Challenges in the Vaccination of the Elderly and Strategies for Improvement

In recent years, the elderly has become a rapidly growing proportion of the world’s
population as life expectancy is extending. Immunosenescence and inflammaging contribute to the
increased risk of chronic non-communicable and acute infectious diseases. Frailty is highly prevalent
in the elderly and is associated with an impaired immune response, a higher propensity to infection,
and a lower response to vaccines. Additionally, the presence of uncontrolled comorbid diseases in
the elderly also contributes to sarcopenia and frailty. Vaccine-preventable diseases that threaten the
elderly include influenza, pneumococcal infection, herpes zoster, and COVID-19, which contribute
to significant disability-adjusted life years lost. Previous studies had shown that conventional
vaccines only yielded suboptimal protection that wanes rapidly in a shorter time. This article reviews
published papers on several vaccination strategies that were developed for the elderly to solve these
problems: more immunogenic vaccine formulations using larger doses of antigen, stronger vaccine
adjuvants, recombinant subunit or protein conjugated vaccines, newly developed mRNA vaccines,
giving booster shots, and exploring alternative routes of administration. Included also are several
publications on senolytic medications under investigation to boost the immune system and vaccine
response in the elderly. With all those in regard, the currently recommended vaccines for the elderly
are presented.