POLICY REPORTS

LifeCourse Immunisation and Health Systems Resilience Report 2020

At the 5th Life Course Immunization Summit, the Working Group on LifeCourse Immunization and Health Systems Resilience examined how COVID-19 exposed the fragility of single-focused health systems and shifted public attitudes towards vaccination. Across seven themes, from health systems resilience to maternal vaccination, the Group set out observations, challenges, strategies, and a slate of actions to advance a life-course approach to immunization.

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5th Life Course
Immunisation Summit
December 2020

Working Group on LifeCourse Immunisation and Health Systems Resilience

Observations, Challenges, Strategies and Actions

Health Systems Resilience
Observations
Many Health Systems Are Currently Single-Focused in Terms of Capacity and Structure
  • COVID-19 caught health systems everywhere in the world off-guard.
  • They were not prepared to take care of health issues that were already existing in the world.
  • Diabetes care, hypertension and cancer services have suffered immensely since the COVID-19 pandemic began.
  • WHO is looking into cause mortality during COVID-19 and will report back.
  • There was a significant drop in routine vaccine coverage in the first few months (March–June 2020) of the COVID-19 crisis.
Challenges
Single-Focused Healthcare Systems Are Not Capable of Handling More Than One Health Issue
  • Many health systems have been forced to commandeer all of the health systems for a single disease.
  • Many health systems are not resilient enough to handle more than one disease at a time.
  • Health systems are working in response mode, and this must change to instil trust and confidence going forward.
  • There should be a health system recovery, which should happen along with the response measures being made in countries during COVID-19.
Strategies
Strengthening Attention on Information Systems, Services, Workforce, Supply Chains and Vaccines
  • Essential to have strong national leadership and governance, institutional support and buy-in from partners who are not used to this approach.
  • Essential to have communication and support between the teams involved in health system strengthening.
  • Factor in open sharing of data and other relevant information for integrated solutions, then commit and fund to sustain them during the acute emergency as well as afterwards.
  • During outbreaks there is heightened awareness among policy planners, but it is essential not to move on to the next crisis without learning from the COVID-19 pandemic.
Increased Acceptance of Vaccinations
Observations
There Has Been an Increased Willingness of the Public to Get Vaccinated as a Way Out of the Pandemic
  • The vast majority of people consider COVID-19 vaccination as necessary for a return to normality.
  • The whole sphere of demand and uptake of vaccinations after the pandemic may be completely different from before, with widespread acceptance and demand across all ages.
  • Before the pandemic, we understood the spectrum of vaccine hesitancy across regions and socioeconomic characteristics.
  • After the pandemic, we do not know how demand for vaccines and willingness to get vaccinated will be distributed across different population strata.
Challenges
Established Norms and Our Understanding of Vaccine Hesitancy Have Shifted in the COVID-19 Era
  • A once-in-a-generation opportunity for LifeCourse vaccinations has emerged.
  • Public confidence must not be undermined by the organisational aspects of demand and supply of immunisation services during and after the pandemic.
  • Demand and willingness across population strata is now uncertain and must be measured.
Strategies
A Once-in-a-Generation Opportunity for LifeCourse Vaccinations
  • Utilise the public experience from the pandemic to relaunch the value of public health, with particular reference to preventive immunisation.
  • Ensure that the organisational aspects around demand and supply of immunisation services during and after the COVID-19 pandemic won't undermine public confidence.
  • Measure the demand and vaccine uptake among different groups of the population.
Increased Acceptance of Vaccinations
Observations
The Delivery of Preventive Services Has Been Negatively Impacted During the COVID-19 Pandemic
  • Both the mechanisms and the delivery of preventive services have been negatively impacted by the shift towards COVID-19 clinical management.
  • In the early stages, parents delayed or put off immunisation sessions because of fear and confusion.
  • School-based vaccination programmes were impacted for HPV and others.
  • The daily work of private practices was disrupted during lockdowns, and routine vaccinations were cancelled.
Challenges
There Has Been a Shift in Risk Perceptions Towards Infectious Disease, Protection and Prevention
  • A considerable effort is needed to bring back trust and the efficiency of routine immunisation services.
  • We are now dealing with a different risk perception towards infectious diseases, meaning people are more sensitive towards protection and prevention than before.
  • A different risk perception also means a different perception towards vaccines overall, not just COVID-19 vaccines.
  • Vaccine hesitancy still exists across Europe and is changing as the pandemic evolves.
Strategies
An Opportunity to Relaunch the Value of Prevention, Prioritising a Life Course Immunisation Approach
  • Utilise the public's experience from the pandemic to establish the importance of preventing all vaccine-preventable diseases through immunisation.
  • Establish a multidisciplinary approach engaging healthcare professionals across all specialties to promote life course vaccinations.
  • Utilise efforts to get routine vaccinations back on track to reassure the public's perception of vaccine safety, efficiency and necessity.
Increased Acceptance of Vaccinations
Observations
The Current Expectation Is That Most People Will Have to Receive a COVID-19 Vaccine or Booster Annually
  • It is expected that all ages and all social groups will have to be vaccinated annually against COVID-19, making it a true Life Course vaccination.
  • All ages and groups will eventually, at some stage, be in contact with the immunisation services to get vaccinated against COVID-19.
Challenges
Through COVID-19 Vaccines, We Will Establish Annual Contact with People Across All Ages and Social Groups
  • Overcoming COVID-19 vaccination hesitancy, widely perceived to allow a return to normality, won't necessarily help overcome hesitancy against other vaccinations.
  • With COVID-19 being the primary concern, it is difficult to switch focus to include other vaccine-preventable diseases.
Strategies
We Must Utilize the Annual Contact to Vaccinate People with All the Appropriate Vaccines for Their Age and Group
  • Utilise the annual COVID-19 vaccination to build a one-stop Life Course immunisation approach.
  • Engage HCPs to utilise their contact for COVID-19 vaccination, bringing up other vaccinations of interest in the particular target or age group.
  • Utilise the public's positive attitude towards COVID-19 vaccination to create willingness for other vaccines offered simultaneously.
Influenza & COVID as Part of Life Course
Observations
There Has Been a Significant Increase in Influenza Vaccinations in 2020/21
  • Widespread campaigns to increase influenza vaccine uptake and alleviate pressure on healthcare services reached 60% coverage in France — a rate not seen for the past two decades.
  • The COVID-19 vaccine will be highly given in nursing homes, to both residents and carers. It is the first time in history that the elderly are in the frontline of the vaccination programme.
Challenges
The COVID-19 Vaccine Is Delivered Through Parallel Systems and Not Through the Primary Health System
  • Many EU countries deliver COVID-19 vaccinations through parallel systems, not through their primary organised prevention system responsible for other vaccinations.
  • With adults being a priority for COVID-19 and influenza vaccination, there is a shift, for the first time in history, towards vaccination in adulthood.
  • COVID-19 mortality rates among the elderly establish and reinforce the need to get vaccinated and protected.
Strategies
A Life Course Approach to Vaccines Is Needed, Starting with Care Homes and the Elderly
  • Utilise the momentum of adults being a priority for protection to achieve high uptake for all vaccinations, especially among the 70+ population.
  • Utilise the newly acquired willingness to get vaccinated against COVID-19 to increase influenza vaccination across adults.
  • Establish that adulthood protection against all vaccine-preventable diseases, and the need to avoid unnecessary hospitalisations, should remain a priority for the years to come.
Healthcare Professionals Education
Observations
Vaccinations Are Not a Concern for Most Medical Specialties
  • Vaccination is not considered an area of concern for most specialists.
  • Immunisation expertise is not transferred across all HCPs, with most specialists abstaining from advocating vaccination to their patients.
  • Wider healthcare professionals are not trained to understand immunisation and do not follow developments in vaccine technology, leaving them ill-equipped to explain and persuade patients on safety, efficiency and necessity.
Challenges
Specialty-Centric Medicine Creates Additional Challenges to Overarching Issues
  • With healthcare professionals focusing on their specialty-related conditions and areas, a holistic approach to health prevention is often overlooked.
  • Cross-specialty education is challenging, with professionals reluctant to engage with issues they do not consider within their scope or workload.
  • The experience acquired by child healthcare professionals and paediatric nurses involved in the vaccination of children is lost when moving from Child Course to Life Course vaccination strategies and programmes.
Strategies
Transfer the Acquired Knowledge to Other Specialties
  • Create a level of knowledge on vaccination across all healthcare professionals, irrespective of their specialty.
  • Mobilise healthcare professionals across the spectrum to engage in prevention through immunisation, by getting vaccinated and advocating vaccination to patients at every opportunity.
  • Enhance the multidisciplinary approach to immunisation by engaging all healthcare workers in knowledge transfer and experience sharing, learning from one age group and transferring the lessons to others.
Risk from COVID Vaccine Rollout
Observations
Mass Vaccination Against COVID-19 Could Create Problems for Other Vaccinations
  • Simultaneous vaccination at the current scale is unprecedented in history, creating a greater risk that ordinary events are attributed to vaccine administration.
  • During the short period while post-vaccine immunity establishes, there will be infections that could inflame anti-vaccination rhetoric.
  • High expectations that the vaccine will stop the pandemic very fast could create disappointment and jeopardise trust in vaccines in general.
Challenges
Increased Interest and Expectations Could Create Problems
  • Even if new vaccines have been tested thoroughly for safety, any alleged adverse events will attract interest and could jeopardise confidence in vaccine safety in general.
  • The public may find it challenging to understand and scale safety and efficiency the way that scientists do.
  • Managing expectations in the middle of a social and economic crisis is challenging, especially when trying to create the enthusiasm to increase uptake and build community immunity fast.
Strategies
Assessing Any Reported Adverse Reactions and Dispelling Misconceptions Is Crucial
  • Utilise the increased public interest to establish a level of objective understanding of vaccine safety and efficiency.
  • Mobilise task forces working on pharmacovigilance to assess any issues reported after vaccination and prepare them to dispel misconceptions that could create hesitancy immediately.
  • Use the great demand opportunity created by the disease threat to build sustainable and long-lasting demand for vaccination after the pandemic ends.
Maternal Vaccination
Observations
We Are Falling Behind with the Vaccination of Pregnant Women
  • We don't currently adopt or embrace strategies focused on the vaccination of pregnant women.
  • Maternal vaccinations are often not offered by HCPs, or not taken up even though they are available.
  • The COVID-19 vaccine complicates things in the short term, since many immunisation trials (certainly at this stage) do not study pregnant women.
Challenges
New Challenges in the Vaccination of Pregnant Women Are Emerging
  • The five C's of vaccines are needed: convenience, confidence, competency, cultural acceptance and now COVID.
  • With the number of women working in healthcare, there will be cases offered the vaccine while they are pregnant.
  • With COVID-19 being a priority, the focus is shifting away from pregnant women and vaccination in the short term.
Strategies
A "Two Lives Protected with One Shot" Approach Needs to Be Taken and Promoted
  • Make maternal vaccination a top priority in each country.
  • Establish a cross-specialty collaboration between gynaecologists and paediatricians to ensure that the mother and the child are protected with one shot.
  • Utilise maternal vaccination to build a consensus towards a LifeCourse immunisation policy.

Life Course Suggested Actions and Campaigns 2021/22

  • Routine Vaccination Campaign — with the focus of governments on COVID-19, the healthcare community needs to step in and communicate with patients on the necessity of not missing their scheduled vaccinations.
  • HCPs Advocating Vaccines in Every Consultation Campaign — with the focus on protecting elderly people from COVID-19, healthcare professionals of all specialties in contact with elderly people need to advocate for all vaccinations.
  • HCPs Educational Campaign on New Vaccine Technology — increase knowledge of vaccine technology among healthcare professionals across all specialties, nurses and pharmacists. An online training programme will offer a deep understanding of the various technologies, their mechanisms, and each technology's pros and cons.
  • An HCP-Focused Maternal Vaccinations Campaign — Two Lives, One Shot — a campaign communicating the benefits of maternal vaccination, to be organised targeting both gynaecologists and paediatricians.
  • Maternal Vaccinations Social Media Campaign to the Public — Two Lives, One Shot — a social media campaign targeting pregnant women (who during pregnancy are searching online for information), answering the most frequently asked questions and informing on the importance of vaccination to protect herself and the child.

Life Course Suggested Actions and Campaigns 2021/22

  • 2021 Expert Working Group on Increasing Maternal Vaccination Rates Across Europe — an expert group should be established on strategies to increase pregnant women's vaccination as an integral part of a Life Course immunisation policy and approach.
  • HCP-Led Pharmacovigilance Task Force — assessing any issues reported after COVID-19 vaccination and preparing to immediately dispel any misconception that could create hesitancy among the public.
  • HCP-Led Vaccination and Health System Resilience Planning Groups — making the most of the heightened awareness among policy planners to plan and prevent the next crisis through a life-course vaccination approach, instead of moving reactively to the next crisis without learning from the COVID-19 pandemic.
  • 2021 Expert Working Group on HCP Vaccination and Leading by Example — an expert group should be established on interventions to increase vaccination uptake among healthcare professionals, to demonstrate the importance of vaccines by advocating to patients and leading by example.

Contributors

Jess McNamara (EPSA) • Daphne Holt (CLCI) • Nenad Miljković (EAHP) • Mihai Craiu • Barbara Rath (ViVI) • Mariano Votta (ACN) • Roy Philip • Catherine Weil-Olivier • Silvia Romeo (Think Young) • Marianne Chagnon (UEMS) • Elizabeth Adams (EFN) • Alison Maaasen (EuroHealthNet) • Maria Viegas (EMSA) • Sam Nye (CoMO) • Daniela Quaggia (ACN)