Vaccine guidelines that advocate immunisation in adults aged ≥ 60 years and an international policy brief that explores the importance of life-course vaccination have been proposed. The guidelines, policy brief and associated data were considered by experts at two meetings during 2009. This paper amalgamates those discussions and recommends practical strategies that may contribute to the successful implementation of adult vaccination. The challenges posed by changes in the global age distribution may be confronted by preparing for healthy ageing early in life – a ‘life-course’ approach to health. Vaccination can provide cost-effective protection against a host of diseases throughout life, but remains an underused public-health strategy in adults for the promotion of healthy ageing. Without specific vaccination programmes for the adult population aged ≥ 50 years (‘50+ vaccine programmes’) infectious diseases will continue to be a cause of substantial morbidity and mortality in late adulthood. The reasons for low vaccination rates among adults (‘what we know’) are identified and the four common determinants for the successful implementation of 50+ vaccination programmes (‘what we should do’) are examined: vaccination programme objectives, the role of healthcare professionals, access to vaccines, and public awareness. To achieve the goal of healthy ageing, nationally customised measures should be instigated to address these determinants in the 50+ age group and to ensure access to vaccination for those who are expected to benefit.