Vaccination for adults

Childhood vaccination is universally organised and adult vaccination largely is not, which means eligible adults routinely miss vaccines that would benefit them.

The main adult vaccines

Varying by country in eligibility and schedule.

Influenza, annually, for older adults, pregnant women, people with chronic conditions, healthcare workers and carers — and available privately at modest cost to others.

Effectiveness varies by season and strain match, and even in poorly matched seasons it reduces severity and hospitalisation.

COVID-19, with boosters offered to defined groups according to current national policy.

Pneumococcal, for older adults and those with certain conditions, protecting against invasive pneumococcal disease.

Shingles, for older adults, with the newer recombinant vaccine substantially more effective than the older live vaccine and also reducing postherpetic neuralgia, which is the complication that causes prolonged and severe pain.

Tetanus, diphtheria and pertussis boosters, including pertussis in pregnancy, which protects newborns before their own vaccinations take effect.

RSV, newly available in several countries for older adults and in pregnancy.

Hepatitis B, for those at occupational or behavioural risk and those with certain conditions.

HPV, where catch-up programmes exist for defined groups above the routine age.

And MMR, where a substantial number of adults are incompletely vaccinated and measles has resurged in several countries.

Why the case is unusually strong

Vaccination is repeatedly identified in health economic analyses as among the highest-return public health interventions, alongside clean water and tobacco control.

The reason is straightforward: prevention costs little and the diseases prevented cost a great deal.

Shingles is a useful example — a course of vaccine against a condition where postherpetic neuralgia can produce years of pain requiring multiple medications and specialist input.

Influenza vaccination in older adults reduces hospitalisation, and hospitalisation in an older person frequently produces deconditioning and loss of independence beyond the illness itself.

The common objections, addressed

Briefly and factually.

The influenza vaccine cannot cause influenza, since the injected vaccines contain no live virus.

Mild soreness, fatigue and low-grade fever afterwards are immune response rather than infection.

Getting influenza after vaccination usually reflects a different virus, exposure before immunity developed, or an imperfect match — none of which means the vaccine failed entirely, since severity is still reduced.

Being healthy is not a reason to skip vaccination if you are eligible, since the aim includes protecting others.

And previous infection does not reliably substitute for vaccination for most of these conditions.

Travel vaccination

Where planning matters.

Requirements depend on destination, season, activities and duration, and several vaccines require courses over weeks.

Which means seeking advice six to eight weeks before travel rather than the week before.

Some vaccines are legally required for entry to certain countries.

Malaria prophylaxis is not a vaccine and requires separate consideration, alongside bite avoidance which is the primary measure.

Travel health advice is available through general practice, travel clinics and pharmacies, at varying cost, and checking which vaccines are free under the routine schedule before paying privately is worth doing.

Occupational vaccination

Frequently an employer responsibility.

Healthcare and laboratory workers, those working with animals, sewage workers and others have specific requirements, generally provided by the employer.

Anyone in these roles who has not been offered them should ask, since occupational health obligations exist in most jurisdictions.

Keeping a record

Practically useful and generally absent in adults.

Vaccination records for adults are frequently fragmented between providers, and reconstructing them is difficult.

Keeping your own list, with dates, saves considerable trouble when travelling, changing provider, moving country, starting a job, or becoming pregnant.

Where records are lost, most vaccines can safely be repeated, and a clinician can advise on catch-up schedules.

Special situations

Where advice differs.

Pregnancy: influenza and pertussis are recommended, live vaccines are generally avoided, and specific guidance applies.

Immunosuppression: live vaccines are generally contraindicated, additional vaccines may be recommended, and timing relative to treatment matters — this is a situation requiring specialist advice.

Asplenia and complement deficiency, where specific additional vaccines are essential.

Chronic liver, kidney, lung and heart disease, where eligibility for several vaccines widens.

And close contacts of immunosuppressed people, who protect them by being vaccinated themselves.

Where to get them

More options than people assume.

General practice, which usually delivers the routine adult programme.

Community pharmacies, which now provide a growing range and which have longer opening hours.

Occupational health.

Travel clinics.

And workplace and community vaccination programmes.

Cost varies from free under the national programme to modest private fees, and eligibility for free provision is broader than most people realise.

General information only, not medical advice. Vaccination schedules and eligibility vary by country — consult a qualified clinician, pharmacist or travel health service.