Major disparities in flu vaccine coverage

Gary Finnegan

Gary Finnegan

May 16th, 2011

Gary Finnegan

‘The proportion of older people who have received the seasonal influenza vaccine varies widely across Europe with most countries falling well below the WHO/EU target of 75% coverage. ’

Vaccine-coverageWhile 82% of senior citizens in the Netherlands have received the annual flu vaccine, coverage has plummeted as low as 16% in Poland. The figures are almost as grim in the Czech Republic and Slovakia where less than one third of the elderly and high risk population have been vaccinated against seasonal influenza.

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The European Council agreed in 2009 to make a concerted effort to immunise three quarters of those at highest risk by the middle of the decade – a target that now looks highly unlikely to be met. Along with the Netherlands, the UK (78%) is on course but the vast majority of European countries are falling well short.

Major disparities

Each country is responsible for setting their own vaccination schedules, leading to considerable variation across Europe, according to researchers at the University of Zurich, Institute of Social and Preventative Medicine.

In a presentation to the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Dr Patricia Blank set out the differences between vaccination policies across Europe in an effort to divine their impact on immunisation rates.

Deepening our understanding will help identify what works and what does not, she said.

The research, conducted in collaboration with Dr Matthias Schwenkglenks and Dr Thomas Szucs, surveyed 15 European National Vaccine Industry Groups on vaccination policies. The study was supported by an educational grant from the European Vaccine Manufacturers.

Specifically, the way vaccination programmes are managed, the influence of healthcare workers, the role of communication campaigns, and price and practical access to vaccines.

Sharing best practice

The results show that no two countries’ vaccination policies are the same. Some of the effective strategies used include monitoring vaccine take up, and vaccine vouchers or the issuing of personal letters inviting people to take advantage of free flu vaccines.

In addition, combinations of other policies – such as awareness campaigns, incentives for healthcare workers, reimbursement of flu vaccines, vaccination targets for doctors – can also yield results if used in tandem.

“There are several possibilities to increase influenza vaccination uptake in the elderly, but only a few countries take advantage of them all,” said Dr Blank.

The Zurich group has developed a ‘Flu Diagnostic Tool’ which can guide countries in choosing an effective combination of policies.

“In the end, we cannot say that the number of policies implemented indicate a high VCR, but VCR can be enhanced if the right policies are implemented. So, if [a country] has the resources for, let’s say, two or three policy measures, we can advise on how they should pick the most effective ones,” she told Vaccines Today.

[See full Q&A interview below]

Vaccination coverage among the 65+ age group (2007/2008)

The Netherlands: 82%

UK: 78%

France: 69%

Spain: 67%

Ireland: 65%

Belgium: 63%

Germany: 61%

Italy: 60%

Switzerland: 58%

Finland: 54%

Sweden: 54%

Portugal: 51%

Czech Republic: 32%

Slovakia: 32%

Poland: 16%

The following is the text of a Q&A with Patricia Blank

Vaccines Today: There are major differences across Europe. Is any country doing ‘everything right’?

Patricia Blank: I think we cannot say that there are “good” or “bad” countries. In some countries, for example the Netherlands, UK, etc., with high VCRs there are many policy elements implemented. Other countries might have not the same resources to do so.

However, I think it is important to guide those countries with very poor VCR and few policies, and to discuss with them which policies are very strong and impactful.

In the end, we cannot say that the numbers of policies implemented indicate a high VCR, but VCR can be enhanced if the right policies are implemented – such as the elements I presented at ECCMID. With this “Flu Diagnostic Tool” we aimed at giving those countries guidance on which policies they should implement. So, if they have the resources for, let’s say, two or three policy measures, we can advise on how they should pick the most effective ones.

Vaccines Today: To what extent can cultural and historical differences influence the effectiveness of a policy? (By that I mean: is it possible for Slovakia or Portugal simply to copy the Netherlands?)

Patricia Blank: In our survey, we did not cover this issue. However, we think that it would be the first step for those countries with low VCR to have a look at their “big brothers”.  As mentioned above, it might be more valuable for them to implement those policies which have been shown to be effective. But for sure, there might be some cultural and religious beliefs but also socioeconomic influences and these might be country-specific. But I think that these historical barriers might be overcome if the right actions are taken. But this needs time and resources.

Vaccines Today: Do you see any effort by national health authorities to share best practice?

Patricia Blank: There are some initiatives going on. I think it is important to provide both the public and health professionals with transparent and scientifically sound information on influenza and influenza vaccination.

The ECDC does a great job in helping countries to overcome vaccination barriers. ECDC is strongly committed to putting vaccine-preventable diseases high on the agenda. They are supporting the WHO to allow Europe to meet the goal of 75% VCR among recommended groups.

ECDC has built very strong networks with European experts and has established several good platforms for collecting data and information and sharing good practices throughout Europe.

Vaccines Today: Is there a role for supra-national organisations such as the WHO or European Union to take the lead in knowledge-sharing in this area? Or are national authorities too protective of their right to make their own health policies, even when the evidence suggests they could do with a little outside guidance?

Patricia Blank: In the end, international organisations, such as the WHO and European Council, can give recommendations, but the decision on whether one or the other policy will be implemented, or how the vaccination schedules are run, remains on a country level.


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