Life-time immunization and influenza vaccination uptake

#TogetherAgainstFlu - 18/01/23

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By Paula Barbosa

Paula Barbosa, #TogetherAgainstFlu Editorial Board Member

Vaccination – one of the greatest health success stories of the twentieth century – has been in sharp focus over the past few years due to the COVID-19 pandemic. It highlighted the power of immunization but also shortcomings in our systems, which were more used to focusing on pediatric vaccination and not well prepared to immunize adults. Vaccines are a critical component of control of many infectious diseases across all ages, yet only a few countries (such as the US, the UK, and Australia) have effectively implemented a life-course approach to immunization (LCI) in line with recommendations in the WHO Global Vaccine Action Plan 2011–2020 (GVAP) and the Immunization Agenda 2030 (IA2030). 

With this in mind, IFPMA’s new publication, “Life-course immunization: Benchmarking main markets & model countries” provides a deep dive into the facts, figures and case studies from each world region, including suggestions on how we can do better to adapt national immunization plans to ensure protection at all stages of life.  

Looking at seasonal influenza, for instance, the flu shot is the most frequently recommended and monitored vaccine in adulthood (56% in 195 countries). However, influenza vaccination coverage remains suboptimal almost everywhere. Very few countries reach the 75% coverage rate for risk groups recommended by WHO. 

Influenza has a considerable toll on lives, economies, and healthcare resources. Vaccination against influenza could significantly reduce the prevalence of severe adverse effects of infection such as heart attacks. The costs of the disease remain persistently elevated: for example, influenza alone resulted in £128 million in hospital costs in England over 2017-2018. 

At the national level, only the United States has come within range of the WHO’s 75% target for flu immunization coverage targets for vulnerable populations. In the EU, 27 countries have established the 75% mark as a target for all groups eligible for the vaccine, yet countries are falling short of this target. For example, in Germany uptake of the flu vaccine amongst pregnant women was as low as 13% across the 2015-2018 period. 

One study calculated that if this 75% target is achieved, average annual influenza-related events would be reduced by 1.6 to 1.7 million cases, 23,800 to 31,400 hospitalizations, and 9,800 to 14,300 deaths. 

With an aging population, the societal need to prolong healthy living in the face of waning immunity means that new methods will be necessary to deliver integrated, people-centered vaccination services, expand protection with existing vaccines, and incorporate new vaccines as they become available for older age groups.  

Healthcare workers (HCWs) play an essential role in the fight, as they are a highly trusted resource to encourage influenza vaccine uptake (particularly among vulnerable groups) and fight misinformation. Yet vaccine uptake among HCWs themselves is often poor, even though they are generally more at risk of catching the flu and are often in contact with vulnerable patients with low immune systems. One large cross-sectional study in England compared high and low-performing areas and found that low vaccine uptake among HCWs is often the result of a lack of easy access, or a lack of communication strategies to highlight the need and availability of vaccination. This means that HCWs cannot set the example they should for patients. 

With all this in mind, initiatives among healthcare workers are a key tool in the fight to expand coverage. There is a well-documented positive effect of HCW recommendations on patients’ vaccine acceptance and uptake. More education and expanding access to easy-to-access sites appears to be critical. Please read the full publication to find out more statistics, case studies and essential recommendations.