Vaccination in Older Adults: Erasure, Barriers, and Hesitancy (Part One)

Authored by Patricia Harte-Maxwell

The history of vaccination and vaccine culture in the Global North has  since the 18th century been predominantly concerned with the health and lives of children, such as this post from Medical News Today which recognizes myths fuelling anti-vaccination as referring only to children. However, children have always only made up a portion of the population and certainly not the entire population that can benefit from vaccination. Especially as the global population continues to age, with the number of people 60 and older expected to double by 2050 (WHO), vaccination and vaccine-hesitancy in older adults should be reconsidered as both a major public health effort and as a vital component of care because vaccines not only have the potential to extend life but protect from and relieve suffering.

Despite these factors, vaccine discussions often diminish the need for adult vaccination for themselves, instead couching adult vaccination in terms of child mortality ( and the existence of unvaccinated adults by employing the Politics of the Child, while putting forth two narratives that erase unvaccinated people from the future. Alongside this narratological absence, low vaccination rates for Influenzaand now SARS-CoV-2 –  in older adults in the US and Canada have persisted for years, but this fact cannot be attributed singularly to anti-vaccination mentalities and/or vaccine hesitancy, suggesting that actions greater than promotional and informational programs need to be undertaken to increase vaccination rates in older adults.

The disappearance of adults from vaccine culture happens on logistical and representational levels. As far as representation, for example, discussions around vaccine hesitancy and anti-vaccination stances often focus on children. In my mind there are three main reasons for this: first is worry that a child with a full life ahead of them will have a negative reaction to vaccines, second is that the recommended vaccine schedule from the CDC is heavy in early life with 10 vaccines/vaccines series suggested within the first 15 months and the completion of series plus more first doses administered up to age 18 (Center for Disease Control and Prevention), and third, informed by and reflecting back on the first two, is that children until an age of majority depending on state and country are not in control of their own health and medical decision making. The first reason, worry that a child might have an allergic reaction to a vaccine, is not unfounded as children can be allergic to components of vaccines. The second reason, that the sheer number of vaccines administered is thought by some to overwhelm a child’s body, sometimes results in a delayed vaccination schedule with greater time between doses. The vaccine schedule for children under 15 months is extensive even in delayed or alternative schedules because the immune system of new-borns is not yet fully activated and relies in part on maternal antibodies for initial immunity. Keep in mind that such young children cannot wash their own hands and do not know to avoid putting things in their mouths. These factors leave new-borns at risk of contracting pathogens that may develop into serious infections. Vaccines are thus administered early in life to minimize the gap between protection within the womb or from maternal antibodies and the time when the infant immune system is developed enough to defend itself. Likewise, despite a functioning immune system, pathogens are not inert – they also adapt, and they have ways around even our complex and efficient immune system.

Reason three diverts from the theory of the first two in that it is political more than immunological. In general, those under age 18 require the consent of parents or legal guardians to receive or not receive vaccines – a person under 18 may claim to be a mature minor under doctrine law but this often extends only to those 16 or older, sometimes to those as young as 14, and may not be recognized or unchallenged in all states (, turning vaccine hesitancy or anti-vaccination in regard to children and their bodies into a question of autonomy: physical and philosophical autonomy of the child from their parents/guardians and the physical and philosophical autonomy of people and families from larger bodies such as a biomedical society and government institutions.

 The reasons I just explained, however, are not actually child specific, in a sense. If one has an allergy to a vaccine that allergy may, though not always, persist throughout life and may be resolved by administering a different type of vaccine, or one may develop an allergy in later life that instigates vaccine hesitancy in one who had previously followed recommendations. If one is worried about the magnitude of the vaccine schedule in new-borns then vaccines can be delayed.  if vaccines are not received at the recommended age one can be vaccinated later in life, the principle from which alternative vaccine schedules operate. The third reason, medical autonomy, is also not child specific. Many people, such as those with severe cognitive impairments, live with another person or entity who decides their healthcare; many people move in and out of the state of having a medical executor throughout life, for example if one is in an accident or undergoes a surgery; and many people enter the care of another in older age, especially if dementia or other conditions develop. A predisposition to focus on children as the seed and site of a future society when speaking of vaccination is traditional and, again, political rather than practical.

**End of Part One**