Optimising Adult Vaccination in Europe

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Optimising Adult Vaccination in Europe

David Sinclair , International Longevity Centre -UK



About ILC-UK

The ILC-UK was established in 2000 to explore and address

the new longevity revolution and its impact on the life-course

and society.

We provide the visionary approach needed for individual and

societal planning to ensure a progressive, economically

viable and socially inclusive tomorrow for all.

We have a global reach with 12 Members of the ILC Global

Alliance.



Some of our publications



.

Our experience of adult immunisation



The case for adult immunisation

Immunisations are beneficial for

most people of all ages.

There is a common perception

(with the exception of the flu

vaccine) that immunisation is for

children

More adults die from vaccine

preventable diseases each year

than children (Fingar et al)http://www.flickr.com/photos/48039948@N02/6070071650/sizes/m/in/pool-92307085@N00/



Vaccination has a good story to sell

Vaccination has controlled 12

major diseases (at least in

parts of the world)

Other than clean water,

vaccination has arguably had

the biggest impact on

mortality reduction and

population growth

http://www.flickr.com/photos/pondspider/4170990903/sizes/m/in/photostream/



Vaccinations prevent diseases

Vaccines can prevent the onset and/or consequences

of these serious, often deadly, diseases including:

influenza pneumococcal disease,

tetanus-diphtheria-pertussis,

chickenpox and shingles,

meningococcal disease,

measles-mumps-rubella,

human papillomavirus,

hepatitis A and hepatitis B,

poliohttp://www.flickr.com/photos/un_photo/5832685007/

sizes/z/in/photostream/



And these diseases often hit adults

Pneumococcal disease kills 1.6 million people -

including more than 800,000 children under age

five — every year.

35,000 people in the United States die from

influenza and its complications each year. More

than 90 percent are persons 65 and older.

Of the 66 confirmed cases of measles in the United

States reported in 2005, nearly 35 percent were in

people over age 20.

Shingles, is common in people over age 50, with

an estimated 500,000 to 1 million cases diagnosed

in the United States each year.



Recommendations versus reality

Yet despite strong evidence for the efficacy of

immunisation against influenza, pneumococcal

disease and other vaccine preventable diseases

there is a gap between recommendations for

vaccination among older people and actual

vaccination rates in Europe

5 million (at risk) people in the UK missed out on

the flu vaccination in 2010-11 despite media

attention



Seasonal Flu Vaccine Uptake (England)



.

Yet we know that policy has a huge influence

In the UK take-up of the

seasonal flu vaccine is much

higher than in England

(Supply/governance/leaders

hip by Scottish health

boards)

Some health trusts immunise

at much higher rates than

othershttp://www.flickr.com/photos/ministere-du-travail/4007266083/

sizes/z/in/photostream/



The context of migration

There is no single system for catch up vaccinations for those who missed

being vaccinated



Where should we get to by 2020

Higher take-up of vaccinations by healthcare professionals

A well informed and empowered consumer

Created a cultural norm of "wellness" across Europe

More accessible immunisation

A stronger evidence base of the respective impact of communications,

education, behavioural economics, and compulsion.

Convinced business of the economic case of vaccination



Higher vaccination rates of healthcare professionals

Pitiful levels of immunisation of healthcare professionals

The Westminster Government has just launched a

campaign to get GPs, nurses and other health workers

vaccinated against seasonal flu in a campaign launched

today - despite no national campaign for the public

Last year, just 34.7% of front-line workers had the

vaccine.

In some Trusts fewer than 10% of workers were

vaccinated last winter.

Let's learn from the best

http://www.flickr.com/photos/lowercolumbiacollege/4473156749/sizes/z/in/photostream/



Is ageism a factor?

The Times, 3rd September 2011




There is a lack of

independent

information for adults

about when and

whether to immunise

Centers for Disease

Control (CDC) in the

USA last year, for the

first time,

recommended that

essentially everybody

should get a flu shot

every year.




All adults should keep a permanent

immunisation record, both to ensure that

protection has been provided against

vaccine-preventable diseases and also to

prevent needless revaccination if there is a

change in a health care provider or during

a health emergency.

http://www.lcr.nhs.uk/_Keepinghealthystayingfit-Healthmatters-Childhoodimmunisation.aspx




The creation of an "independent immunisation authority” which would:

Be truly independent and evidence based

Support national campaigns on take-up

Provide consistent and impartial advice to consumers on when and whether

they should be immunised

Be an authoritative voice in the media and to politicians about immunisations

Take a life course approach

Engage the third sector



Use the opportunities to communicate well

Use opportunities like the

European Year of Active Ageing

and Intergenerational Solidarity.

http://www.flickr.com/photos/simonr/308766839/sizes/z/in/photostream/



.


We have a culture of going to the

doctor as adults when we are ill

(many countries)

Children tend to see doctors more

regularly.

There is a need for more regular “well

care” sessions mid life.

Promote life course vaccination as

part of the healthy ageing message

http://www.flickr.com/photos/keep-on-moving/2977922686/sizes/z/in/photostream/




We need to incorporate immunisation into our prevention policies

Free or partially reimbursed vaccination has important effect on use.

In Australia publicly funded pneumococcal vaccination increased take-

up from 39% to 73%

Free vaccination, incentives for physicians to vaccinate and a national

advertising campaign increased influenza vaccination from 27% to

72.8% of people aged 65+ this year




Create a culture of immunisation by

extending free or part subsidised

immunisations to over 50s (seasonal flu,

shingles, pneumococcal)

Extending the flu vaccination programme

to all over 50s would normalise the

process of being immunised, and ensure

that misperceptions of who is or is not at

risk do not hold people back from

protecting themselves.



More accessible immunisation

Greater role for

community pharmacy in

national vaccination

programmes

http://www.flickr.com/photos/mc4army/6077204964/sizes/z/in/photostream/



A stronger evidence base of the respective impact of communications, education,behavioural economics, and compulsion.

Last year the Westminster

Government (UK) cancelled it's public

communications campaign (had

grown to a cost of £15 million per

year).

Let’s use this money to pilot different

approaches.

Need to be clear on what we want to

communicate to who. And what is the

best way of doing so.

http://www.flickr.com/photos/alalsacienne/94458561/sizes/z/in/photostream/



Can we learn from Nudge?



Can we learn from "nudge"

Vaccinations protect the unvaccinated

(herd). Let's use this as a nudge. Parents

might be willing to self vaccinate if we

communicate that its in the interest of their

children

Or "nudging" by asking people to self

certify (sign a form) saying they don't want

advice on immunisation on hospital

discharge.

Need to test behavioural approaches

http://www.flickr.com/photos/billmcintyre/3031148540/sizes/z/in/photostream/



Convinced business of the economic case of vaccination

The recession/European

financial crisis

We need to collate and

disseminate the evidence of

cost effectiveness

Can we incentivise business to

intervene?

Is there a role for insurance? http://www.flickr.com/photos/europedistrict/4092903450/sizes/z/in/photostream/



But let’s not make assumptions

“They have fewer ties to family

responsibilities... With their homes paid for

their major housing concern is for property

taxes and repairs... Being essentially free

from obligation, they may spend their income

and assets as they wish. Here is a potential

market, therefore for those marketers who

wish to appeal to it. It is a new market,

almost unrecognised which must be

developed with care as it depends upon the

changing role of older persons in our society

and the realisation that they are more free

than their predecessors in the past century.”

Dodge, 1962



Many thanks

David Sinclair

Head of Policy and Research

International Longevity Centre

[email protected]

02073400440

Twitter: @ilcuk and @sinclairda

Health & Medicine

Optimising Adult Vaccination in Europe