Viruses know no borders – European cooperation is essential

Gary Finnegan

Gary Finnegan

October 27th, 2017

Gary Finnegan
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‘Collaboration on disease surveillance and immunisation records could help to combat outbreaks of vaccine-preventable diseases in the European Union’

How do you keep track of your family’s vaccinations? Electronic health records and smartphone apps have been developed in many countries but some still use immunisation cards.

And, where electronic records exist, they are not always compatible with other systems. However, the viruses and bacteria that cause vaccine-preventable diseases can travel across borders – without need for passports or visas.

Ongoing measles outbreaks have prompted the EU to look at how electronic immunisation registries can help. The topic was discussed in detail this month at a conference in Austria– the European Health Forum in Gastein – where the European Commission and European Centre for Disease Prevention & Control (ECDC) expressed support for closer cooperation.

During a debate on the issue, Martin Seychell, Deputy Director General of the European Commission’s health directorate, is reported to have said the EU is exploring ways to connect national immunisation registries where they exist and support their development in countries that rely on paper-based records.

Key to making this work is establishing agreed ways to record the information in databases that are technically compatible. ‘If you have commonly agreed rules it’s easier to work together […] as for infectious diseases, member states need to be jointly prepared, not just individually,’ he said.

This was echoed by EU Health Commissioner Dr Vytenis Andriukaitis who said a Europe-wide register ‘is necessary, absolutely. It’s a big step for coordinating Member States’ needs”. A specific plan to connect national vaccination registries could form part of the EU Joint Action on Vaccines which will be launched in spring 2018.

National databases – but a common approach

The Gastein debate was organised by MSD and chaired by Dr Arnold Bosman, an epidemiologist and former ECDC official. ‘It seems that the Commission is in favour of moving towards an EU-wide immunisation registry, to which all Member States contribute from their national registration systems,’ he told Vaccines Today. ‘During the workshop we learned that the ECDC is working on guidelines for immunisation registries for all Member States.’ This is expected to be published early in 2018.

The ECDC released results of a survey in April 2017 showing that 21 countries have an immunisation information system – or a pilot system – already in place.

‘At this moment it is too early to say that this will lead to a single European Electronic Record, since there may be several options to harmonise and standardise such registries,’ according to Bosman, who now heads up a Transmissible, a public health consultancy. ‘Yet the broad consensus is that there is a need for full interoperability between national immunisation registries, based on an agreed EU standard.’

Technical challenges

Making this happen is ‘technically feasible but costly’, according to Bosman. A number of cross-border databases exist – such as the electronic health records developed by the International Organisation for Migration – and Mes Vaccins, a French website, is seen as a user-friendly system that could be scaled up.

Merging data from existing and new databases raises wider privacy and security issues which would need to be tackled before proceeding. ‘There is probably a significant role for ECDC,’ according to Bosman. ‘This will include providing guidance on technical principles, and defining the minimum data sets required at EU level, to facilitate the Centre’s tasks in threat detection and threat assessment.’

Another big decision will be whether a European Immunisation Registry would form part of a future European Health Record. Integrating immunisation records into a full patient records makes sense but is more complex than stitching together existing national vaccine records.

Joint Action on Vaccination 2018

Meanwhile, the European Commission has promised support for national vaccination programmes and is preparing to launch an EU Joint Action on Vaccination in 2018 – an initiative co-funded by Member States and the EU Health Programme.

‘A main focus of this work is on strengthening the evidence-base, monitoring and sustainability of national vaccination programmes,’ a Commission spokesperson told Vaccines Today. ‘In this context, immunisation information systems are pivotal in supporting critical and transparent decision-making, and improving compliance with vaccination schedules.’

The EU’s role in public health is limited to cross-border issues, with national governments responsible for deciding how to fund and organise their health systems. The Joint Action would bring individual governments and the Commission together for the purposes of improving vaccination systems.

‘The project will address inter alia cross-border interaction of electronic immunisation information systems to increase vaccine surveillance capabilities,’ the Commission said. ‘This will include an assessment of the interoperability of European immunisation information systems and of opportunities for standardization. The joint action will not start before March 2018.’

The prospect of a clear step forward by European Immunisation Week 2017 looks good. Stay tuned…