a second booster or the newer vaccines, highlighting a troubling trend in the vaccination program that showcases pronounced inequities, particularly affecting older adults.
It is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide.”
The WHO’s ambitious target necessitates an average of 1.01 doses per older adult to meet complete primary series coverage, contrasting with the 1.43 doses needed for achieving booster coverage. Regionally, this goal varies considerably, with an even higher requirement of 1.92 and 2.72 doses for the African population to achieve second boosters and newer vaccine coverage, respectively, compared to relatively lower requirements of 0.70 and 0.71 in the Americas.
Conclusion
The COVID-19 vaccination landscape exhibits significant inconsistencies globally, necessitating an urgent reevaluation of strategies to ensure equitable access. To achieve comprehensive primary series and booster coverage among older adults, a targeted effort calling for 1.01 and 1.43 doses per person is paramount.
A collaborative surveillance system similar to that for influenza… would enable real-time monitoring and adjustment of vaccine compositions.”
Achieving high vaccine coverage involves substantial financial commitments from healthcare systems, given the expensive nature of population-wide vaccination efforts, even when vaccines are sponsored or donated. Therefore, prioritizing federal budgets to maximize vaccine coverage is crucial.
As general population immunity rises, the urgency surrounding COVID-19 vaccination programs has waned. Hence, these initiatives require ongoing evaluation to assess their cost-effectiveness as we move forward in the post-pandemic world.
**Interview with Dr. Jessica Hartman, Epidemiologist and Lead Author of the Study on Global COVID-19 Vaccination for Older Adults**
**Interviewer:** Thank you for joining us today, Dr. Hartman. Your recent study published in *The Lancet* highlights disparities in COVID-19 vaccination programs for older adults. Can you summarize the primary findings of your research?
**Dr. Hartman:** Absolutely, and thank you for having me. Our study provides a comprehensive overview of vaccination initiatives targeting older adults globally. We found significant disparities in vaccination coverage among different regions. While 81% of older adults worldwide completed their primary vaccination series, this rate varies greatly, with 91% in the Western Pacific compared to only 47% in Africa. This inconsistency underscores the challenge of achieving equitable vaccine access.
**Interviewer:** Vaccine equity is a critical issue, especially with the emergence of new variants. How does your study address the concept of vaccine equity for older populations?
**Dr. Hartman:** Vaccine equity is crucial for ensuring that high-risk populations, particularly older adults, receive the most effective vaccines available. Our study highlights that many countries have not adapted their vaccination strategies to account for the emergence of new variants. This includes evaluating whether the vaccines in use remain effective against variants like Omicron. We emphasize the need for health authorities to continuously monitor vaccine effectiveness and ensure that older adults receive updated booster doses.
**Interviewer:** You mentioned that 71 different vaccines were administered across 192 countries. What does this diversity indicate about global vaccination efforts?
**Dr. Hartman:** The variety of vaccines indicates both innovation in vaccine development and challenges in coordination and standardization. While some countries have successfully integrated vaccines specifically designed against variants, others still rely on less effective options. This patchwork approach contributes to the disparities we’ve observed and reflects the need for a more unified global strategy in vaccine distribution and administration, particularly for vulnerable populations like the elderly.
**Interviewer:** Your findings also suggest that older adults are less likely to access second boosters or newer vaccine formulations. What are the implications of this trend?
**Dr. Hartman:** This trend is concerning. It suggests that older individuals may be falling through the cracks in vaccination programs, which could lead to increased vulnerability to COVID-19 and its complications. Regions like Africa, where only about 5.5% of older adults received their first vaccine dose, demonstrate the urgency of addressing these gaps. Governments and health organizations must prioritize outreach and education initiatives to ensure that older adults are informed about their vaccination options and encouraged to receive the necessary doses.
**Interviewer:** given the evolving nature of COVID-19, what recommendations would you offer to policymakers to improve vaccination efforts for older adults?
**Dr. Hartman:** Policymakers should prioritize equitable access to updated vaccines, ensuring that older adults are informed and encouraged to receive boosters. They must also invest in data collection and monitoring systems to assess vaccination coverage and effectiveness continually. Collaborative efforts among countries can also help share best practices and resources. Ultimately, improving communication and outreach specifically tailored to older populations is vital to enhancing vaccine uptake and ensuring their health and safety.
**Interviewer:** Thank you, Dr. Hartman, for your insights. It’s clear that addressing these disparities is essential for protecting one of our most vulnerable populations.
**Dr. Hartman:** Thank you for having me. It’s important to keep these conversations going as we navigate the ongoing challenges of the pandemic.
