Increasing life-course immunisation
Overview of Life Course Immunisation
Life-course immunisation refers to immunisation from childhood through to adulthood and even for the elderly population. A life-course approach recognizes the role of immunisation as a strategy to prevent disease and to maximize health over one’s entire life, regardless of age. A life-course approach requires that immunisation schedules and access to vaccination respond to an individual’s stage in life, their lifestyle, and specific vulnerabilities/risks to infectious disease that they may face.
Life-course immunisation holds significant benefits at the individual, population and socioeconomic levels. For example, immunizing an ageing population facing the onset of chronic conditions such as diabetes, lung disease, and/or cardiovascular disease seeks to avoid development of serious complications from vaccine-preventable illnesses like influenza or pneumococcal disease. According to WHO, immunisation saves 2-3 million deaths per year and is widely recognized as one of the world’s most successful and cost-effective health interventions. Life-course immunisation holds significant value to developed countries as well as those seeking to evolve forward from lower or middle-income status. A recent study headed by the Johns Hopkins Bloomberg School of Public Health revealed that vaccinations yield a return of $44 on every $1 spent on immunisations for families in LMICs.
Immunisation across the life-course is a cost-effective way to improve health, support health system sustainability, and promote economic prosperity. Effective vaccination may furthermore help mitigate risks such as antimicrobial resistance (AMR) that occurs from the misuse of antibiotics against infectious diseases, which in itself is projected to consume 10 million lives each year by 2050 if not addressed in an urgent way.
Among the preventable infectious diseases, seasonal influenza (flu) has been a major burden on public healthcare. Annually it is estimated that the flu attacks 5-10% of adults and 20-30% of children globally, causing significant levels of illness, hospitalization, and even death. A recent modelling study of flu-associated mortality estimated there were up to 645,000 deaths per year .Such a burden results in increased healthcare costs, not to mention workplace absences and reduced productivity. Countries must seek to increase life-course immunisation coverages rates, especially for the high-burden disease areas like influenza/ flu..
Problem statements of Life Course Immunisation
Problem statement #1: Awareness and confidence
A lack of awareness of the importance and value of vaccination, particularly for adult and elderly populations, is a commonly reported issue in the Asia-Pacific region. Similarly, hesitancy around vaccinations is another barrier to sufficient flu protection. For example, when flu vaccination is not included as part of compulsory schedules, “voluntary immunisation” might lead people to think that such vaccines are non-essential and therefore undermines vaccine confidence required to achieve strong coverage rates. Data shows that a commitment to annual vaccination is important given that the flu is unpredictable, owing to virus mutation.
- How can we improve vaccine confidence in the Asia-Pacific, leading to an understanding of the importance of annual vaccination and increased uptake?
- How can best practices from other regions such as US, UK, Canada, and Australia be leveraged?
- How can the solution work across stakeholders, including policymakers, healthcare practitioners, NGOs, pharmaceutical companies, and patient cohorts?
Problem statement #2: Financial barriers
Although the benefits of life-course immunisation significantly outweigh the implementation investment, the “perceived cost” remains a key barrier to wide-scale adoption of vaccination programs in the Asia Pacific region both at the individual and governmental levels. A study conducted in Singapore found that uptake of vaccines is greater among individuals with higher household income. At the government level, the costs associated with vaccine acquisition, delivery, and surveillance is cited as a primary barrier to the implementation of a comprehensive life-course vaccine schedule. Such a barrier is even more prominent among the low and middle-income countries in the Asia Pacific region with fewer resources that can be attributed to health and long-term care services. As we are entering “The Decade of Healthy Ageing” (endorsed by WHO), it is more important than ever to invest in holistic immunisation programs so as to reduce the threats of infectious disease on the aging population.
- What could be creative and sustainable funding concepts that health system stakeholders can leverage to finance life-course immunisation, and what would be the expected benefits/outcomes?
- Which players need to be involved to ensure the solution is adopted and scaled appropriately?
Problem statement #3: Surveillance and data collection
Monitoring vaccinations, especially into adulthood and beyond, is a challenge in the Asia-Pacific. The lack of integrated health records or vaccination registers to track the uptake rates of adult vaccination directly affects proper development of good public health policy, as well as leading to a gross underestimation of the problems and consequences on individuals and wider society . As a result, surveillance and data collection of adult vaccination programs is seen as a key barrier toward achieving life-course immunisation program implementation. Moreover, disease-specific data is limited in some countries. For example in India, surveillance efforts for Japanese Encephalitis are hindered by lack of diagnostic facilities in some regions. For life-course immunisation to be prioritized and adequately resourced, we need greater evidence generation.
- How can countries leverage on new health solutions (including digital tooling but also other creative mechanisms) to develop disease surveillance plans and a coherent immunisation database in order to more effectively monitor coverage rates and impact?
- What are some examples of KPIs that could be measured and therefore used to design proper life-course immunisation policies in the near-term future?
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