Expats & vaccination: one parent’s mission to link global immunisation schedules

Gary Finnegan

Gary Finnegan

March 16th, 2020

Gary Finnegan

‘When Shashank Jain relocated his family from the UK to Dubai, keeping his children’s vaccines up to date was a struggle. Now he wants to make life easier for other expats’

Shashank JainMoving countries is challenging. The planning, the packing; finding a school and somewhere to live, maybe starting a new job. It can all make keeping up with vaccine schedules seem low on the list of priorities.

Parents are often surprised to find that vaccine schedules vary from country to country. Even within Europe there are differences between countries – and sometimes between regions of a single country. That is why the European Centre for Disease Prevention & Control (ECDC) developed an online tool for comparing vaccine schedules.

But what about people moving beyond the EU? For Shashank Jain, moving his Indian-born child from the UK to Dubai in 2005 made staying on top of vaccinations tricky. ‘Our first child was born in Mumbai in 2003. He had some vaccines in the hospital, but then moved to the UK where he followed the NHS infant immunisation schedule,’ Shashank recalls.

‘He was two when we relocated to Dubai, so we had three distinct vaccine calendars to work with. My wife’s family ties brought her to Dubai frequently before our permanent relocation in 2005. Some of my older son’s vaccines were even administered in Dubai prior to permanent relocation in 2005, in addition to the UK and India’, Shashank explains.

The family did their best to stay on top of the children’s vaccines – a straightforward task for their younger Dubai-born child born in 2008. However, Shashank decided that it will not be prudent to rely on the handwritten records provided during their time in the UK for the older child and he decided to lay out the complete schedule in order to determine the vaccines required going forward.

‘I work in corporate finance where data analysis is at the heart of decision-making. It was surprising to see healthcare professionals writing vaccine information by hand rather than using electronic tools,’ he says.


Vaccine calendars

Figuring out which vaccines might be outstanding was far from straightforward. ‘Whilst seeking advice from doctors, I was asked to send the date records of vaccination and I realized that given the doctors’ tight schedules, the period interval from the date of birth to the date of vaccine administration was sometimes erroneously calculated, when I provided the vaccination dates,’ explains Shashank. ‘This presented a need to help the Doctors by showing the exact time interval between the birth and vaccine dates, as the efficacy of immunizations is predominantly dependent on time periods.’

Piecing together everything he had, Shashank developed a simple spreadsheet to share with doctors, containing immunisation information about his children. The tool used vaccination guidelines by the US CDC, UK NHS and the Dubai Health Authority to compare against the actual vaccination time intervals of administered vaccines. This made it easier for doctors to engage with the family about what’s required, he says.

Shashank then decided to share a simpler version of this tool online, for parents or others to download. ‘The current tool which is available on eloquens.com allows the user to simply enter the date of birth followed by the dates of all the vaccines administered and the excel tool displays the weeks and months interval after the date of birth for each vaccine,’ he says. ‘The tool focuses on the actual months and weeks that have elapsed or passed after the date of birth, for each vaccine administered.’ The tool can be downloaded here.

Support for parents

‘Each country has a vaccination schedule that lays down the suggested time interval for each vaccine after the date of birth,’ Shashank tells Vaccines Today. ‘The struggle for parents, then, is to compare the actual time intervals that the doses were administered against the suggested time intervals. This tool helps the parents lay out the exact actual time intervals and present those records to health practitioners, schools or universities, allowing accurate evaluations and records.’

Users can print out these records or upload on cloud platforms. Shashank says health authorities could make the tool widely available: ‘If any health authority shows interest in making available a comparative tool, or if someone is looking to compare their actual schedule against any recommended guidelines, I will be happy to support based on what I developed personally for my children.’

‘The current available tool will be particularly valuable to expats or parents who wish to set out clean records especially given how conscious people are about disease outbreaks right now, in addition to increased requirements for records by schools and universities’, adds Shashank.

‘I hope this can make life a little easier for a lot of people,’ says Shashank. ‘If something like this had been available a few years ago, I certainly would have used it.’

Expats & vaccination

What is an ‘expat’ anyway? By most definitions, an expatriate is someone who lives and works outside their home country, typically for a temporary (but not necessarily short) period. (Vaccines Today will publish a separate story on vaccination and migrant health in April.)

Because the definition can vary, the estimated number of expats in the world ranges from 50 million to 230 million. If the global expat population were combined, it would make for one of the most populous countries on the planet.

Language and cultural barriers, along with structural, legal and technical differences, can make integrating into health systems difficult. Preventative measures, such as vaccination, are just one element of child health thatparents on the move must consider.

The challenge is less acute in the EU where the ECDC has created a vaccine scheduler and supports the development of immunisation information systems. More help is on the way. As part of the EU Roadmap on Vaccination, The European Commission has asked MesVaccins.Net to conduct a feasibility study on the development of a common EU vaccination card. A Commission proposal for a common ‘vaccination passport’ for EU citizens is expected in 2022.