Indonesia has the fifth-largest elderly population in the world, with 18 million elderly people, 9.6 percent of the country’s total population. Combine these demographics with the World Health Organization data that shows immunization against seasonal influenza reduces severe illness and complications by up to 60 percent and deaths by 80 percent among the elderly and you will start to see influenza as an all-too-common preventable cause of illness, hospitalization and death among the elderly.
With these striking facts in mind, deciding how to ensure the elderly live healthy and active lives is not only the right thing to do, it also makes sense in terms of managing a country’s health care resources.
Sadly, in many countries across Asia, these facts are either not known or overlooked. Therefore very few elderly people get vaccinated each year against seasonal influenza, resulting in unnecessary illness and economic costs. Today, Indonesia’s elderly influenza immunization rates are particularly low with less than 1 percent of 18 million Indonesians 60 years or older receiving immunizations.
Similarly low levels of immunization are recorded in Pakistan and India, while Malaysia (at around 5 percent) and Thailand (at 15 percent) have marginally better immunization rates. Indeed, in the Asia-Pacific region, only Australia, Japan, New Zealand and South Korea have successful influenza programs covering most of their seniors.
A major challenge for seasonal influenza immunization programs is the unpredictability of influenza; some years there is a high level of influenza and other years it is lower. Yet on average each year, about 5 to 10 percent of adults and up to 30 percent of children worldwide will suffer from seasonal influenza infections, resulting in medical visits, hospitalization and death, not to mention the millions of lost work and school days. Also, studies have shown that our seniors have the highest risk of serious illness and death.
So how do you make the case for immunization of the elderly to politicians and health policy decision-makers? One potentially powerful argument is that raising awareness and having robust annual influenza vaccination programs are important in establishing pandemic vaccination capabilities, while also helping to protect against annual epidemics.
This is what more than 200 leading experts, including Indonesian representatives, discussed in Bangkok at the first Asia Pacific Influenza Summit earlier this month. There was a clear consensus that Asia Pacific vaccination levels are too low and that immediate action is needed if we are to reach WHO recommendations aiming for 75 percent vaccination of vulnerable groups by 2014. With this in mind, we agreed that the first step was to get down to business and make things happen. We need to work together on national policies for influenza vaccination and to make sure doctors, nurses and other health care workers recommend immunization to their patients and, equally importantly, get vaccinated themselves.
To assist this process, governments need to commit to providing free or subsidized vaccines to the priority groups. The last building block is for governments, experts and other stakeholders to work together to find more effective ways of communicating the impact of influenza and the benefits of vaccination to wider groups to encourage people to ask about vaccination.
The Bangkok Summit was a good first step in stimulating development of policies to improve influenza vaccine uptake in high-risk groups. Now we need to move from discussion to action so as to ensure that Asia’s elderly people are protected against influenza and can live long, healthy and fulfilling lives.
As experts, we need to have the courage to express our views and explain them effectively. But we also need a clear commitment from officials. With the United Nations predicting that the percentage of Indonesians over the age of 60 may reach 25 percent of the population in 2050 — or nearly 74 million elderly people — this is a challenge that is not going to go away.
Lance Jennings is chairman of the Asia-Pacific Alliance for the Control of Influenza.