The days of viewing vaccination as a childhood health issue are fading fast. Today adolescents in Europe are offered HPV vaccines against cancers; pregnant women are vaccinated against flu and pertussis; and older people are benefiting from vaccines against pneumococcal disease, shingles and influenza.
The principle of life-course vaccination is being embraced by the WHO in its 2030 agenda, and several European countries have rewritten their vaccination schedules to take a whole-of-life approach.
However, not all countries are implementing life-course immunisation in the same way. Some have produced comprehensive new vaccine schedules without investing in promotion, training and infrastructure; others have more modest ambitions backed up with strong programmes.
A new report on life-course immunisation by the Health Policy Partnership (HPP), commissioned by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), looks at how six countries are delivering life-course immunisation: France, Brazil, Australia, Japan, the UK and the US. It offers several case studies and examples of how life-course immunisation is supported in various target groups and makes the case for accelerating access for people at every stage of life.
France is particularly intriguing: the birthplace of vaccine innovator Louis Pasteur, a major producer of vaccines, yet a hotbed of vaccine hesitancy. A 2016 survey by the Vaccine Confidence Project found that 41% of people surveyed in France disagreed that vaccines were ‘safe and effective’. However, it should be noted that subsequent surveys were a little less negative and most people in France continue to vaccinate on time, every time.
The French government has also decided to make virtually all childhood vaccines mandatory. Previously, a handful of vaccines were compulsory while most others were ‘recommended’. The decision followed a lengthy public consultation which saw more than 10,000 comments submitted through an online platform.
Vaccines for life
France’s immunisation programme has been designed to support key groups throughout life, the new report notes, but the public debate about childhood vaccination has distracted attention from life-course immunisation. The 2018–2022 National Health Strategy includes, as its first priority, promotion of lifelong health.
However, despite the vaccination schedule covering all ages and some specific at-risk citizens, uptake is low in most target groups. HPV vaccine uptake is around 20%, flu vaccination rates are well below the 75% target for older people, and vaccine hesitancy remains a surprisingly thorny issue among French healthcare professionals.
Official guidance recommends flu vaccination during pregnancy while advising that women be vaccinated against pertussis before becoming pregnant – this is quite different to the situation in several other European countries.
Cause for optimism
However, France has had some significant successes from which others can learn. Perhaps the most innovative is the introduction of a web- and smartphone-based electronic vaccination record. Launched in 2010, MesVaccins.net stores individuals’ vaccine records and makes recommendations based on age and risk profile, using an algorithm updated by experts in real time.
Subscriptions to MesVaccins.net have also been provided to physicians and pharmacists by regional health agencies, supporting HCPs to give correct and consistent immunisation advice. This system promises to increase vaccine uptake for people of all ages and could inspire other countries – or perhaps even the EU – to develop similar tools.
To target health professionals, Public Health France launched an online vaccine information platform in 2018. Professionnels.vaccination-info-service.fr provides detailed information about how vaccines work, recommendations and coverage data, guidance for different population groups and disease-specific information.
Innovative immunisation programmes
Authorities are also looking at how system innovations can help improve access – and uptake – to immunisation. For example, vaccination in schools has been trialled in the region of Grand-Est. The immunisation records of 1,000 students were checked and more than half were found to be out of date. Parents were notified of their children’s immunization status and asked for consent to provide these vaccines in school. In two years, 254 children received vaccinations as a result of this trial.
Pharmacy-based vaccination is another success story. In 2017, an influenza vaccination programme in pharmacies was introduced in selected Agences Régionales de Santé (Regional Health Agencies; ARSs) to increase vaccine coverage. Through this program, pharmacists who attended specific training were permitted to administer the influenza vaccine at no cost to target groups.
Following a trial in four regions, vaccination in pharmacies was deemed to be successful and the pilot was ended. More than 743,554 people receive the influenza vaccine in the experimental regions during the pilot, 23.5% of whom were getting the vaccine for the first time. The programme has now been rolled out nationwide. In support of this new policy, vaccination training became compulsory for all pharmacy students.
Despite facing a range of challenges to vaccination in general, and life-course immunisation in particular, France is showing signs that it could leave behind its reputation for vaccine hesitancy to become a leader in Europe.