Many older people embrace vaccines; research is proving them right

NEW YORK – Ms Kim Beckham, an insurance agent in Victoria, Texas, had seen friends suffer so badly from shingles that she wanted to receive the first approved shingles vaccine as soon as it became available, even if she had to pay for it out of pocket.

Her doctor and several pharmacies turned her down because she was below the recommended age at the time, which was 60.

So, in 2016, she celebrated her 60th birthday at her local CVS pharmacy. “I was there when they opened,” Ms Beckham recalled. After her Zostavax shot, she “felt really relieved”.

She has since received the newer, more effective shingles vaccine, as well as the pneumonia shot, the respiratory syncytial virus vaccine, annual flu shots and all recommended Covid-19 vaccinations.

Some older people are very eager to be vaccinated.

Ms Robin Wolaner, 71, a retired publisher in Sausalito, California, has been known to badger friends who delay getting recommended shots, sending them relevant medical studies. “I’m sort of hectoring,” she acknowledged.

Ms Deana Hendrickson, 66, who cares daily for three young grandsons in Los Angeles, sought an additional MMR shot, though she was vaccinated as a child, in case her immunity to measles was waning.

For older adults who express more confidence in vaccine safety than younger groups, the past few months have brought some welcome research. Studies have found important benefits from a newer vaccine and enhanced versions of older ones, and one vaccine may confer a major bonus that nobody had foreseen.

Overwhelming evidence

The evidence that vaccines are beneficial remains overwhelming.

The phrase, “vaccines are not just for kids any more”, has become a favourite for Dr William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “The population over 65, which often suffers the worst impact of respiratory viruses and others, now has the benefit of vaccines that can prevent much of that serious illness,” he said.

Take influenza, which annually sends from 140,000 to 710,000 people to hospitals, most of them older than 65, and is fatal to 10 per cent of those hospitalised older patients.

For about 15 years, the Centers for Disease Control and Prevention (CDC) have approved several enhanced flu vaccines for people older than 65. More effective than the standard formulation, these either contain higher levels of the antigen that builds protection against the virus or incorporate an adjuvant that creates a stronger immune response. Or they are recombinant vaccines, developed through a different method, with higher antigen levels.

In a meta-analysis in the Journal of the American Geriatrics Society, “all the enhanced vaccine products were superior to the standard dose for preventing hospitalisations”, said Dr Rebecca Morgan, a health research methodologist at Case Western Reserve University and an author of the study.

Compared with the standard flu shot, the enhanced vaccines reduced the risk of hospitalisation from flu by 11 to 18 per cent in older adults. The CDC advises adults older than 65 to receive the enhanced vaccines, as many already do.

More good news

Vaccines to protect people older than 60 from the respiratory syncytial virus (RSV) are performing admirably.

RSV is the most common cause of hospitalisation for infants and poses significant risks to older people. “Season in and season out,” Dr Schaffner said, “it produces outbreaks of serious respiratory illness that rivals influenza.”

Because the Food and Drug Administration first approved an RSV vaccine in 2023, the 2023-24 season provided “the first opportunity to see it in a real-world context”, said Dr Pauline Terebuh, an epidemiologist at Case Western Reserve School of Medicine and an author of a recent study in the journal Jama Network Open.

In analysing electronic health records for almost 800,000 patients, the researchers found the vaccines to be 75 per cent effective against acute infection, meaning illness that was serious enough to send a patient to a healthcare provider.

The vaccines were 75 per cent effective in preventing emergency room or urgent care visits, and 75 per cent effective against hospitalisation, both among those ages 60 to 74 and those older.

Immunocompromised patients, despite having a somewhat lower level of protection from the vaccine, will also benefit from it, Dr Terebuh said.

As for adverse effects, the study found a very low risk for Guillain-Barre syndrome, a rare condition that causes muscle weakness and typically follows an infection, in about 11 cases per one million doses of vaccine. That, Dr Terebuh said, “shouldn’t dissuade people”.

The CDC now recommends RSV vaccination for people 75 and older, and for those 60 to 74 if they are at higher risk of severe illness, for example, from heart disease.

As data from the 2024-25 season becomes available, researchers hope to determine if the vaccine will remain a one-and-done or whether immunity will require repeated vaccination.

People older than 65 express the greatest confidence in vaccine safety of any adult group, a survey by non-profit KFF found in April. More than 80 per cent said they were very or somewhat confident about MMR, shingles, pneumonia and flu shots.

Although the Covid-19 vaccine drew lower support among all adults, more than two-thirds of older adults expressed confidence in its safety.

Bonus of shingles vaccine

Even sceptics might become excited about one possible benefit of the shingles vaccine. This spring, Stanford University researchers reported that over seven years, vaccination against shingles reduced the risk of dementia by 20 per cent, a finding that made headlines.

Biases often undermine observational studies that compare vaccinated with unvaccinated groups. “People who are healthier and more health-motivated are the ones who get vaccinated,” said Dr Pascal Geldsetzer, a public health researcher at the Knight Initiative for Brain Resilience at Stanford and lead author of the study. “It’s hard to know whether this is cause and effect or whether they’re less likely to develop dementia anyway.”

So, the Stanford team took advantage of a “natural experiment” when the first shingles vaccine, Zostavax, was introduced in Wales.

Health officials set a strict age cut-off: People who turned 80 on or before Sept 1, 2013, were not eligible for vaccination, but those even slightly younger were eligible.

In the sample of nearly 300,000 adults whose birthdays fell close to either side of that date, almost half of the eligible group received the vaccine, but virtually nobody in the older group did.

“Just as in a randomised trial, these comparison groups should be similar in every way,” Dr Geldsetzer said. A substantial reduction in dementia diagnoses in the vaccine-eligible group, with a much stronger protective effect in women, therefore constitutes “more powerful and convincing evidence”, he added.

The team also found reduced rates of dementia after the shingles vaccine was introduced in Australia and other countries. “We keep seeing this in one data set after another,” Dr Geldsetzer said.

In the United States, where a more potent vaccine, Shingrix, became available in 2017 and supplanted Zostavax, Oxford investigators found an even stronger effect.

By matching almost 104,000 older Americans who received a first dose of the new vaccine – full immunisation requires two – with a group that had received the earlier formulation, they found delayed onset of dementia in the Shingrix group.

How a shingles vaccine might reduce dementia remains unexplained. Scientists have suggested that viruses themselves may contribute to dementia, so suppressing them could protect the brain. Perhaps the vaccine revs up the immune system in general or affects inflammation.

“I don’t think anybody knows,” said Dr Paul Harrison, a psychiatrist at Oxford and a senior author of the study. But, he added, “I’m now convinced there’s something real here”.

Shingrix, now recommended for adults older than 50, is 90 per cent effective in preventing shingles and the lingering nerve pain that can result. In 2021, however, only 41 per cent of older Americans had received one dose of either shingles vaccine.

A connection to dementia will require further research, and Dr Geldsetzer is trying to raise philanthropic funding for a clinical trial.

And if you needed another reason to get this vaccine, Dr Schaffner said, here it is. NYTIMES