Roz Bekker, Infectious Diseases & Vaccines, Janssen EMEA, discusses solutions for older adults and their needs when tackling infectious diseases.
Older adults are an under-served population, an issue brought to the fore during the COVID-19 pandemic, which emphasised the implications of infectious diseases on this age group. Infectious diseases are a deadly threat to public health; each year, they account for 15% of all deaths worldwide. The worrying implications of infectious diseases were evident during the COVID-19 pandemic which struck all generations, leaving the greatest mark on older adults.
Rozlyn Bekker, Vice President and Lead Commercial Strategy in Infectious Diseases and Vaccines at Janssen EMEA, has vast experience working in the pharmaceutical industry. She recently spoke with Health Europa Quarterly about addressing the challenges associated with infectious diseases in older adults, the impact of COVID-19 on this population and targeted clinical drug development.
What key risk factors make older adults particularly vulnerable to infectious diseases?
There are various factors associated with ageing that make the elderly population more vulnerable to infections and infectious diseases.1 These can include changes in the immune system leading to reduced immunity, higher rates of comorbidities and changes in normal organ functions.1 Additionally, social determinants of health such as nursing home residence or poor access to care can also increase the risk of infections in older adults.1
Some of the most common infections in older adults include respiratory infections such as influenza and respiratory syncytial virus (RSV), bacterial urinary tract infections (UTIs), skin and soft tissue infections, sepsis, and Clostridioides difficile infection (CDI).1
If we look at RSV (respiratory syncytial virus) for example, although it affects both adults and children, modelling estimates in the UK suggest that the vast majority of deaths, and the most severe complications, are seen in older adults.2,3 RSV disproportionately impacts adults over 65 years, who are more likely to develop a lower respiratory tract infection due to diminished immune systems and other conditions that make them pre-disposed to infection.4 The infection can lead to life-threatening complications, including pneumonia, and/or exacerbate the symptoms for older adults with underlying conditions such as asthma and chronic obstructive pulmonary disease (COPD), and even lead to heart failure.5
There is also an awareness element that can make older populations more vulnerable. While the impact of RSV on infants and younger children is widely known, older adults and those with underlying conditions are also at risk, yet most people, and many healthcare professionals, remain unaware of this.6 Many older people who are infected with RSV may not be properly diagnosed because the symptoms can be difficult to distinguish from the flu or other respiratory infections. It is therefore incredibly important to raise awareness of infectious diseases such as RSV in older adults to allow for appropriate protection and treatment.
What measures could have been taken in the early stages of the COVID-19 pandemic to better protect the older population?
Beyond vaccination, which was clearly the single biggest measure that protected the ageing population against COVID-19, one of the legacies of the early (and later) stages is the impact of delayed diagnosis and treatment pathways caused by missed and cancelled healthcare appointments.
Healthcare systems rightly took measures to stop the spread of COVID-19 and protect staff and patients. But because those systems were under immense pressure and because many patients were reluctant to seek medical care, huge numbers of diagnoses were missed and treatments delayed, and that continues to have devastating effects today.
And, as there was such a strong focus on COVID-19, other infectious diseases could have potentially been overlooked.7,8 RSV, COVID-19 and flu symptoms are very similar,7,9 which can make it difficult to diagnose the particular infectious disease a patient has. Moving forwards, increased awareness and testing to differentiate between COVID-19 and other infectious diseases can help people identify which disease they have and, in turn, help healthcare professionals treat it effectively.10
How can vaccine effectiveness and uptake in older adults be addressed?
Collaboration between all those involved in protecting older adults against infectious diseases is crucial. Health systems, community and advocacy groups and the healthcare industry should continue working closely together to help address the three Cs:
- Confidence barriers – challenges still remain around confidence in the safety and efficacy of vaccines, and levels of trust in the pharma industry and the health system.11 Raising awareness around the scientific expertise, best-in-class capabilities and collaborative approach that lies behind the development of vaccines can help instil confidence and improve uptake.
- Complacency barriers – there is a tremendous lack of awareness of the risk of some infectious diseases, such as RSV, among older adult populations who are at high risk.12 It is important to inform and educate older adults around the risk of serious illness and the protection that vaccination can provide.
- Convenience and access barriers – while vaccines remain one of the most effective methods of prevention, the benefits are unevenly shared, and coverage varies widely among and within countries.13,14 Vaccination rates could be improved by ensuring the right infrastructure is in place to allow people to access and receive the vaccination at a convenient time and place, as well as considering any group’s specific cultural context.
Vaccination education and awareness is an ongoing need, so encouraging the loved ones and carers of older people to share credible information and address vaccination concerns can also help drive uptake.
What is the significance of considering ageing as a factor in clinical drug development and prescribing? Can you outline any ways in which the pharmaceutical industry is helping to address the healthcare challenges faced by today’s ageing population?
The number of older people in the world is increasing significantly. The WHO estimates over two billion by the middle of the century.15 Along with this increase in older people comes a higher number of people with reduced immunity and higher rates of comorbidities.1 This will likely cause a growth in chronic ailments affecting the elderly and, in terms of prescribing, many patients will require treatment for two or more chronic diseases, which brings challenges in terms of compliance, drug interaction and adverse event management.16 Additionally, when looking specifically at infectious diseases that older people are more vulnerable to, only a limited number of infectious diseases can be prevented by current vaccines.17
The pharmaceutical industry will continue to develop vaccines and preventative solutions that address urgent unmet needs in adults, helping them stay healthy as they age. The industry is also involved in the development of a spectrum of solutions for infectious diseases and high-burden chronic diseases such as Alzheimer’s, diabetes, arthritis and osteoporosis, where innovative treatments are urgently needed. Clinical drug development needs to continue to evolve to address an ageing population, and the pharmaceutical industry can help drive this
This is, however, a collaborative effort, and the pharmaceutical industry must continue to work closely with all stakeholders, including health systems and patient advocacy groups, to ensure that the ageing patient population have broad spectrum access to the vaccines and medicines that they need.
References
1. Esme M, Topeli A, Yavuz BB and Akova M (2019) Infections in the Elderly Critically-Ill Patients. Front. Med. 6:118. doi: 10.3389/fmed.2019.00118
2. Fleming, D. M., Taylor, R. J., Lustig, R. L., Schuck-Paim, C., Haguinet, F., Webb, D. J., … & Taylor, S. (2015). Modelling estimates of the burden of Respiratory Syncytial virus infection in adults and the elderly in the United Kingdom. BMC infectious diseases, 15(1), 1-12.
3. Taylor, S., Taylor, R.J., Lustig, R.L., Schuck-Paim, C., Haguinet, F., Webb, D.J., Logie, J., Matias, G. and Fleming, D.M., 2016. Modelling estimates of the burden of respiratory syncytial virus infection in children in the UK. BMJ open, 6(6), p.e009337.
4. Respiratory Syncytial Virus in Children and Adults. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/8282-respiratory-syncytial-virus-in-children-and-adults. Last accessed: September 2022.
5. RSV in Older Adults and Adults with Chronic Medical Conditions. CDC. Available at: https://www.cdc.gov/rsv/high-risk/older-adults.html Last accessed: September 2022.
6. Hurley LP, Allison MA, Kim L, et al. Primary care physicians’ perspectives on respiratory syncytial virus (RSV) disease in adults and a potential RSV vaccine for adults. Vaccine. 2019;37(4):565-570.
7. Respiratory syncytial virus (RSV). Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098. Last accessed: October 2022
8. Global Tuberculosis Report 2020. WHO. Available at https://www.who.int/tb/publications/global_report/en/. Last accessed: October 2022
9. Respiratory Syncytial Virus Infection (RSV). CDC. Available at www.cdc.gov/rsv/index.html. Last accessed: October 2022
10. Korsten K, Adriaenssens N, Coenen S, Butler CC, Verheij TJ, Bont LJ, Wildenbeest JG (2021) World Health Organization Influenza-like Illness underestimates the burden of respiratory syncytial infection in community-dwelling older adults. J. Infect. Dis.
11. Figueiredo A, Sima C, Karafillakis E, Pterson P, Larson HJ (2020). Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. The Lancet, 396, 898-908
12. Tseng HF, Sy LS, Ackerson B, Solano z, Slezak J, Luo Y, Fischetti CA, Shindo V (2020). Severe morbidity and short- and mid- to long-term mortality in older adults hospitalised with respiratory syncytial virus. J. Infect. Dis., 222: 1298-1310
13. World Health Organization. Immunization Agenda 2030. A Global Strategy to Leave No One Behind. Available at https://cdn.who.int/media/docs/default-source/immunization/strategy/ia2030/ia2030-draft-4-wha_b8850379-1fce-4847-bfd1-5d2c9d9e32f8.pdf?sfvrsn=5389656e_69&download=true. Last accessed: July 2022.
14. World Health Organization. Ten years in public health 2007-2017 – The power of vaccines: still not fully utilized. Available at: https://apps.who.int/iris/bitstream/handle/10665/255355/9789241512442-eng.pdf. Last accessed: July 2022
15. World Health Organization. Ageing and health. Available at https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
16. Jin J, Sklar GE, Oh VMS, Li SC (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. Thera. Clin. Risk Manag., 4(1): 269-286.
17. World Health Organization. Table 1: Summary of WHO position papers – recommendations for routine immunization. Available at: https://cdn.who.int/media/docs/default-source/immunization/immunization_schedules/immunization-routine-table1.pdf?sfvrsn=c7de0e97_9&download=true. Last accessed: October 2022.
Rozlyn Bekker
VP Infectious Diseases & Vaccines Commercial Strategy Lead
Janssen Europe, Middle East & Africa (EMEA)
https://www.janssen.com/emea/
https://www.linkedin.com/company/janssen-europe-middle-east-&-africa?trk=ppro_cprof
https://twitter.com/janssenemea
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This article is from issue 24 of Health Europa Quarterly. Click here to get your free subscription today.
