#VaccinesWork. This is the theme chosen by the World Health Organization (WHO) for the 2019 World Immunization Week (24-30 April).
So, let’s pause and celebrate the value of immunization as one of the world’s most effective public health interventions – second only to access to clean water. But celebration should not invite complacency: it is incumbent on us all to continue intensifying our efforts to close the vaccination gap. The WHO estimates that, across the world, 20 million children are still unvaccinated or under-vaccinated. This is not acceptable.
In our “post-truth” era, public health is unfortunately not “immune” to fake news and misinformation, leading many people to irresponsibly challenge the value of vaccines, threatening the progress made over the last few decades in beating back vaccine-preventable disease. A new approach to rebuilding public confidence in vaccines is much needed, as was recently suggested in a report by Professor Heidi Larson from the London School of Hygiene and Tropical Medicine.
Challenging our perspectives on vaccination
Looking forward, we need not only to counter bad information, but to expand our view: vaccines are not just for children, but can help protect everyone at every stage of life.
This means to apply a life-course approach to immunization. Just as the WHO promotes a life-course approach to health, envisioning a continuum through all stages of life, we need to shift the vaccination paradigm.
This approach can play a key role in keeping populations healthier, and also in contributing to the financial sustainability of healthcare systems. By preventing infections, vaccination is a cost-effective tool that strengthens entire populations and increases workforce productivity. There is an important social dimension to the benefits of vaccination as well. Giving school-age kids and teenagers the best chance to succeed free from vaccine-preventable diseases is a step towards improving equality, especially in less affluent households and in countries where healthcare access is a challenge.
Embracing life-course immunization will be increasingly important as more societies age. Globally, the United Nations estimates that the number of people aged 60 years or older will more than double by 2050. In the US, older people will outnumber children by 2030. Other countries, such as China, will have far less time to adapt to demographic transformation than OECD countries did. According to a World Bank report, in just 26 years China will experience a change in population age that took 115 years in France.
At a time when “healthy ageing” is becoming a top priority for governments across the world, vaccination remains an underused strategy, even though it is known that our immune function declines with age, making us more susceptible to disease. The most striking illustration of this is influenza. Age brings greater susceptibility to influenza infection and reduces our capacity to fight it. Older adults are at higher risk of influenza-related complications, hospitalization and death. In people over 65, for instance, influenza increases the risk of heart attack sixfold during the week after diagnosis. Influenza also aggravates underlying chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disorder, asthma and diabetes. This places additional financial pressure on already constrained healthcare systems.
Vaccination can help address global health security threats such as antibiotic resistance. It can prevent the transmission of resistant bacteria or febrile illnesses like influenza that drive unnecessary antibiotic consumption – a major driver of increasing antibiotic resistance.
Broadening our perspective about vaccination is also important in our evermore interconnected world. Vaccine-preventable disease outbreaks can have strong impact on international economy, trade and tourism. As a manufacturer of the yellow fever vaccine, we are acutely aware of the disruption caused by the outbreaks in Angola, Nigeria and Brazil over the last three years.
Identifying some key policy considerations
A shift is still needed to fully unlock the potential of life-course immunization. This will take both investment and time. But we can start with some basics, such as amplifying the value of vaccination whenever we can and fully equipping healthcare professionals with adequate knowledge on the benefits of immunization.
It is also the right time to adapt immunization to changing lifestyles. Designing “easier” access to vaccination is paramount. In France, the government recently tested a pilot of pharmacy-based vaccination in several regions. Seen as a success, 2019 health financing law has extended nationwide influenza vaccination to pharmacies for certain at-risk people.
Last but not least, “health data” is a new currency, and strengthening surveillance and research on the impact of life-course immunization is critical. If it is sometimes argued that more data is needed to prove the benefits of life-course immunization, the policy response should be to implement measures that ensure such evidence is generated.
Moving forward as a global health community
One thing is certain: advancing life-course immunization will require greater collaboration between all stakeholders in healthcare system. And collaboration always starts with dialogue. In that context, 2019 offers multiple dialogue opportunities to reinforce understanding on its benefits for healthcare systems.
We should look to key opportunities such as the UN High-Level Meeting on Universal Health Coverage in New York this September, and this summer’s WHO consultation for immunization in the next decade, due to go to the World Health Assembly in May 2020. The time has come to team up and make life-course immunization the cornerstone of sustainable healthcare systems.