Korea considers adding enhanced flu vaccines to NIP for people aged 75 and older

Korea is moving toward formal discussions on introducing enhanced influenza vaccines for people aged 75 and older under the National Immunization Program (NIP). These vaccines are designed to generate stronger immune responses than standard-dose vaccines.

The move comes as the Korean Senior Citizens Association has called for the phased introduction of such vaccines, starting with high-risk older adults.

The Korea Disease Control and Prevention Agency (KDCA) has also included the issue among its priority policy items for review in the second half of this year.

Lee Joong-geun, chairman of the Korean Senior Citizens Association, met with KDCA officials, including Jeong Tong-ryeong, director-general of the Bureau of Healthcare Safety and Prevention, and Lee Hye-rim, director of the Division of Immunization, on July 31 to discuss ways to improve the national vaccination program for older adults.

During the meeting, Lee stressed that influenza vaccination policy for older adults should shift from simply increasing vaccination rates to improving vaccine effectiveness. He argued that the introduction of enhanced vaccines should be accelerated to reduce influenza-related disease burden and deaths among older people.

Enhanced influenza vaccines are designed to induce stronger immune responses in older adults, whose immune function declines with age. They include high-dose and adjuvanted vaccines. High-dose vaccines, in particular, contain four times as much antigen as standard-dose vaccines.

In response, Director-general Jeong said the KDCA was reviewing relevant policy proposals to improve the NIP and would work to reduce mortality among older adults.

Korea is considering introducing enhanced influenza vaccines, designed to generate stronger immune responses than standard-dose vaccines, under the National Immunization Program (NIP) for people aged 75 and older.(Credit: Getty Images)

Vaccination rate tops 80%, but hospitalizations and deaths concentrated among older adults

The growing discussion over which type of influenza vaccine should be used for older adults reflects the persistently high disease burden despite high vaccination rates, raising the question of whether enhanced vaccines should be used in place of standard-dose vaccines for some older adults.

Influenza vaccination coverage among people aged 65 and older in Korea has remained above 80 percent. However, about 70 percent of influenza-related hospitalizations and more than 80 percent of influenza-related deaths in the country occur among people aged 65 and older.

Immunosenescence, the age-related decline in immune function, is also considered a major factor reducing vaccine effectiveness. Even when given the same vaccine, older adults may develop weaker immune responses and receive less protection than younger people.

According to a review published in the European Respiratory Review in 2021, standard-dose influenza vaccines showed effectiveness of 70 percent to 90 percent in healthy adults, compared with 17 percent to 53 percent in people aged 65 and older. A study involving eight university hospitals in Korea that analyzed influenza vaccine effectiveness during the 2023-2024 season estimated effectiveness at about 14 percent among people aged 65 and older.

Against this backdrop, calls are growing for influenza vaccination policy for older adults to move beyond maintaining high vaccination rates and instead focus on how effectively vaccination reduces hospitalizations, severe illness and deaths, an issue now at the center of the policy debate.

Ahead of the June 3 local elections, the senior citizens association proposed that political parties phase in high-dose influenza vaccines, starting with high-risk people aged 75 and older. The proposal was included in the local election pledges of both the ruling Democratic Party of Korea and the main opposition People Power Party.

KDCA prioritizes review of enhanced vaccines for people 75 and older as other countries adopt age-specific recommendations

The KDCA is also formally reviewing whether to introduce enhanced influenza vaccines for older adults under the NIP.

In its "Key Initiatives for the Second Half of 2026," presented during a presidential policy briefing on July 16, the agency identified the introduction of enhanced influenza vaccines for people aged 75 and older as a priority issue for consideration under the NIP.

The KDCA plans to consider age-specific disease risks and fiscal conditions in determining whether to introduce the vaccines. At the time, the agency said stronger protection for older adults may require a transition to vaccines offering greater preventive effectiveness, making cost and risk central to the decision.

Other countries have already adopted different influenza vaccine recommendations based on age and risk.

In the United States, the Advisory Committee on Immunization Practices under the Centers for Disease Control and Prevention (CDC) has preferentially recommended high-dose, recombinant or adjuvanted influenza vaccines for people aged 65 and older since the 2022-2023 season. Germany's Standing Committee on Vaccination (STIKO) also recommends high-dose influenza vaccines for people aged 60 and older.

Similar policies are being introduced in Asia. Taiwan will begin providing high-dose and adjuvanted influenza vaccines in the 2026-2027 season, initially targeting people aged 65 and older in long-term care and welfare institutions. Japan has added high-dose vaccines as an option alongside standard-dose vaccines under its national immunization program for people aged 75 and older.

If Korea introduces enhanced vaccines into the NIP in phases, beginning with people aged 75 and older, it could mark a shift in influenza prevention policy for older adults from a focus on vaccination coverage toward reducing severe illness and deaths.