Vaccines and vacation - 10 May 2022.pptx

Vaccines and vacation
The role played by immunisation in getting
tourism moving again
Join the conversation: @ilcuk @C_L_C_I
#VaccinesAndVacation

Welcome
Patrick Swain, Coordinator,
CLCI-ILC Alliance

How vaccines can help
the tourism industry
Dr Daphné Holt, Chair, CLCI

How can vaccination help tourism?
• Consumers are ageing – almost a quarter of EU tourism is spent by older
adults
• It is estimated that $4 trillion has been lost in global tourism due to COVID-19
• Vaccination is the key to keeping healthy and preventing severe disease,
helping to keep the economy – and tourism – moving
• Keeping older people healthier is very important to help this sector, especially
as it begins to recover

Vaccinating the workforce
• Vaccinating older consumers is economically important, but it is also key to
remember the workforce
• People who work in tourism also need to be vaccinated to ensure there is a
healthy workforce that can deliver an economic service
• The recovery of the tourism sector is dependent on an active workforce that
is free from absenteeism and can meet the demand of post-COVID travel

COVID-19 has shown the power of
vaccination
• On the whole, Europeans of all ages
and stages of life have responded
well to the COVID-19 vaccination
programme
• Between May and July 2021, 40%
of adults received two doses
• Nearly 500,000 lives of people over
the age of 60 have been saved by
COVID-19 vaccines
ECDC (2021), from CLCI (2022) COVID & Beyond
Cumulative vaccine uptake (% of 2 doses) among adults (18+)
in EU/EEA countries, Jan-Dec 2021

However, immunisation for flu is low
• While older adults have taken up
COVID-19 vaccines, immunisation
against flu is below target
• Apart from England, European
countries are still under the WHO’s
75% uptake goal
• We await EU post-COVID flu
vaccination data
82.3%
73.5%
71.4%
65.5%
54.6% 54.6%
20.2%
England Greece Ireland Spain Italy Iceland Liechtenstein
WHO target
Flu vaccine uptake in over-65s in EU/EEA countries (2020) and England
(2022)
Eurostat (2020) & UKHSA (2022)

Pneumococcal vaccine coverage is
even lower
• Coverage of pneumococcal
vaccination in older Europeans
is much lower, around 20-30%
• Data from the 2000s highlights
the need for more up-to-date
records to highlight current
uptake levels and where better
coverage is needed
49
271
452
583
218
333
587
652
677
721
901
922
1220
1280
1488
1607
2123
Netherlands
Denmark
Portugal
France
Finland
Switzerland
Norway
Austria
Italy
Iceland
Sweden
Greece
Belgium
Spain
Ireland
Germany
UK
Countriesrecommending pneumococcal
vaccination forolderpeople and those
considered ‘at risk’of pneumococcal infection
Countriesrecommending pneumococcal
vaccination only forthoseconsidered ‘at risk’
ofpneumococcal infection
Cumulative PPV doses distributed per 10,000 in European
countries, 2001–2010
Fedson, D.S. et al, (2011), from CLCI & ILC (2022) Hitting new heights

Immunisation spending is suboptimal
• 77% of EU countries spend less
than 0.5% of their healthcare
budgets on immunisation
• Increasing spending is key to
ensuring the performance and
resilience of existing
programmes and access to
novel vaccines
Faivre, P. et al (2021), from CLCI (2022) COVID & Beyond
Proportion of healthcare budget dedicated to immunisation
budget or expenditure, EU & UK, 2015-2019

What needs to be done?
• Beyond COVID-19, vaccination programmes need to be properly funded and
expanded to ensure older adults get vaccinated
• Making it easier to access vaccination is also vital – providing vaccines in
locations such as pharmacies, community centres and places of worship will
help to widen access and increase uptake
• Vaccinating the tourism workforce in the workplace is also something which
should be considered
• Tourists and workers health goes hand in hand – healthy consumers and
staff will help create a proactive and productive tourism sector

Tourism and the
longevity dividend
Sophia Dimitriadis, Senior Economist, ILC

Older adults are spending more in the
UK…
• Older household (HH) expenditure is
rising fast: by 2040, over 50s will
spend 63p in every £1 (up from 54p in
2018)
• This is driven by rising spending by
HHs aged 65+ which grew by 75%
from 2001 to 2018
• Growing spending power: the share
of total disposable income that
belongs to older HHs is projected to
rise to almost 60% by 2040
ILC (2019) Maximising the longevity dividend

…and also across the world
• Across the G20, older households’
market share, which rose from
54% to 56% from 2010 to 2015
• In 2015, spending by older
households in the G20 averaged
22% of GDP (~$10 trillion) – more
than the GDP of Japan, Australia,
Canada and Brazil combined.

Especially on leisure and travel…
• Older HH consumption growth is
mainly driven by increases in non-
essential purchases, such as leisure
• The top three growing sectors for
older consumers in the UK are
recreation and culture; transport; and
HH goods & services
• The top four fastest-growing sectors
serving older consumers in the US,
Australia and Canada include
recreation and culture or transport

Opportunity to increase older adults’
spending further: poor health is a barrier
• Spending falls and savings increase for HHs
aged 75+ (80-year-olds save an average of
£5,870 a year, most of free time watching TV)
• These HHs have the means to spend more
but don’t due to avoidable barriers
• Poor health is associated with lower
spending rates at older ages (controlling for
income)
• Tackling the barriers to spending by
people aged 75+ by 2025 could add 2% to
GDP a year by 2040

Health equals wealth
• Across 27 European countries, older people
in better health (i.e., those who have better
cognition, are less limited in daily activities
and/or who report being in good health) are
more likely to spend more (&
work/volunteer)
• Across countries, spending rates (&
employment rates) at older ages are
higher in countries that:
 spend more on health and prevention
as a % of GDP
 have higher flu vaccination rates
 have healthier older populations ILC (2020) Health equals wealth: The global
longevity dividend

Health equals wealth
• A1 pp increase in the flu vaccination rate across
countries is associated with a 0.6% increase in
average yearly spending by people aged 60+
• This would have added $12 billion to US consumption
in 2015
• Increasing preventative health spend by just 0.1% can
unlock a 9% increase in annual spending by people
aged 60+ - would add $180bn to the US in 2015; ~1%
of GDP
• McKinsey estimate a return of $2-$4 for each $1
invested in improving global health (mainly via
preventative interventions).
• Two opportunities: ensure spending projections are
realised & create new market opportunity

Economic value of vaccination
• Previous ILC research indicates
that in the best-case scenario,
flu vaccination can prevent
~245,000 cases in over-65s in
the UK
• £28.9 million could also be
saved in sick days annually
• That’s money which could be
spent travelling, consuming and
working ILC (2018) An economic analysis of flu vaccination

Older adults like to travel
• Pre-COVID, nearly a quarter
(23%) of EU tourism nights were
spent by those aged 65+ while
people aged 55+ accounted for
41 %.
• Nearly half of
Europeans aged 65+ who did not
make tourism trips
mentioned health reasons
• Reinforcing cycle: increased
spending on tourism at older ages
also supports health
Eurostat (2019) Tourism trends and ageing

Why we need to invest in prevention
• Being healthy in later life is key for European tourism – older adults make up
a large share of travellers and are active consumers
• Immunisation is a key component of healthy ageing – vaccination against flu,
pneumonia and shingles, among other VPDs, is just as important as COVID-
19
• Ensuring older adults get vaccinated against all preventable diseases is vital
to ensure greater economic activity

Panellist presentations

Professor Mark Doherty
Senior Manager,
Global Medical Affairs, GSK

Vaccines and vacation:
Health and Quality of
Life
May 2022

As population ageing is expected to increase strain on healthcare,
maintaining lifelong good health in the community is paramount
24
1. United Nations, Department of Economic and Social Affairs, Population Division, 2019. World Population Prospects 2019.
https://population.un.org/wpp/Graphs/Probabilistic/PopPerc/60plus/900; 2. IFPMA Health Policy Partnership, 2019. Implementing a life-course approach to immunization.
https://www.ifpma.org/resource-centre/implementing-a-life-course-approach-to-immunization/; 3. Doherty MT et al. Ann Med 2019;51:128–140 (URLs accessed January 2021)
These changes are
increasing demand on
healthcare systems2
Maintaining lifelong health
is important to help
minimise the burden2,3
Proportion of the global population
aged ≥60 years1
2020
2100
13%
28%

*Based on 2018 data. DALY, disability-adjusted life year (number of years lost due to ill-health, disability or early death in a population)
Many comorbidities are widespread in the population, and the
burden is growing
25
1. Global Burden of Disease, 2017. GBD Compare. https://vizhub.healthdata.org/gbd-compare/ (accessed September 2020); 2. Razzaghi H et al. MMWR Morb Mortal Wkly Rep
2020;69:945–950; 3. Clark A et al. Lancet Glob Health 2020;8:e1003–e1017
Approximately 1 in 5 people
globally are now estimated to have
≥1 underlying risk condition for
severe COVID-19 infection3
of US adults aged ≥18 years had
≥1 underlying medical condition
associated with increased risk for
severe COVID-19*2
Between 1990 and 2017, the
proportion of global DALYs caused
by non-communicable conditions
increased by 20%1
0
10
20
30
40
50
60
70
1990 2017
Percent
of
total
DALYs
41%
20%

*In 16 public health jurisdictions. **Some decedents had >1 comorbid condition, so categories sum to >100% of all deaths.
Mortality due to COVID-19 is particularly high when older age
and comorbid conditions are combined
26
Wortham JM et al. MMWR Morb Mortal Wkly Rep 2020;69:923–929
0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000
Chronic liver conditions
Immunosuppression
Neurological conditions
Chronic lung disease
End-stage renal disease
Chronic kidney disease
Diabetes
Cardiovascular disease
All deaths**
>50% of patients with each
comorbid condition who died
were aged ≥65 years
Number of deaths
COVID-19-related deaths in individuals with specified comorbid conditions, by age*
(12 February – 24 April, 2020 [N=10,647])
<65 years ≥65 years

CVD, cardiovascular disease
Many risk factors for severe outcomes with COVID-19 are
similar to those observed with other infectious diseases
27
Centers for Disease Control and Prevention (CDC), 2020. FluView: Influenza Hospitalization Surveillance Network (data as of 12 September 2020).
https://gis.cdc.gov/grasp/fluview/FluHospChars.html (accessed September 2020)
Asthma
CVD Chronic lung disease Immunosuppression
Metabolic disorder Renal disease
Aged ≥65 years
Proportion of individuals hospitalised for influenza with specified comorbid conditions, 2019–2020 season
(N=19,383)
No comorbidity
Comorbidity

CI, confidence interval; MI, myocardial infarction; RTI, respiratory tract infection
As well as acute illness, some diseases such as influenza can
also increase the risk of events such as MI or stroke
28
Smeeth L et al. N Engl J Med 2004;351:2611–2618
0
1
2
3
4
5
6
1–3 4–7 8–14 15–28 29–91
Incidence
ratio
(95%
CI)
Period after infection (days)
Age-adjusted incidence ratios of a first myocardial infarction or stroke after respiratory
tract infection, in adults aged ≥18 years
MI (N=20,921)
Stroke (N=22,400)
Rates of MI and stroke were ~5 and ~3
times higher, respectively, than baseline
in the first 3 days following RTI
Rates remained elevated up
to 91 days following RTI

Influenza impact beyond acute infection
Reprinted from Macias AE et al. Vaccine 2021;39:A6–A14, copyright 2021 with permission from Elsevier
COPD, chronic obstructive pulmonary disease
Macias AE et al. Vaccine 2021;39:A6–A14
29

Some impacts of influenza vaccination on non-
communicable disease
1. Clar C et al. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD005050. 2. Liu J et al. Medicine 2016;95:e2868; 3. Tsivgoulis G et al. J Neurol Sci
2018;386:12–18
30
Impact of
influenza
vaccination
Cardiovascular mortality
Overall reduction of 56% (RR: 0.44; 95% CI: 0.26–0.76)1
Alzheimer’s disease/dementia
Risk of dementia in patients at-risk reduced by 36%
(HR: 0.64; 95% CI: 0.57–0.71)2
Ischaemic stroke
Overall risk reduced by 13% (RR: 0.87; 95% CI: 0.79–0.96)3
CI, confidence interval; RR, risk ratio

CI, confidence interval; HZ, herpes zoster
Herpes zoster increases the odds of cerebrovascular and
cardiovascular events by up to 40% and 30%, respectively
31
Erskine N et al. PLoS ONE 2017;12:e0181565
0.8
1
1.2
1.4
1.6
1.8
Odds
ratio
(95%
CI)
3 months 1 year >1 year
Time following herpes zoster exposure
Meta-analysis of the association between herpes zoster and cerebrovascular and cardiovascular events,
stratified by length of follow-up
While cardiovascular risk
decreases, cerebrovascular
risk remains at 40% >1 year
post-exposure
Significantly increased odds of
cardiovascular (30%) and cerebrovascular
(34%) events for 3 months after HZ
Cardiovascular
event
Cerebrovascular
event

Some impacts of zoster vaccination on non-
communicable disease
1. Schnier, C et al., MedRxiv 2021.07.22.21260981. 2. Scherrer JF, et al. PLoS One. 2021 Nov 17;16(11):e0257405.; 3. Yang et al. Stroke 2021;52:1712–1721
32
Impact of
zoster
vaccination
Cardiovascular mortality
Overall reduction of 14% in myocardial infarction (HR:
0.86; 95% CI: 0.82–0.90)1
Alzheimer’s disease/dementia
Risk of dementia in patients at-risk reduced by 31-35%
(95%CI: 0.67-0.72; and 0.57-0.74)2
Ischaemic and hemorrhagic stroke
Overall risk reduced by 16% (HR: 0.84; 95% CI, 0.83–0.85)3
CI, confidence interval; RR, risk ratio

Insights from a multi-country survey of 16000 adults 50 years and older
Changing how we talk about adult immunization
33
Make vaccination clear, consistent and convenient. Improve vaccination rates with
better access along with clearer, more consistent information, and reminders.
Talk about the ‘immune fitness’ of older adults. Increase awareness and acceptance
by speaking in terms of the immune system to overcome barriers instead of speaking about
age.
Find the right messenger to bring your messages. Educate and partner with
healthcare professionals and other believable, trusted sources for vaccine information.
GSK Global Adult Vaccination Study 2021: In July and August of 2021, Kantar — on behalf of GSK — conducted a vaccination study among 16,000 men and women ages 50+ in Japan, Spain, Italy, France, Germany, Brazil, USA, and Canada
to understand the role that vaccination plays in the health and wellbeing of adults 50+.
Advocacy
Access
Activation

Promoting life-course vaccination to improve immune resilience as
part of a wellness package may help encourage behavioural change
34
1. World Health Organization (WHO), 2002. Active ageing: a policy framework. http://www.who.int/ageing/publications/active_ageing/en/ (accessed January 2021); 2. Doherty MT
et al. Ann Med 2019;51:128–140; 3. Korn L et al. Health Psychol 2018;37:1045–1054
Active participation in self-care and healthy lifestyle behaviours, such as
physical activity, healthy eating and not smoking, are important
throughout the life-course1
Promoting life-course vaccination as part of an informed health and
wellbeing package alongside such behaviours may help generate a
change in focus and improved uptake2,3
Even in older age, positive health behaviours continue to have
significant impact, extending longevity and enhancing quality of life1

Isabel de la Mata
Principal Advisor, Health and Crisis
Management, DG SANTE

Annagrazia Laura
President, European Network for
Accessible Tourism

• EU project, 2006 to 2007
• Mainstreaming disability
• Combatting discrimination
• ENAT founded as non-profit
association, Brussels 2008
• International Board of
Directors
• Multi-stakeholder network
• 290+ members
• 50+ countries world-wide
www.accessibletourism.org
Promoting Tourism for All
Who we are

Our Mission
“To make European tourism destinations,
products and services accessible to all
travellers and to promote accessible
tourism around the world.”

Tourism has been badly hit and it is very hard to foresee
a strong recovery in 2022 or 2023
New challenges for Accessible Tourism:
• The economic crisis due to the Pandemic has reduced
the available income
• New travel behaviours of tourists with specific access
requirements
• Afraid of a touristic assistance not being fully adequate
Covid-19: A Different Strategy for Tourism

The future of Tourism
The tools we could count on
• Guidelines for the tourism sector
• Economic support at national and international level
• Release of the severe restrictions to travelling
• Vaccines
Even if……..

The future of Tourism
We had to confront with
• Oppositions
• Scientific disinformation, fake news
• Unequal distributions of vaccines

COVID-19 Guidelines for Tourism operators
Reopening tourism for
travellers with disabilities
• Travel planning and protocols
• Transport,
• Hotel accommodation,
• Bar, restaurants
• Tourist activities
Safety for all without imposing
unnecessary obstacles
https://www.accessibletourism.org/?i=enat.en.news.2185

COVID-19 Inclusive Recovery Guide
Presented on the occasion of the International day of
People with disabilities 3rd December 2021
Assistance provided during pandemics
• Repatriate passengers without delay
• Provide courtesy accessible
accommodation extended to “essential
staff”
• Engage in DMO/DPO peer support
• Adapt sanitary protocols ( NO one-
size-fits-all attitude)
• Keep accessibility features across the value
chain

COVID-19 Inclusive Recovery Guide
Presented on the occasion of the International day of People
with disabilities 3rd December 2021
Inclusive policies in post-COVID 19 tourism
• Gather data on accessible tourism:
• Adjust accessibility policies and strategies
• Treat accessibility as a competitive advantage
• Improve Customer Service
• Encourage feed-back from end users
• Apply international standards
• Extend professional training by including safety
• Ensure labour inclusion
• Use innovative technology

New Trends
transforming tourism
• Demographic changes and emerging markets
• Sustainability
• New technologies
Implications for tourism sector in general and for
Accessible Tourism in particular
M1 LU1 - Tourism Trends and Megatrends
The Future of Tourism

Post-Covid
Ageing population Millennials and new generations
Still the population with more
economic possibilities and
time to travel, but stuck for
fear of the pandemic risks
Ready to travel and follow
health directions, digital
nomads with diminished
purchasing power

Sustainable tourism

Impact of new technologies on tourism
consumption behaviour
Two drivers of change:
1. Social media, review, web reputation as communication
tools between tourists, destinations and businesses
Tourists become testimonials who share their own judgements on tourism
attractions and services determining the web reputation of destinations and
companies
2. Virtual and Augmented Reality
VR and AR offer the potential to create substitute experiences that
may be particularly beneficial for people with access limitations

Regenerative Tourism
Tourists, tourism destinations, local communities, tourism operators are
all part of the same:
ECOSYSTEM
Survival Prosperity
Source: Anna Pollock, Conscious Travel
… shift the focus from
growing numbers of
tourists to creating
thriving destinations
and communities,
allowing them to say
what kind of tourism
they want
New Models of Inclusion and Development

• The regenerative tourist destination has the
task of bringing together tour operators and
communities to build its offer together
• A thriving tourist destination is a place where
guests and community can "give more" to
each other generating more well-being
(economic, environmental, social)
• A community that chooses its own way of
welcoming will be more open,
inclusive and accessible
New Models of Inclusion and Development

1. Develop National and Regional policies and
action plans, in cooperation with tourism
actors and stakeholders
2. Engage with International Networks
3. Improve skills (training & education)
4. Improve the offer (infrastructure and
activities)
5. Improve communication and
information (to businesses & visitors)
Accessibility from start to finish….
…Ensuring an inclusive experience for All
… Leaving no-one behind
Accessible Tourism: How to Proceed

Thank you for your attention!
enat@accessibletourism.org
www.accessibletourism.org
@Euaccesstourism
To join ENAT go to: www.enat.eu

Q&A
Please submit your questions to panellists via
the Q&A tab

Closing remarks
Patrick Swain, Coordinator,
CLCI-ILC Alliance

Thank you

Vaccines and vacation - 10 May 2022.pptx

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