Optimising Adult Vaccination in Europe


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Optimising Adult Vaccination in Europe

  1. 1. Optimising Adult Vaccination in Europe <ul><li>David Sinclair , International Longevity Centre -UK </li></ul>
  2. 2. About ILC-UK <ul><li>The ILC-UK was established in 2000 to explore and address the new longevity revolution and its impact on the life-course and society. </li></ul><ul><li>We provide the visionary approach needed for individual and societal planning to ensure a progressive, economically viable and socially inclusive tomorrow for all. </li></ul><ul><li>We have a global reach with 12 Members of the ILC Global Alliance. </li></ul>
  3. 3. Some of our publications
  4. 4. Our experience of adult immunisation .
  5. 5. The case for adult immunisation <ul><li>Immunisations are beneficial for most people of all ages. </li></ul><ul><li>There is a common perception (with the exception of the flu vaccine) that immunisation is for children </li></ul><ul><li>More adults die from vaccine preventable diseases each year than children (Fingar et al) </li></ul>http://www.flickr.com/photos/48039948@N02/6070071650/sizes/m/in/pool-92307085@N00/
  6. 6. Vaccination has a good story to sell <ul><li>Vaccination has controlled 12 major diseases (at least in parts of the world) </li></ul><ul><li>Other than clean water, vaccination has arguably had the biggest impact on mortality reduction and population growth </li></ul>http://www.flickr.com/photos/pondspider/4170990903/sizes/m/in/photostream/
  7. 7. Vaccinations prevent diseases <ul><li>Vaccines can prevent the onset and/or consequences of these serious, often deadly, diseases including: </li></ul><ul><li>influenza pneumococcal disease, </li></ul><ul><li>tetanus-diphtheria-pertussis, </li></ul><ul><li>chickenpox and shingles, </li></ul><ul><li>meningococcal disease, </li></ul><ul><li>measles-mumps-rubella, </li></ul><ul><li>human papillomavirus, </li></ul><ul><li>hepatitis A and hepatitis B, </li></ul><ul><li>polio </li></ul>http://www.flickr.com/photos/un_photo/5832685007/sizes/z/in/photostream/
  8. 8. And these diseases often hit adults <ul><li>Pneumococcal disease kills 1.6 million people - including more than 800,000 children under age five — every year. </li></ul><ul><li>35,000 people in the United States die from influenza and its complications each year. More than 90 percent are persons 65 and older. </li></ul><ul><li>Of the 66 confirmed cases of measles in the United States reported in 2005, nearly 35 percent were in people over age 20. </li></ul><ul><li>Shingles, is common in people over age 50, with an estimated 500,000 to 1 million cases diagnosed in the United States each year. </li></ul>
  9. 9. Recommendations versus reality <ul><li>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 </li></ul><ul><li>5 million (at risk) people in the UK missed out on the flu vaccination in 2010-11 despite media attention </li></ul>
  10. 10. Seasonal Flu Vaccine Uptake (England)
  11. 11. Yet we know that policy has a huge influence <ul><li>In the UK take-up of the seasonal flu vaccine is much higher than in England (Supply/governance/leadership by Scottish health boards) </li></ul><ul><li>Some health trusts immunise at much higher rates than others </li></ul>. http://www.flickr.com/photos/ministere-du-travail/4007266083/sizes/z/in/photostream/
  12. 12. The context of migration <ul><li>There is no single system for catch up vaccinations for those who missed being vaccinated </li></ul>
  13. 13. Where should we get to by 2020 <ul><li>Higher take-up of vaccinations by healthcare professionals </li></ul><ul><li>A well informed and empowered consumer </li></ul><ul><li>Created a cultural norm of &quot;wellness&quot; across Europe </li></ul><ul><li>More accessible immunisation </li></ul><ul><li>A stronger evidence base of the respective impact of communications, education, behavioural economics, and compulsion. </li></ul><ul><li>Convinced business of the economic case of vaccination </li></ul>
  14. 14. Higher vaccination rates of healthcare professionals <ul><li>Pitiful levels of immunisation of healthcare professionals </li></ul><ul><li>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 </li></ul><ul><li>Last year, just 34.7% of front-line workers had the vaccine. </li></ul><ul><li>In some Trusts fewer than 10% of workers were vaccinated last winter. </li></ul><ul><li>Let's learn from the best </li></ul>http://www.flickr.com/photos/lowercolumbiacollege/4473156749/sizes/z/in/photostream/
  15. 15. Is ageism a factor? <ul><li>The Times, 3 rd September 2011 </li></ul>
  16. 16. A well informed and empowered consumer <ul><li>There is a lack of independent information for adults about when and whether to immunise </li></ul><ul><li>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. </li></ul>
  17. 17. A well informed and empowered consumer <ul><li>A ll 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. </li></ul>http://www.lcr.nhs.uk/_Keepinghealthystayingfit-Healthmatters-Childhoodimmunisation.aspx
  18. 18. A well informed and empowered consumer <ul><li>The creation of an &quot;independent immunisation authority” which would: </li></ul><ul><li>Be truly independent and evidence based </li></ul><ul><li>Support national campaigns on take-up </li></ul><ul><li>Provide consistent and impartial advice to consumers on when and whether they should be immunised </li></ul><ul><li>Be an authoritative voice in the media and to politicians about immunisations </li></ul><ul><li>Take a life course approach </li></ul><ul><li>Engage the third sector </li></ul>
  19. 19. Use the opportunities to communicate well <ul><li>Use opportunities like the European Year of Active Ageing and Intergenerational Solidarity. </li></ul>http://www.flickr.com/photos/simonr/308766839/sizes/z/in/photostream/
  20. 20. Created a cultural norm of &quot;wellness&quot; across Europe <ul><li>We have a culture of going to the doctor as adults when we are ill (many countries) </li></ul><ul><li>Children tend to see doctors more regularly. </li></ul><ul><li>There is a need for more regular “well care” sessions mid life. </li></ul><ul><li>Promote life course vaccination as part of the healthy ageing message </li></ul>. http://www.flickr.com/photos/keep-on-moving/2977922686/sizes/z/in/photostream/
  21. 21. Created a cultural norm of &quot;wellness&quot; across Europe <ul><li>We need to incorporate immunisation into our prevention policies </li></ul><ul><li>Free or partially reimbursed vaccination has important effect on use. </li></ul><ul><li>In Australia publicly funded pneumococcal vaccination increased take-up from 39% to 73% </li></ul><ul><li>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 </li></ul>
  22. 22. Created a cultural norm of &quot;wellness&quot; across Europe <ul><li>Create a culture of immunisation by extending free or part subsidised immunisations to over 50s (seasonal flu, shingles, pneumococcal) </li></ul><ul><li>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. </li></ul>
  23. 23. More accessible immunisation <ul><li>Greater role for community pharmacy in national vaccination programmes </li></ul>http://www.flickr.com/photos/mc4army/6077204964/sizes/z/in/photostream/
  24. 24. A stronger evidence base of the respective impact of communications, education,behavioural economics, and compulsion. <ul><li>Last year the Westminster Government (UK) cancelled it's public communications campaign (had grown to a cost of £15 million per year). </li></ul><ul><li>Let’s use this money to pilot different approaches. </li></ul><ul><li>Need to be clear on what we want to communicate to who. And what is the best way of doing so. </li></ul>http://www.flickr.com/photos/alalsacienne/94458561/sizes/z/in/photostream/
  25. 25. Can we learn from Nudge?
  26. 26. Can we learn from &quot;nudge&quot; <ul><li>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 </li></ul><ul><li>Or &quot;nudging&quot; by asking people to self certify (sign a form) saying they don't want advice on immunisation on hospital discharge. </li></ul><ul><li>Need to test behavioural approaches </li></ul>http://www.flickr.com/photos/billmcintyre/3031148540/sizes/z/in/photostream/
  27. 27. Convinced business of the economic case of vaccination <ul><li>The recession/European financial crisis </li></ul><ul><li>We need to collate and disseminate the evidence of cost effectiveness </li></ul><ul><li>Can we incentivise business to intervene? </li></ul><ul><li>Is there a role for insurance? </li></ul>http://www.flickr.com/photos/europedistrict/4092903450/sizes/z/in/photostream/
  28. 28. But let’s not make assumptions <ul><li>“ 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.” </li></ul>Dodge, 1962
  29. 29. Many thanks <ul><li>David Sinclair </li></ul><ul><li>Head of Policy and Research </li></ul><ul><li>International Longevity Centre </li></ul><ul><li>[email_address] </li></ul><ul><li>02073400440 </li></ul><ul><li>Twitter: @ilcuk and @sinclairda </li></ul>