The Economic Affairs Committee launched an inquiry to investigate the impact of ageing on the UK economy and society, and the policies necessary to adapt to this future. The following is an extract from OHE’s written submission to parliament focused on raising population health in older age and increasing access to fertility treatments as two possible avenues to address the challenges of demographic change.

Overview
The UK is confronting a seismic demographic shift with an ageing population and declining fertility rates. In preparing for this change, it is critical that we shift how we think about health across our lifecycles. The focus should shift from illness care to health care: being prepared to prevent, rather than react to pressing health issues; and from ageing to longevity: appreciating the economic and societal value potential of people across their lifecycle.

Keeping people productive and in employment for longer is critical to countering a shrinking workforce

Estimates of the loss to the UK economy due to ill-health related absenteeism and presenteeism at work were approximately £92 billion in 2019, with three-quarters attributed to poor mental well-being and unhealthy lifestyle choices that are preventable.

Carers also disproportionately suffer the impact of vaccine-preventable illnesses. Our research found that in the UK, the burden of respiratory infections is higher for women, possibly because people with greater caregiving responsibilities, particularly for children, may face increased impacts from respiratory infections.

1. It’s clear that investing in better population health can help avert productivity losses and can lead to substantive socioeconomic pay offs. The question therefore is what policies might help achieve that. We recommend that UK policymakers consider the following to achieve this end:

• While substantial progress has been made in childhood immunisation, the value of adult immunisation programmes often remains overlooked. The UK has a limited adult immunisation framework, offering only 5 out of 18 possible programmes, and only targeting people mostly over the age of 65.
• Last year, OHE published a first-of-its-kind analysis of adult immunisation programmes commissioned by IFPMA, looking at four adult vaccines (against influenza, pneumococcal disease, respiratory syncytial virus (RSV), and herpes zoster (shingles)) across across ten countries that represent a range of healthcare systems, demographics, and vaccine schedules: Australia, Brazil, France, Germany, Italy, Japan, Poland, South Africa, Thailand, and the United States.
• Our research concluded that adult vaccines can return up to 19 times their initial investment to society, when their significant benefits beyond the healthcare system are monetised. This is the equivalent of up to $4637 for one individual’s full vaccination course.
• In addition, we’re currently conducting focuses on adult respiratory vaccination in the UK, and initial results were recently presented at the ESCMID Global 2025. Our findings indicate that in the UK, social benefits of adult respiratory vaccination programs far exceed their costs, with a net benefit of £24.7 billion in the first year alone, amounting to 1.07% of UK GDP.
• Our research shows that existing HTA methods and recommendations by the Joint Committee on Vaccination and Immunisation (JCVI) rarely consider the full value of immunisation programmes. For example, vaccines have significant value in maintaining health system capacity under times of severe excess demand or can deliver a positive return on investment to the treasury when wider productivity effects are accounted for. This is all the more important given that the burden of vaccine-preventable diseases is projected to rise, and undervaluation can lead to underfunding and hence threaten societal welfare.
• Finally, the UK’s uptake of adult vaccines that are widely available (e.g. HPV or flu) is relatively high when compared internationally. Therefore, given what we know about the societal value generation potential (19x) of adult immunisation, other immunisation programs (such as for respiratory infections) could play a stronger role as a key preventative measure for those aged 50-64 – keeping an ageing workforce in better health for longer.

2. Employer-led preventative measures can avert productivity losses and can ensure a healthy workforce at all ages

• Ill health has a substantive impact on the national economy. According to ONS data, nearly 2.5 million people in the UK are out of work due to long term ill health. For those economically inactive due to long-term sickness, nearly two-fifths (38%) had five or more health conditions, implying interlinked and complex health issues.

Although much of the national attention on illness and productivity losses have focused on long term illnesses, our research finds that short term infections bear a substantive and underestimated cost to the economy.

Our recent report, funded and commissioned by Pfizer, found that short-term respiratory infections cost UK business £44 billion a year in productivity losses, with presenteeism (working while ill) costing more than absenteeism.

• ONS data shows that the highest sickness absence rates at work in 2022 were in people aged 65 and over, with the highest overall absence rates taken by men aged 50-64. Notably, the sickness absence rate rose for all age groups in 2022 compared to previous years.

Our report found no statistically significant age-based differences in the number of days reported as absenteeism and presenteeism for the respondents in our sample (in absolute terms, numbers were actually lower across the board for individuals aged 55+, compared to those in all age categories under the age of 55). This suggests that older employees may have more flexible work arrangements or may feel a stronger sense of responsibility to avoid taking time off. These attitudinal differences are supported by the literature, which shows that older survey respondents assess their health more positively.

By 2031, 23% of the UK’s workforce is predicted to be over 55, and older age brings about increased risks from infections like influenza, RSV, and pneumococcal pneumonia. This suggests an increasing need for investing in preventative measures to ensure a productive and healthy workforce at all ages – which is especially important within the context of a shrinking workforce.

Further, given that the majority of people leave the workforce due to long term / chronic conditions, including poor mental health, early detection and intervention should necessarily form an important part of prevention.

3. With the constraints on existing NHS funding greater than ever, alternative ways of funding prevention are critical

Our 2023 Prevention White Paper proposed considering innovative financing both within and outside NHS budgets to invest in public health programmes, including social impact bonds and a dedicated prevention fund (as is used for cancer and innovative medicines).

In the case of averting productivity losses for businesses, employer-led preventative measures — including vaccinations, hand washing, mask-wearing and social distancing — have the potential to deliver significant returns on investment (ROI) for employers.

With most working-aged adults ineligible for NHS-provided respiratory vaccinations, workplace vaccination programs could also reduce the burden imposed by respiratory infections on employers, as they have demonstrated effectiveness in mitigating absenteeism and presenteeism. This is one measure that could prove effective in improving workforce health, particularly for those aged 50+, in the short to medium term.

Our recently published ‘cost calculator’, developed by OHE and commissioned by Pfizer, gives employers tailored an estimate of costs to their business due to respiratory infections. This is an example of one tool that can help guide decisions around investing in preventative health measures in the workplace and underscores the role of the private sector in easing the strain on the NHS and playing a larger role in averting productivity losses within their workforce.

Innovative policies to counter falling birth rates are critical in the context of currently projected demographic trends.

• The latest ONS data shows that in 2023, the total fertility rate (TFR) in England and Wales dropped to its lowest value on record (1.44 children per woman).
• Advances in quality of life – with more women participating in the workforce, having advanced degrees, able to access contraception, and facing reduced stigma around childlessness – means that being child-free is more of an option.
• In general, countries with higher human development indices have lower rates of childbirth. When child mortality is low and child labour is not practised, parenthood goals have naturally shifted, where people are more likely to have fewer children, aiming to be able to provide those children with the best possible education and future (sometimes referred to as a preference for “quality” over “quantity”)
• Research by the Centre for Longitudinal Studies shows that in the UK, financial and employment constraints are also viewed by many as major challenges and key reasons for postponing parenthood.
• Nearly all European countries are experiencing similar long-term downward trends in population fertility. With more people postponing parenthood it is also expected that the number of people seeking treatment for infertility will increase in the coming years, given the increasing risk of infertility and subfertility with age.

OECD (2024), Society at a Glance 2024: OECD Social Indicators, OECD Publishing, Paris, https://doi.org/10.1787/918d8db3-en.

Recommendation: Investing in universal, publicly funded fertility treatments will have some positive impact on fertility rates.

• According to the WHO, 1 in 6 prospective parents have experienced infertility at some point. Supporting these prospective parents with fertility treatments will have some positive effect on fertility rates, although any impact will be moderated by changing parenthood goals – in particular the growing preference for smaller families.
• Our research – which comprises a large, multicountry study, including the UK – on public attitudes towards infertility concludes that there is public support and willingness to pay for funding national fertility treatments programmes for prospective parents.
• A majority of respondents in our age-gender nationally representative public samples agreed that infertility was a treatable medical condition, and supported the idea that all infertile individuals should have access to treatments that improve the chance of conception. A majority also agreed that the desire for children is a basic human need.

Our research confirms strong support for the principle of universal fertility treatments for all infertile individuals. Most respondents also supported at least some increase in their taxes or insurance premiums to fund this access. In the UK, nearly 50% of respondents supported contributing some funding towards this access; notably there wasn’t majority support for full funding of fertility treatments.

• It’s important to note that although there is data to support public willingness to pay for universal fertility treatments, similar initiatives in countries like Hungary have seen limited success. This suggests that even with increased access to treatments, changing social attitudes towards parenthood may have a bigger impact on fertility rates. Therefore, whilst fertility programmes may ‘soften the landing’, and provide wellbeing and life satisfaction benefits to subfertile parents, they are unlikely to reverse current demographic trends.

Conclusion

Research from OECD concludes that we should prepare for a “low-fertility future”, which includes considering how immigration, bringing under-represented groups into the workforce, and improvements in productivity could help to address the challenges of the demographic contraction.

Within this paradigm, keeping as many people as healthy and productive as possible – for as long as possible – is a requisite measure in addressing a shrinking workforce. Health economics is critical to achieving this goal, balancing both budget considerations with the long-term imperative to reduce the strain on healthcare systems and drive productivity. Investing in prevention is a key part of this. Expanding access to vaccinations for a broader adult population can generate more value and higher net cost savings for healthcare systems and society. Adult immunisation programmes present a critical opportunity to help our societies age well and sustainably long into the future – and deliver an excellent return on investment in the process.

In the long run, population decline is the fundamental challenge to address. Tackling this requires multi-factorial solutions, one of which includes investing in universal, publicly funded fertility programmes to support prospective parents – which will have some impact on fertility rates but which alone is unlikely to be sufficient in reversing declining birth rates.