Boom in elderly, how we must protect them

In 2050, in Italy, one in three people will be over 65. To paraphrase the title of a film, Italy, as all the demographic figures confirm, is a country for old people: we are the second nation in the world, and the first in Europe, for the highest percentage of citizens over 65 and the lowest percentage of young people. The low birth rate, moreover, suggests a prospect of further growth of the oldest part of the population.

It is a scenario that involves major challenges, especially in the welfare and healthcare sectors, and requires more urgently than ever a timely commitment to transform this potential criticism into an opportunity. More elderly people means more pensions to pay, fewer people of working age, more chronic diseases, more people to assist, more spending on the healthcare system.

These are the themes that are the focus of the first meeting of the series “Apco Health Talks: exploring the health system”, focused on the role of prevention in protecting the elderly, which took place today in Rome: the initiative was an opportunity to take stock of one of the most complex and strategic challenges, with a particular focus on the socioeconomic value of vaccination in the elderly population, the health policies currently in place in this area and the centrality of timely access to prevention.

Too little prevention

Let's start with the numbers, which rarely lie or sugarcoat the pill. In the face of the declining demographic trend in Italy, there is a significant drop in spending on prevention (-18.6% between 2024 and 2023, according to the Gimbe foundation) and an alarming trend in vaccination coverage among the over 65s, far from the recommended objectives. According to data from the Ministry of Health, influenza coverage, for example, in the 2023-2024 season recorded a drop of 3.4 percentage points compared to the previous season (coverage was just 53.3% compared to a minimum target of 85%); for Covid it went even worse, with coverage of just 4.47% in the over 60 population in the 2024-2025 campaign. It is suspected that the trend is similar for pneumococcus and herpes zoster, although the lack of a structured monitoring system makes a more precise estimate difficult. Finally, last but not least, respiratory syncytial virus, recommended at European level but not in Italy.

Poor perception of risk

One of the problems, say the experts who spoke at the meeting, is an insufficient perception of risk: “Among the elderly population,” explained Michele Conversano , professor of hygiene at the University of Florence and president of the scientific committee of HappyAgeing, “there remains a poor perception of the risk associated with the complications of infectious diseases preventable with vaccines. It is clear that targeted actions are needed both towards doctors and towards elderly citizens, to make them understand the real danger of diseases such as Covid-19, influenza, pneumococcus, herpes zoster and also RSV and the opportunities offered by vaccination. However, without an effective monitoring system and with data published promptly, it is difficult to intervene in a targeted way. A structured active call strategy is needed: starting from the age of 65 or in the presence of chronic pathologies, every citizen should be reached by clear and coordinated communication. Only in this way can we truly protect the health of the elderly and guarantee healthy aging.”

The time for targeted interventions

In addition to the issue of risk perception, another critical issue is related to the insufficiency of interventions by the legislator: experts say that a timely update of the National Vaccination Prevention Plan is needed based on the latest vaccinations, interventions aimed at leveling the inhomogeneities between regions and more coordinated and efficient governance models. And not only that: it is necessary to promote a culture of prevention as an investment, strengthen access to vaccine innovation and enhance the virtuous models already in place: Lazio with its digital network of vaccination hubs, Lombardy with the involvement of general practitioners and pharmacies, and Tuscany with the integrated and institutional approach.

The cost problem

Lack of prevention is certainly not only a health cost, but also an economic one, which has been quantified with an ad hoc study, Altem Advisory : “The aim of the study by Altems Advisory was to quantify the cost of “lack of vaccination”, in terms of lower health and higher costs in the different regional contexts identified by enhancing the economic and social implications of the expansion of vaccination coverage and methods as foreseen by the National Plan for Vaccination Prevention 2023-2025”, explained Eugenio Di Brino , researcher at the Graduate School of Economics and Management of Health Systems – ALTEMS, Catholic University of the Sacred Heart of Rome . We are talking about lots and lots of money: “We have measured the value of vaccinations by broadening the very concept of value by introducing a measurement of the impact of the effects of vaccine-preventable disease on the gross domestic product (GDP) due to the depletion of labor and capital, and we have estimated the economic value that we could recover by increasing vaccination coverage at 10 billion euros .”

In light of all this, vaccination currently remains our most formidable tool for protecting individual health, collective health and the healthcare system: “Vaccination is not just an intervention for individual health, but for collective health. It is a fundamental public health tool that protects the entire community, especially the most fragile and elderly people, who are most exposed to the complications of infectious diseases,” concluded Simona Ursino , president of the Italian Society of Hygiene, Preventive Medicine and Public Health of the Lazio Region and health director of ASL Roma 4. “Ensuring high levels of vaccination coverage means strengthening the resilience of our Healthcare System and ensuring its sustainability, especially in a context of an aging population.”