G20 high-level side event in India

G20 high-level side event in India:
Unlocking the benefits of healthy
ageing and prevention

Welcome
David Sinclair, Chief Executive, ILC-UK
Join the conversation: @ilcuk
#PreventionIndex

About ILC
• We are the UK’s specialist
think tank on the impact of
longevity on society, and
what happens next.
• We are one of the founding
members of the ILC Global
Alliance, an international
network on longevity with
members across 16
countries.

The Healthy Ageing and Prevention
Index: the health and economic
benefits of longevity across the G20
Arunima Himawan
Senior Health Research Lead, ILC-UK
#PreventionIndex

The six
metrics
comprising
the Healthy
Ageing and
Prevention
Index.
1. Life span: The number of
years an individual can expect
to live.
2. Health span: The number of
years an individual can expect
to spend in good health.
3. Work span: The expected
number of years spent being
economically active between
ages 15-65.
4. Income: The measure
of GDP per capita, using
purchasing power parity
(ppp) ($ 000s).
5. Environmental performance:
This is measured using the Yale
Environmental Performance Index
(EPI) which positions countries on
a scale of 0 to 100 (100=best).
6. Happiness: Taken from the
annual Gallup World Poll,
happiness positions countries on
a scale of 0-10. Scores of 0-4 are
interpreted as “suffering”, 5-7 as
“struggling”, and 8-10 as
“thriving”.
The Index uses pre-COVID baseline data from
2019, which is the latest, most complete
dataset currently available. However, as new
data becomes available, the Index will track
progress over time.
@ilcuk
#PreventionIndex preventionindex.org

@ilcuk
Only top 1%
of world
population is
best adapted
to longer,
healthier
lives.
With an average population
of only 8.4 million, the top 10
countries account for only
1.1% of the world’s
population.

@ilcuk
There is a 24-year
gap in life span
(life expectancy)
between the top 10
and bottom 10
countries.
There is a 21-year
gap in health span
(healthy life
expectancy) between
the top and bottom
10 countries.
There is a 23-year
gap in work span
(working life
expectancy)
between the top
and bottom
countries.
Our analysis
finds that
there are
significant
inequalities
between
countries at
the top and
bottom of
the Index.

@ilcuk
The top 50
countries on
the Index
...
102. India

@ilcuk
Political and
economic
bloc
rankings
The Index ranks political
and economic country
blocs, such as the G20,
EU and OECD to
demand action on
sustainable longevity at
the global level.

@ilcuk
G20
countries
with a higher
Index
ranking have
a higher old
age
dependency
ratio.

There are
significant
economic
costs to
countries
when they fail
to invest in
prevention
@ilcuk
If we increase preventative health
spend by just 0.1 percentage points it
could unlock an additional 9% of
spending every year by people aged 60
or over.

@ilcuk
Countries that
spend a higher
proportion of
their health
budgets
on prevention
perform better
on the Index.

@ilcuk
G20 spending
on healthcare
versus
spending on
prevention
(ppp$)

@ilcuk
Countries that
invest in
Universal
Health
Coverage
(UHC) perform
better on the
Index.

@ilcuk
Average years
of schooling
across the
G20 v Index
ranking

The Healthy Ageing and Prevention
programme
• Use our convening power and position the Healthy Ageing and
Prevention Coalition as a leading voice on prevention to ensure
longevity is at the heart of global health policy.
• Use the Index as a tool to engage global health leaders and move
from commitment to action on healthy ageing and preventative
health.
“As Governments, boasting about how much we spend on something isn’t actually
important if we aren’t getting the outcomes, and I think people want to see those
outcomes… I don’t want Canada to be 11th anymore, I want to be in the top 10. What are
those higher on the Index doing? We are happy to be on the Index, but we’ve got to do
more.”
Canadian Minister of Mental Health and Addictions and Associate Minister for Health

Healthy Ageing in India
Jayant Umranikar
Chair, ILC-India
#PreventionIndex

Healthy Ageing in India: A Broad Illustration
Jayant Umranikar
Chairman,
International Longevity Centre-India
Influencing Change at the G20 Health Ministers’ Meeting in India
16th August 2023
Gandhinagar, Gujarat, India
ILC-I_16th August_Roundtable 18

International Longevity Centre-India
• The International Longevity Centre-India is registered as a
not-for-profit company under Section 25 of the Indian Companies
Act, 1956 since 2008, and currently applicable is Section 8 of the
Company Act, 2013.
• International Longevity Centre-India as a member of the
Global Alliance of the International Longevity Centres and as an
NGO enjoys Special Consultative Status with United Nations’
Economic and Social Council (UN ECOSOC).
• ILC-I is also the “Satellite Centre for the SAARC Region” of
the United Nations’ International Institute on Ageing, Malta (UN
INIA).
Late Dr. S D Gokhale
Founder-President of
ILC-I

PadmaVibhushan Dr. R A Mashelkar
Hon’ble President
Jayant Umranikar
Chairman
Dr. S Siva Raju
Director
Mathew Cherian
Director
The Vision of ILC-I is
“Celebrating Age and Creating a Society for all
Ages.”
Mission:
The Mission of ILC-India is to function as a not-
for-profit organization in the areas of Policy,
Training, Research, Documentation, Advocacy and
Field programmes for the benefit of population
ageing.
BOARD of Directors of ILC-I

• India is facing many challenges due to rise in population ageing (60+) which stands at 10.1%
of the total population (2021).
Population Ageing in India…!
Source: UN Population Estimates (2017)

Population Ageing in India…!
The population of older adults in India, which was around 138
million in 2021, is projected to touch 194 million (41 percent
increase over a decade) in 2031.
The old-age dependency ratio provides a
clearer picture of persons aged 60-plus per
100 persons aged 15-59 years
It has risen from 10.9% in 1961 to 14.2% in
2011 and is further projected to increase to
15.7% and 20.1% in 2021 and 2031
respectively.
https://blog.forumias.com/elderly-population-in-india/

Health Status of older adults in India
(Findings from LASI)
• Longitudinal Ageing Study in India (LASI, 2017-18) is the first of its kind study as it has
data of more than 72,000 individuals aged 45 and older, along with their spouses
(irrespective of age), making it the largest health and retirement study in the world.
• LASI-DAD (Diagnostic Assessment of Dementia) aims at estimating the prevalence of
dementia and mild cognitive impairment and to contribute to a better understanding of
the determinants of late-life cognition, cognitive aging, and dementia.
• Also aims to study the impact of dementia and cognitive impairment on families and
society.

More the age, more the
prevalence of NCDs was
observed
Diabetes, Hypertension and Vision
impairment were found undiagnosed
and underdiagnosed among older
adults
Gender differences in Health, Economic and
Social wellbeing were prominent.
Among older Men diseases as heart disease,
stroke, diabetes mellitus, chronic lung
disease& neurological problems are higher.
Older women are more likely to have
hypertension, anemia, bronchitis,
depression, Alzheimer’s disease and
dementia, any bone or joint disease, and
cancer.
The prevalence of
dementia at the national
level was estimated as
7.4%;
one-fifth of the Indian
older population has
rated their health as
poor.
Majority of the population work
in informal sector, so ineligible
to receive a pension.
Highest incurred cost is for
Hospitalization
Place of residence, caste, religion,
education and income have a
considerable effect on the wellbeing of
older adults
https://www.nature.com/articles/s43587-021-00155-yILC-I_16th August_Roundtable 24
Health Status of Older Adults in India
Major Findings from LASI (First Wave)

What We Need?
• India has specific policies and schemes for
Indian older adults
There is a provision of:
• Concession in local and state transport and
airlines,
• Special Fixed Deposit Rates in Banks,
• National HelpLine for elderly,
• Income tax exemption,
• Separate ticket counters,
• Geriatric wards in hospital (a few)
• Seniorcare Ageing Growth Engine (SAGE) to
encourage innovative start-ups to develop
products, processes, and services for the
welfare of the elderly.
• Ministry of Social Defence and Welfare to
tackle issues related to ageing and encourage
research in this field.
• All aspects of National Policy on older
persons (1999) or its amendments are not
fulfilled
• Considering the diversity of older adults in
India, implementation of schemes is a
challenge
• Issues of migrated older adults or those
with physical and mental disability are not
specifically addressed in the working
documents
• Obtaining documentation proofs of senior
citizens is challenging
• Implementation of the Maintenance Act is
influenced by socio-cultural norms (Elder
abuse and vulnerability of seniors)
• Low literacy levels and jobs in the
unorganized sector increase the
vulnerability of rural elderly
• Soundness in technology usage is lacking
among current elderly population
ILC-I_16th August_Roundtable
25
What We Have?

Govt of India’s Policies and Schemes for Older Adults
National Policy on Older Persons
(1999)
-Emphasizes the role of individuals, families,
communities, civil society and private sector
National Health Policy (2017)
-Geriatric Healthcare, palliative care,
rehabilitative care services & advocates
continuity of care at all levels
Maintenance & Welfare of Parents
and Senior Citizens Act, 2007 (Under
Revision)
-The Act provides for a Tribunal to receive &
take action on complaints
Social Pension Scheme
-In 1995, National Social assistance
Programme was launched for poor and
destitute elderly
In 2007, Old Age Pension Scheme was
renamed as Indira Gandhi National Old
Age Pension Scheme & covered all
families below Poverty Line!

Programmes for the Elderly in India
Sub-schemes of AVYAY:
1. Integrated Programme for Senior Citizens
2. State Action Plan for Senior Citizens
3. Rashtriya Vayoshri Yojana
4. National Helpline (Awareness, Training and Capacity Building)
5. Equity participation in the start-ups for elderly care
Atal Vayo Abhyuday Yojana (AVYAY)
To create a society in which senior citizens live a healthy, happy,
empowered, dignified and self-reliant life with strong
intergenerational bonding.
National Programme for the Health Care of Elderly (NPHCE):
Aims to provide dedicated health care facilities through primary,
secondary and tertiary care systems

Programmes for Elderly In India
Antodaya Anna (Food) Yojana (2000):
Provision of food grains at highly subsidized
rates to terminally ill/widows and Persons
with disability
Annapurna Scheme (2010): For those 65+
who are not receiving national pension,
10Kg food grains/person/month
Varishta Pension Bima Yojana (2003,
revived in 2014):
Pension to older persons through the Life
Insurance Corporation (LIC)
Jeevan Pramaan (2014): Allows seniors to
digitally provide proof of his/her existence for
continuation of pension
Financial assistance to Veteran Artists who
are 60+: Provides monthly allowance of Rs 6000/-
Atal Pension Yojana (2015) to help
unorganized sector’s workers
Senior Citizens Savings Scheme (2019):
To provide a regular income to 60+, receive
tax benefits, higher interest rate
Rashtriya Vayoshri Yojana: Provides
Physical aids and assisted living devices to
BPL seniors
National Helpline (Elderline): A toll-free
number 14567
Promoting Silver Economy: It provides
equity participation in start-ups for elderly care

Field experience to evaluate the execution of State and
National Level Schemes for Older Persons in India!
• ILC-I team visited Three Primary Health
Centres, initially known as PHCs, but now
are referred to as Health and Wellness
Centres under Ayushman Bharat
• Medical Officers and Residential managers
were over-burdened, and supporting staff
positions were vacant
• Rural older adults sought health
intervention primarily for Diabetes and
Blood pressure and Arthritis
• Cataract operations are carried out at Rural
hospitals taken care by PHC staff through
medical camps/referrals
• Brochures and IEC material were in place.
Palliative care training was given to staff
nurses in one of the PHCs
• Identified Need:
1. Creating awareness regarding
mental health of older adults at
PHCs and Sub-center level
2. Young doctors should be
encouraged to work in rural parts of
India
3. Digitization should reach lonely
older adults in rural India

ILC-UK’s Healthy Ageing and Prevention Index
• INDIA ranks 102nd out of 121 countries on the Healthy Ageing and Prevention
Index-the lowest of all the G20 countries
• Healthy Ageing Matrices-
LIFE SPAN
(79th rank)
INCOME
(79th rank)
HAPPINESS
(112th rank)
ENVIRONMENTAL
PERFORMANCE
(108th rank)
HEALTH SPAN
(83rd rank)
WORK SPAN
(98th rank)
“This is indeed an eye-opener for the Indian government, civil society and
private sector to prioritize issues and concerns of population ageing for being
addressed comprehensively!”

ILC-I’s vision…..!
• Understanding this dire need for population ageing issues and concerns to be
addressed comprehensively and holistically, ILC-I, as a not-for-profit
organization working in this domain, has taken upon itself this
responsibility!!
• Its programmes and projects are designed to alleviate these issues and
concerns and ensure the well-being and empowerment of the older adults!
• ILC-I is working on Programmes targeting senior citizen beneficiaries in the
state of Maharashtra, which has a total population of 12 Crore (120 million) ,
which is equivalent to total population of Japan!

ILC-I’s Programmes Promote Healthy Ageing…
Physiotherapy Assessment Camps:
-To promote strengthening of physical abilities, relief from
joint pain and arthritis
-Early diagnosis, focus on customised exercise regime
-Covered 1500 seniors till date in Pune and Nashik cities of
Maharashtra
Mobile Literacy Training Programme for Senior
Citizens: Two half-days training programme focuses on
teaching basics of smartphone to seniors on day 1,
followed by “how to book a cab, order food online, save
documents in digital locker, make online payments and do
online shopping and so on.” We also orient them on digital
frauds and how not to fall for those!

Distribution of medical aids/utilities: ILC-I with the
support of Gharda Chemicals Ltd. has distributed medical
kits, digital Sugar levels and BP monitoring machines,
Carrom and Chess boards, Television set to seniors in
various parts of Maharashtra to enhance their physical and
mental wellbeing.
Online Happy Hours Café (During Covid-19
Pandemic):
Seniors all across India joined a webinar series on mental
and mindful abilities called Online Happy Hours Café,
once a week, where our resource persons taught basics of
Sanskrit and German languages, memory-enhancing
games, mindfulness techniques, Origami, and so on in an
infotainment way!

ILC-I_16th August_Roundtable
34
Research Studies by ILC-I:
ILC-I have conducted community-based pilot studies in Pune city on various issues
related to older adults since 2016.
In the year 2021-22 and 2022-23, ILC-I’s research team conducted two studies.
1. To study the availability of instrumental and emotional support and how
seniors in Pune city spent their lockdown. (Presented in a national conference
and Published in the HelpAge India, Special issues (2023))
(https://www.helpageindia.org/wp-content/uploads/2023/07/Vol-26-No-2-HI-RD-
Journal-May-2023.pdf)
2. Issues and concerns of trained geriatric caregivers-A study from various care
centres in Pune, Maharashtra under the guidance of Dr S Siva Raju, Hon.
Director, ILC-I(Report writing is in the process)
ILC-I contributed a chapter titled “Enhancing Physical and Mental Health of the
Older Adults in India Through Community Interventions” in the Handbook of
Ageing, Health and Public Policy of Springer Publication, Singapore.
(https://link.springer.com/referenceworkentry/10.1007/978-981-16-1914-4_49-1 )

• Being Satellite Centre for the SAARC region of
INIA, ILC-I has hosted five international
training programmes till date, where we have
trained researchers, scholars, seniors,
students, doctors, para medicals interested in
working in gerontology.
• The course is taught by an international faculty
along with nationally renowned experts. UN
certificate is given to the participants on
successful completion of the course.
• This is an academic step taken by ILC-I
towards building an age friendly society for all
ages!

Awards: ILC-I applauds those who bring quality of life to
the elderly by its annual ILC-I Awards.
1. A national award named the Anjani Mashelkar
Inspiration Award to felicitate the journey of an older
woman over the age of 60 - who has been through
hardships and overcome them successfully
2. The BG Deshmukh Awards for Excellence in
Promoting Qualitative Ageing- for Senior Citizens’
Organisations and for individuals over the age of 70
years.
3. The Late Dr. S. D. Gokhale Award for promoting
Qualitative Journalism on Ageing.

G20 India and “Ageing” as a priority…
• Several NGOs in India had appealed to the Govt of India to include the issue of
“Dementia” in the meeting agenda of the present G20 Meet in India.
• Former Union health minister J P Nadda had shared his commitment to tackle
dementia in the third G20 health ministers' meeting held in Japan in 2019.
• “The government should develop a national dementia plan”, the appeal said.
• This G20 Side event is indeed an opportunity to work as a gentle reminder for this
issue to be taken forward!
https://www.deccanherald.com/india/karnataka/bengaluru/include-dementia-in-g20-meeting-agenda-ngo-appeals-to-govt-1199630.html

A Way Forward-Some Suggestions
• So…India has a system in place. Documents exist, implementation partially
creates impact and execution needs multi-level support from the Govt, NGOs and
the community!
• Geriatric Care-centres, Day-care centres, Dementia care centres, and Well-
equipped Old Age Homes in Metro cities are growing! But Standard Operational
Guidelines to maintain the standard of care across all types of centres is a dire
need!
• Encouraging 45+ population to plan their post-retirement life is essential!
• Digital literacy among seniors across India is required to empower them!
• Healthy and Active Ageing “Mindset” must be imbibed among seniors of all ages!

References:
• World Population Ageing, United Nations, 2017.
(https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf)
• Elderly in India 2021, Ministry of Statistics & Programme Implementation, Govt. of India, 2021. Available on:
https://www.mospi.gov.in/documents/213904/301563/Elderly%20in%20India%2020211627985144626.pdf/a4
647f03-bca1-1ae2-6c0f-9fc459dad64c
• Kapur, R. (2018). Problems of the Aged People in India. On May, 15, 2018.
• World Health Organization. (2020). Decade of healthy ageing: baseline report.
• Bloom, D. E., Sekher, T. V., & Lee, J. (2021). Longitudinal Aging Study in India (LASI): new data resources
for addressing aging in India. Nature Aging, 1(12), 1070-1072.
• Kandapan, B., Pradhan, J., & Pradhan, I. (2023). Living arrangement of Indian elderly: a predominant
predictor of their level of life satisfaction. BMC geriatrics, 23(1), 1-14.
• Chauhan, S., Srivastava, S., Kumar, P., & Patel, R. (2022). Decomposing urban-rural differences in
multimorbidity among older adults in India: a study based on LASI data. BMC Public Health, 22(1), 502.
• https://main.mohfw.gov.in/major-programmes/Non-Communicable-Diseases/Non-Communicable-Diseases-1
• https://pib.gov.in/PressReleasePage.aspx?PRID=1806506

Opportunities to support
healthy ageing: UK and India
Stephen Hickling
Deputy High Commissioner to Gujarat and
Rajasthan, British Deputy High Commission
#PreventionIndex

Healthy living on a healthy
planet
Anna-Katharina Hornidge,
Director, German Institute of
Development and Sustainability (IDOS)
#PreventionIndex

The role of life-course immunisation
in supporting healthy ageing
Esther McNamara
Senior Health Policy Lead, ILC-UK
#PreventionIndex

Life course immunisation
The cost-effectiveness of immunisation as a public
health measure
Esther McNamara, Senior Health Policy Lead
Esthermcnamara@ilcuk.org.uk
ilcuk.org.uk
What happens next
International
Longevity Centre UK

Immunisation is safe and effective…
• Beyond access to clean water and sanitation,
immunisation is the most effective way to prevent
dozens of life-changing diseases.
• Vaccination programmes have been used for
decades across the globe to prevent dozens of
serious illnesses.
• Childhood vaccination in particular is understood to
be one of the greatest triumphs of the 20th century.
ilcuk.org.uk
What happens next
…but we’re not where we should be.

Adult vaccination in particular is lagging
75%
95
%
This disparity may exist for a variety of reasons. One of these could be that
we expect, and aim for, lower take-up rates amongst adults:
Childhood
Adult
World Health Organisation vaccination uptake targets

Routine adult vaccines are underused…
• Approximately 100 million fewer doses of some
adult vaccines (excluding Covid-19 vaccines)
were administered in 2021 and 2022 than
anticipated.
• Seasonal influenza is responsible each year for
up to 50 million symptomatic cases in the EU
and EEA, leading to up to 70,000 deaths.
ilcuk.org.uk
What happens next
…despite the benefits they can bring.

This is particularly true in the G20
Nation % COVID-19 vaccine uptake
First dose / full initial course
91.1 76.7
84.9 82.7
88.1 81.8
90.4 82.6
91.9 89.5
80.6 78.4
77.8 76.2
72.5 67.1
73.9 63.5
86.2 81.2
84.4 83.4
76.2 64.1
61.3 55
74.3 69.9
40.4 35.1
86.4 85.6
67.9 62.3
79.7 75.2
81.4 69.5
* 86.9 85.7
*Spain is this year’s President of the Council of the European Union.

Immunisation’s value extends far beyond
the health system
Reducing healthcare
costs in the short term by
reducing the incidence
and/or severity of vaccine-
preventable diseases.
Reducing healthcare costs down
the line by reducing the severity of
secondary conditions; e.g.,
incidence of cardiac events after
respiratory infection.
Supporting the wider
economy through
greater workforce retention;
fewer pressures on
healthcare systems and
funding; individuals may draw
on their pensions later; more
activity overall if fewer people
are unwell.
Keeping people
productive, active and
engaged means fewer
working days missed;
reduced sick pay payments;
continued spending,
volunteering and caring.
Individuals who remain well can work, care, volunteer and
spend as normal.

Reducing healthcare costs in the
short term
…which generated
an approximate total
cost of £731 million
($911 million)
to England’s health
system in 2019
The cost of each adult
hospitalisation due to
serious pneumococcal
disease was calculated
to be £3,904 ($4,868) in
England in 2019…
Spanish healthcare
systems spent €134.1
million in 2015 on
treating four vaccine-
preventable diseases
in people aged 45+
Campling et al, 2022
de Miguel et al, 2022

$47,479 per
confirmed
case
(n=72)
$2.3 million: public
health response
$1 million:
productivity losses
$76,000: direct
medical costs
Healthcare costs are only a drop in the ocean when we
look at the whole picture
Estimated overall cost of a measles outbreak in
2018 in Washington DC, USA:
$3.4 million Source: Pike et al, 2021

Keeping people productive, active
and engaged
In 2022, flu was estimated to cost the US economy
$11.2 billion.
$3.2 billion
in direct medical
costs
$8 billion
in absence from
paid employment
$? in unpaid care,
volunteering and
changes in spending
Flu cost OECD countries around 159 million working days in 2018
for workers aged 50-64 alone [ILC, 2019]

Supporting the wider economy
Every €1 invested in
vaccination
=
>€4.02 future revenue

Following the economic shock and disruption of
COVID-19, we need to change course
Source: World Bank, 2022
This graph illustrates how our economic growth deviates from pre-pandemic
estimations; Emerging Market and Developing Economies will struggle most
to recover.

And the consequences will reach far into the future
Not enough has been
done to address
inequalities in access to
healthcare, both within and
between countries
We need to act on
COVID’s crucial lessons
about the need to trust
vaccination, governments
and health systems
Global economic losses
reached $12.5 trillion
between 2020-21; these are
projected to rise to
$28 trillion by 2025

It’s difficult to measure cost effectiveness…
A 2016 systematic review of cost-benefit analyses within the EU
found 7 of 8 studies identified at least one cost-effective
scenario of seasonal flu vaccine programmes.
Each study used different data sets and measures of cost-
effectiveness.
We revisit the cost of seasonal flu vaccines regularly: other
vaccines are designed to have longer-term efficacy so perform
better in cost-effectiveness analyses.
Source: Shields et al 2016
…but doing so can support decision-making.

Vaccine-preventable diseases affect
every aspect of our economy
When individuals contract COVID-19:
• temporarily absent from
employment;
• money not spent on transport or
activities outside the home;
• sick pay may be less than they
would have earned had they worked
as normal.
COVID-19 pandemic:
• total shutdown of global
economy, costing $12.5
trillion in first two years;
• millions of deaths and
major disruption.
And everything in between.

Safeguarding our health and pandemic
preparedness: life course immunisation
across the G20 and in LMICs
Professor Surjit Singh
Director, WHO Collaborating Centre for Paediatric
Immunology Director
#PreventionIndex

Head, Department of Pediatrics,
and Chief, Allergy Immunology Unit,
Advanced Pediatrics Centre, PGIMER, Chandigarh, India
WHO Collaborating Centre for Pediatric Immunology (2022-2026)
President, Asia Pacific Society for Immunodeficiencies (2020-2024)
Asia Pacific League of Associations for Rheumatology (APLAR)
Centre for Excellence in Rheumatology (2020-23)
Life course vaccination
Dr. Surjit Singh
MD; DCH (Lon.); FRCP (Lon.); FRCPCH (Lon.); FAMS

Safeguarding health and pandemic preparedness:
life course immunization across the G20
and in LMICs

What is life course vaccination?
• Life-course immunization:
concept of vaccination to individuals throughout their lives -
at different stages, and in varying circumstances
• The goal is to provide immunity against a range of diseases that can
be prevented through vaccination (e.g. measles, polio, influenza)

Importance of life course vaccination
• Appearance of new diseases (e.g. Zika virus, COVID-19) and re-emergence of old
diseases (e.g. measles, pertussis) in adults
• Necessity of prevention, rather than treatment, in the face of an ageing population
• Creation of ‘community immunity’ across a lifespan
• Improvement of health outcomes and reduction of healthcare costs by preventing
illnesses and complications that can arise from vaccine-preventable diseases
Philip RK, Attwell K, Breuer T, Di Pasquale A,
Lopalco PL. Life-course immunization as a
gateway to health. Expert Rev Vaccines.
2018;17(10):851-864

Why do we need vaccination in older adults?
• By 2030, almost 1 billion individuals will be > 65 years
• For the first time in history, this age group will outnumber children < 5 years
World Health
Organization. (2002). Active ageing : a
policy framework. World Health
Organization. https://apps.who.int/iris/h
andle/10665/67215

Why do we need vaccination in older adults?
• Many infectious diseases (e.g. influenza,
pneumococcal disease, Herpes zoster) have
their greatest incidence and severity in older
adults
• Infectious diseases in older adults may also
worsen existing co-morbidities and
accelerate the loss of functionality and hasten
death
• Due to the success of childhood vaccination
programs, the burden of some infectious
diseases has greatly decreased in children,
shifting the bulk of the disease burden to
older individuals
Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis.
2002;2(11):659-66
Sir William Osler

Vaccination guidelines in elderly individuals
• The WHO recommends annual vaccination with the seasonal inactivated
influenza vaccine for all individuals aged ≥ 65 years
• All countries in the European Union recommend seasonal influenza
vaccination to older age groups, with the age ranging from ≥ 50 to ≥ 65 years
• In the United States, there are recommendations for influenza, tetanus-
diphtheria or tetanus- diphtheria-pertussis (Tdap), Herpes zoster, and
pneumococcal vaccines
• In Australia and the United Kingdom, vaccines for influenza, Herpes zoster,
and pneumococcal vaccines are provided free to older adults Philip RK, Attwell K, Breuer T, Di Pasquale A,
2018;17(10):851-864

Vaccination in pregnant women
• In 2012, the WHO recommended influenza vaccination for all pregnant women
• Currently, inactivated influenza, tetanus, and pertussis vaccines are
recommended during pregnancy in several countries
• New vaccines are also being developed for maternal immunization to prevent
neonatal infectious diseases such as respiratory syncytial virus and Group B
streptococcus
2018;17(10):851-864

BCG
Diphtheria
H. Influenzae
Hepatitis A
Hepatitis B
Influenza
Measles
Meningococcal
Mumps
Pertussis
Pneumococcal
Poliomyelitis
Rotavirus
Rubella
Tetanus
Typhoid fever
Varicella
Diphtheria
Hepatitis B
Influenza
Pertussis
Tetanus
Anthrax
HPV
Cholera
Dengue
Diphtheria
H. Influenzae
Hepatitis A
Hepatitis B
Hepatitis E
Influenza
Measles
Meningococcal
Mumps
Pertussis
Poliomyelitis
Rabies
Rubella
Tetanus
Tick-borne
encephalitis
Typhoid
Varicella
Yellow fever
Diphtheria
Hepatitis A
Hepatitis B
Herpes
zoster
Influenza
Pertussis
Tetanus
Modified from: Philip RK, Attwell K, Breuer T, Di Pasquale A, Lopalco PL. Life-course
immunization as a gateway to health. Expert Rev Vaccines. 2018;17(10):851-864c
Life course
vaccination

Barriers to life course vaccination
Ignorance
Complacency
Vaccine
hesitancy
Cultural
acceptance
Low
vaccine
coverage
Challenges in
vaccinating
special
populations

Impact of COVID-19 on vaccination programs
Disruption of
vaccination services
Decreased demand
for vaccines
Shortage of
vaccine supplies
Repurposing of
healthcare resources
Delayed introduction of new vaccines:
interruption of clinical trials, regulatory approvals and funding
Budhia DM, Jaiswal A, Prasad R, Yelne S, Wanjari MB. From Polio to
COVID-19: Examining the Impact of Pandemics on Childhood
Vaccination Programs. Cureus. 2023;15(5):e39460

Improving vaccination culture: the role of
pediatricians
• Concerns about vaccination reflect the perceptions about vaccination in
specific cultures
• Vaccination acceptance depends on local context
• An interdisciplinary approach may enhance the capacity of other health
professionals
• Pediatricians can become ambassadors of vaccination culture and
ensure that vaccination becomes part of a healthy lifestyle at all ages
2018;17(10):851-864

Paradigm shifts needed
• Improving vaccine convenience for adults:
provision of vaccination at work place
• Collaborations with pharmaceutical companies
• Addressing vaccine concerns and limit ‘vaccine hesitancy’
• Making the concept of life course vaccination a social norm for
a healthy lifestyle
2018;17(10):851-864

Lessons learnt from COVID-19 pandemic
Global collaboration
High income
countries
Low income
countries
Vaccine equity
Education and
communication
Pandemic
preparedness
Investment in research on new vaccines and delivery systems
Incorporate
technology
Budhia DM, Jaiswal A, Prasad R, Yelne S, Wanjari MB. From Polio to
COVID-19: Examining the Impact of Pandemics on Childhood
Vaccination Programs. Cureus. 2023;15(5):e39460

Pillars of healthy living
Healthy food
habits
Physical activity /
Exercise
Life course
immunization

India as a resource for life course vaccination
• India is uniquely placed for taking a leadership role in this field

India: the vaccine provider to the world
• India is the largest vaccine producer in the
world
• Contributes 60% of global vaccine supply
• Indian producers supply 1.5 billion doses
annually to more than 150 countries
• It is the largest supplier of DPT, BCG and
measles vaccines globally
• The WHO sources 70% of its essential
immunisation vaccines from India
Sharun K, Dhama K. COVID-19 Vaccine
Diplomacy and Equitable Access to Vaccines
Amid Ongoing Pandemic. Arch Med Res.
2021;52(7):761-763

Major indigenous
vaccine manufacturers

India’s response to COVID-19: Vaccine Maitri
• In 2021, India started a diplomatic mission named ‘Vaccine Maitri’:
an initiative to provide COVID-19 vaccines to low-income countries
• Later on, even developed nations were included

69.8
80.7
Figures in 105 40
5.8
10
50 1136
70
27
98
5
11
42
45
14.7
12.6
492
309
12.6
Distribution of COVID-19 vaccines through
‘Vaccine Maitri’
Ministry of External Affairs, Govt. of India [as updated on 18 June, 2023]

India’s roadmap to combat COVID-19
World’s largest vaccination drive
Vaccination
prioritization
Nationwide
deployment plan
Addressing
vaccine hesitancy
Digital health:
CO-WIN app
Vaccination
monitoring
Innovative strategies:
• Har Ghar Dastak
• Jan Bhagidari Andolan
Modified from: Singh K, Verma A, Lakshminarayan M. India's efforts to achieve 1.5 billion COVID-19
vaccinations: a narrative review. Osong Public Health Res Perspect. 2022;13(5):316-327
Total vaccinations till
14th August, 2023:
220,67,57,946

Q&A
#PreventionIndex

Closing remarks
David Sinclair, Chief Executive, ILC-UK
#PreventionIndex

Upcoming events
UN General
Assembly Side-
Event: ILC
roundtable
New York City
Tuesday 19
September
Future of Ageing 2023:
An age of possibilities
Wellcome Collection,
London, & virtual
Thursday 7 December
Healthy Ageing and
Prevention in Europe: how
do European countries
compare?
Webinar
Tuesday 24 October

G20 high-level side event in India

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