Longer life expectancy is one of the greatest successes of the last century. Since the 1960s alone, people in the European Union have gained, on average, more than two additional years of life per decade, and other regions are following the same path. This is a great achievement to be built upon.

Europe is ahead of much of the world in this transition, which means it will be among the first to confront the central question of how to ensure that longer lives are spent in good health. The answer will depend largely on how quickly governments shift from planning around dependency to investing in preventive care, innovation, and healthy ageing. Within a generation, nearly one-third of working adults will be over 60[i]. Almost every advanced economy faces the same shift, and those that keep people healthy into later life will be best placed to turn longevity into growth. Whether ageing becomes a competitive advantage or a threat to economic growth depends on policy choices made today, particularly whether non-communicable and vaccine-preventable diseases continue to drive avoidable healthcare spending and productivity losses.

Whether ageing becomes a competitive advantage or a threat to economic growth depends on policy choices made today, particularly whether non-communicable and vaccine-preventable diseases continue to drive avoidable healthcare spending and productivity losses.

 

Nearly two-thirds of future health gains are projected to come from preventive care and public health measures, yet most countries spend less than 2% of their health budgets on prevention[ii]. In most EU member states, less than 0.5% of healthcare budgets are allocated to immunization programs[iii]. This imbalance threatens health system sustainability and undermines long-term economic resilience[iv]. A modern preventive care agenda must move beyond reactive, acute care and invest more systematically in preventive care, health promotion adult immunization, early detection, chronic disease management, and workplace health measures. Together, these interventions can extend healthy life expectancy while strengthening economic resilience[v].

Immunization: a powerful tool against chronic disease

Reducing the burden of non-communicable diseases is central to this effort. Cancer, cardiovascular disease, chronic respiratory disease, and diabetes account for roughly two-thirds of deaths in the EU[vi] and chronic diseases as a whole generate an estimated €700 billion annual economic burden[vii]^{,[viii],[ix],[x]}.

Adult immunization is one of Europe’s most underused preventive care tools. Several infections are known to cause cancer, making immunization, particularly against HPV and hepatitis B – an essential pillar of cancer prevention and of Europe’s ambition to eliminate cervical cancer, as recognised in Europe’s Beating Cancer Plan[xi].

New evidence also shows that routine immunization delivers benefits far beyond protection from acute infection[xii]. Preventing infection can mean preventing inflammation and longer-term damage it can trigger, including cardiovascular complications and, for some infections, cancer. Influenza immunization has been associated with reduction of up to 34% in serious cardiovascular events[xiii] while around one in four adults aged 65 and older hospitalized with influenza and other acute respiratory illnesses experiences sustained decline in health and autonomy[xiv].

Burden compounds when considering how other diseases, such as pneumonia, respiratory syncytial virus (RSV)[xv], and shingles are similarly linked to chronic conditions that increase vulnerability to severe outcomes[xvi]. People living with cardiovascular disease are nearly four times more likely to develop pneumococcal disease[xvii] – which can lead to severe illnesses such as pneumonia – than people without cardiovascular disease. Pneumococcal vaccination can lower the risk of CVD-related mortality by 8% and lower the risk of any cardiovascular disease event by 14%[xviii]. While further research is needed, a growing body of observational evidence also suggests a potential link between shingles vaccination and a reduced risk of dementia[xix].

The economic case for preventive care is equally compelling[xx]. Adult immunization programs can generate returns of up to 19 times their initial investment, through avoided hospitalizations, reduced treatment costs, and preserved productivity, alongside supporting the fight against antimicrobial resistance and enhancing resilience[xxi]. An OECD estimate[xxii] indicates that an increase in the spending for prevention, compared with total hospital spending by 10% can reduce healthcare spending by nearly 1% by curbing the volume of chronic diseases.

Closing Europe’s preventive care gap

Despite the clear benefits, implementation remains uneven. Across Europe, inconsistent recommendations, access, and uptake continue to limit the benefit and value of preventative policies. Today, many European countries recommend immunization against respiratory infections for people over 65[xxiii], with Germany and Italy extending this to people over 60. These inconsistencies drive inequity, leaving millions of older adults and people living with chronic conditions vulnerable, and costing health systems billions of euros annually.

The Safe Hearts Plan[xxiv] marks the first explicit recognition at EU level of vaccination against respiratory infections and shingles as a preventive measure for cardiovascular disease. This provides a basis for stronger EU-level coordination on guidance, data and access, complementing national efforts rather than replacing them. The Steering Group on Prevention of Respiratory Infections recommends establishing an annual EU-wide coverage target for flu, COVID-19, RSV and pneumococcal disease[xxv], building on the EU and WHO target of 75% for older and at-risk populations and national targets like Italy’s[xxvi] and Spain’s[xxvii] 75% pneumococcal target for adults 65 and older.

Coverage targets are an important means towards a broader objective: ensuring that people at cardiovascular risk are adequately protected against vaccine-preventable infections that can worsen their health. That also means looking beyond age thresholds alone. Vulnerability does not begin at 65. From around age 50, chronic conditions increasingly shape health outcomes – affecting the very people driving Europe’s productivity and competitiveness. Aligning recommendations more closely with individual risk, rather than age alone, would better protect today’s workforce and support people to remain healthy and active throughout their lives.

When it comes to access, community pharmacies can provide the foundation of preventive care. They are one of the easiest ways to reach adults where they are: in their communities. Workplaces also have a practical and scalable role to play in supporting healthy aging by promoting immunization, health screening, and flexible work arrangements. Workplace programs improving lifestyles, health and well-being, help reduce sick leave absenteeism by 25%[xxviii].

Unlocking the economic advantages of healthy ageing

The consequences of poor health extend well beyond healthcare systems and into the labour market[xxix]. The European labour force is projected to decline by 12% by 2070[xxx] while healthcare spending could represent 8.1% of GDP if Europeans age in poor health. by the same year. Among adults aged 50–64, employment rates are around 20% lower for those living with one chronic condition and 40% lower for those with two or more conditions[xxxi]. Conversely, improvements in functional ability among older adults could contribute up to 0.4 percentage points to annual global GDP growth[xxxii]. Health is a core component of human capital, alongside education and workforce skills. Healthy adults are more productive, and healthy populations save and invest more. Europe therefore needs a forward-looking healthy aging strategy that treats preventive care as an investment, not a cost. The time to course correct isn’t 30 years from now – it’s now.

Europe can lead by example

Europe can lead by example, starting where the investment is lowest but the macroeconomic payoff is highest. Today, immunization programs consume a negligible fraction, less than 0.5%, of overall European healthcare budgets, and adult immunization even less. Scaling up this tiny baseline requires virtually no fiscal heavy-lifting, yet under the newly implemented New Economic Governance Framework (NEGF)[xxxiii], activating these rules allows Member States to formally categorize preventive care as a growth-enhancing investment rather than current spending.

Crucially, this technical reclassification excludes these proactive expenses from the strict EU net expenditure caps used to calculate deficit penalties. By sheltering these high-yield health programs from mandatory budget cuts, countries gain a powerful, non-inflationary mechanism to protect long-term growth while actively driving down their debt ratios.

Europe’s demographic transition is not going away. By treating preventive care as the investment it is, Europe can turn longer lives into drivers of stronger economies and set an example for others facing the same shift globally.

[i] Organisation for Economic Co‑operation and Development. (2026). Building healthy, productive workforces for our 21st century: Accompanying issues note for the joint OECD‑GCOA workshop on ageing and long‑term care [PDF]. OECD Publishing. https://www.oecd.org/content/dam/oecd/en/topics/policy-sub-issues/ageing-and-long-term-care/Paper_OECD_GCOA_LTC.pdf

[ii] McKinsey Health Institute, The health of nations: Stronger health, stronger economies. https://www.mckinsey.com/mhi/our-insights/the-health-of-nations-stronger-health-stronger-economies

[iii] PubMed. Immunization funding across 28 European countries. https://pubmed.ncbi.nlm.nih.gov/33759675/

[iv] Beauvais, A., Herbig, B., Wilson, M., & Kumar, P. (2026, February 17). The health of nations: Stronger health, stronger economies (McKinsey Health Institute Report). McKinsey & Company. https://www.mckinsey.com/mhi/our-insights/the-health-of-nations-stronger-health-stronger-economies

[v] Mbata, A. O., Soyege, O. S., Nwokedi, C. N., Tomoh, B. O., Mustapha, A. Y., Balogun, O. D., Forkuo, A. Y., & Iguma, D. R. (2024). Preventative medicine and chronic disease management: Reducing healthcare costs and improving long-term public health (International Journal of Multidisciplinary Research and Growth Evaluation, 5(06), 1584–1600). https://www.researchgate.net/publication/390694904_Preventative_Medicine_and_Chronic_Disease_Management_Reducing_Healthcare_Costs_and_Improving_Long-Term_Public_Health.pdf

[vi] Eurostat. (2025, March 21). Circulatory diseases – main cause of death in 2022. https://ec.europa.eu/eurostat/web/products-eurostat-news/w/ddn-20250321-2

[vii] Luengo-Fernández, R., Walli-Attaei, M., Gray, A., Torbica, A., Maggioni, A. P., Huculeci, R., Bairami, F., Aboyans, V., Timmis, A. D., Vardas, P., & Leal, J. (2023). Economic burden of cardiovascular diseases in the European Union: A population-based cost study. European Heart Journal, 44(45), 4752–4767. https://doi.org/10.1093/eurheartj/ehad583

[viii] European Federation of Pharmaceutical Industries and Associations. (2025). Cancer care: Comparator Report on Cancer in Europe 2025 – Cancer care overview. https://www.efpia.eu/publications/cancer-comparator-report-2025/cancer-care/

[ix] European Commission. (2025, November 4). Cost of non‑communicable diseases in the EU. Knowledge for Policy – Health Promotion and Disease Prevention Knowledge Gateway. https://knowledge4policy.ec.europa.eu/health-promotion-knowledge-gateway/cost-non-communicable-diseases-eu_en

[x] European Commission, Health and Consumers Directorate‑General. (2014). The 2014 EU Summit on Chronic Diseases: Conference conclusions, Brussels, 3 and 4 April 2014. https://health.ec.europa.eu/system/files/2016‑11/ev_20140403_mi_en_0.pdf

[xi] European Commission. Europe’s Beating Cancer Plan (2021) A cancer plan for Europe – European Commission; Council recommendation on vaccine-preventable cancers (2024) https://ec.europa.eu/commission/presscorner/detail/en/ip_24_519

[xii] European Society of Cardiology. (2025). EU Cardiovascular Health Plan (Public health webpage). https://www.escardio.org/public-health/eu-cardiovascular-health-plan/

[xiii] Behrouzi, B., Bhatt, D. L., Cannon, C. P., Vardeny, O., Lee, D. S., Solomon, S. D., & Udell, J. A. (2022). Association of influenza vaccination with cardiovascular risk: A meta‑analysis. JAMA Network Open, 5(4), e228873. https://doi.org/10.1001/jamanetworkopen.2022.8873

[xiv] Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, Bowie W, Katz K, McGeer A, Semret M, McNeil SA. Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness. J Am Geriatr Soc. 2021 Mar;69(3):696-703. doi: 10.1111/jgs.16950. Epub 2020 Dec 8. PMID: 33294986; PMCID: PMC7984066

[xv] Bettina Heidecker, Peter Libby, Vassilios S Vassiliou, François Roubille, Orly Vardeny, Christian Hassager, Michael A Gatzoulis, Mamas A Mamas, Leslie T Cooper, Felix Schoenrath, Marco Metra, Offer Amir, Scott D Solomon, Ulf Landmesser, Thomas F Lüscher, Vaccination as a new form of cardiovascular prevention: a European Society of Cardiology clinical consensus statement: With the contribution of the European Association of Preventive Cardiology (EAPC), the Association for Acute CardioVascular Care (ACVC), and the Heart Failure Association (HFA) of the ESC, European Heart Journal, Volume 46, Issue 36, 21 September 2025, Pages 3518–3531, https://doi.org/10.1093/eurheartj/ehaf384

[xvi] Nyberg, S. T., Frank, P., Ahmadi‑Abhari, S., Pentti, J., et al. (2026). Adult obesity and risk of severe infections: A multicohort study with global burden estimates. The Lancet. Advance online publication. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02474-2/fulltext

[xvii] Torres A, Blasi F, Dartois N, et al. 2015. Thorax 70(10): 984-9.

[xviii] Vlachopoulos CV, Terentes-Printzios DG, Aznaouridis KA, et al. 2015. Eur J Prev Cardiol 22(9): 1185-99.

[xix] Eyting, M., Xie, M., Michalik, F. et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 641, 438–446 (2025). https://doi.org/10.1038/s41586-025-08800-x

[xx] How greater spending on preventive health can promote economic growth. https://www.weforum.org/stories/health-and-healthcare-systems/preventive-health-europe-economic-growth/

[xxi] El‑Banhawi, H., Chowdhury, S., Neri, M., Radu, P., Hodgson, S., Bell, E., Brassel, S., & Steuten, L. (2024). Socio‑economic value of adult immunisation programmes (Contract Research Report). Office of Health Economics. https://www.ohe.org/publications/the-socio-economic-value-of-adult-immunisation-programmes/

[xxii] Organisation for Economic Co‑operation and Development. (2026). Building healthy, productive workforces for our 21st century: Accompanying issues note for the joint OECD‑GCOA workshop on ageing and long‑term care [PDF]. OECD Publishing. https://www.oecd.org/content/dam/oecd/en/topics/policy-sub-issues/ageing-and-long-term-care/Paper_OECD_GCOA_LTC.pdf

[xxiii] Jones, C. H., Jenkins, M. P., Williams, B. A., Welch, V. L., & True, J. M. (2024). Exploring the future adult vaccine landscape—crowded schedules and new dynamics. npj Vaccines, 9(1), Article 27. https://www.nature.com/articles/s41541-024-00809-z

[xxiv]  Communication from the Commission to the European Parliament, The Council, The European Economic and Social Committee and the Committee of the Regions on an EU cardiovascular health plan: the Safe Hearts Plan

. https://health.ec.europa.eu/document/download/dfb60cde-21a5-426d-8616-e394a326abc2_en?filename=ncd_com-2025-1024_act_en.pdf

[xxv] Steering Group on Prevention of Respiratory Infections. (2025, October). Strengthening EU action on respiratory infections through immunisation: Call for a Council Recommendation on the value of immunisation against respiratory infections [Manifesto]. https://www.vaccineseurope.eu/wp-content/uploads/2025/10/Manifesto_SG-on-Prevention-of-Respiratory-Infections.pdf

[xxvi] Polistena, B., Icardi, G., Orsi, A., Spandonaro, F., Di Virgilio, R., & d’Angela, D. (2022). Cost-Effectiveness of Vaccination with the 20-Valent Pneumococcal Conjugate Vaccine in the Italian Adult Population. Vaccines, 10(12), 2032. https://doi.org/10.3390/vaccines10122032

[xxvii] Tobalina, B. (2025, November 17). Muy lejos de llegar al objetivo de vacunación de neumococo en mayores. La Razón. https://www.larazon.es/salud/muy-lejos-llegar-objetivo-vacunacion-neumococo-mayores_202511176916042ceba8bc0ecef64ebd.html

[xxviii] Organisation for Economic Co‑operation and Development. (2022). Promoting health and well‑being at work: Policy and practices (OECD Health Policy Studies). OECD Publishing. https://www.oecd.org/en/publications/promoting-health-and-well-being-at-work_e179b2a5-en.html

[xxix] OECD & European Union. (2022). Health at a glance: Europe 2022: State of health in the EU cycle. OECD Publishing. https://www.oecd.org/content/dam/oecd/en/publications/reports/2022/12/health-at-a-glance-europe-2022_b73a1698/507433b0-en.pdf

[xxx] The Impact of Ageing on the Fiscal Sustainability of EU Health Care Systems: Projections and Policy Responses. https://economy-finance.ec.europa.eu/publications/impact-ageing-fiscal-sustainability-eu-health-care-systems-projections-and-policy-responses_en

[xxxi] OECD 2025. Building Health, Productive Workforces for Our 21^st Century. Paris. OECD Publishing. https://www.oecd.org/content/dam/oecd/en/topics/policy-sub-issues/ageing-and-long-term-care/Paper_OECD_GCOA_LTC.pdf

[xxxii] International Monetary Fund. (2025, April). World Economic Outlook, April 2025: A critical juncture amid policy shifts [PDF]. https://www.imf.org/-/media/files/publications/weo/2025/april/english/text.pdf

[xxxiii] New Economic Governance Framework. https://economy-finance.ec.europa.eu/economic-governance-framework/what-economic-governance-framework/evolution-eu-economic-governance/new-economic-governance-framework_en

Authors

• 
  Laetitia Bigger Director, Vaccines Policy l.bigger@ifpma.org
• 
  Sibilia Quilici Executive Director, Vaccines Europe
• 
  Michael Hodin CEO, Global Coalition on Aging