“Vaccination in adults is an issue that we must always insist on; we have a lot to improve ”. Thus began Ángel Gil, professor of Preventive Medicine and Public Health at the Rey Juan Carlos University of Madrid, the debate at the IV Public Health Forum: ‘Towards the improvement of vaccination in adults in times of pandemic’ , organized in collaboration by Fundamed and GSK Spain.
And it is that this year, COVID-19 has introduced new challenges in adult vaccination. José Javier Castrodeza, also a professor of Preventive Medicine and Public Health at the University of Valladolid and former Secretary of the Ministry of Health, considers that the adult vaccination schedule still presents areas for improvement in which it is necessary to work. It includes the vaccines recommended for healthy adults for different segments of life and under different conditions (tetanus and diphtheria, triple viral, chickenpox, meningococcal, hepatitis B, human papillomavirus (HPV), pneumococcus and influenza vaccine) .
However, in his opinion, the future inclusion of other vaccines such as the zoster vaccine or the pertussis booster should be considered. And, said Castrodeza, several countries have already measured the high effectiveness of the new vaccine against herpes zoster. Regarding whooping cough, he points out that some community “has put a souvenir dose for adults”, but it is not yet on the calendar, so he urges to consider its inclusion in the short term.
In addition, it considers that future vaccines against COVID-19 “should be incorporated normally in our calendars”, in accordance with the provisions of the competent bodies, without conditioning or altering the vaccination strategies already implemented. Likewise, Castrodeza stressed that, today more than ever, information and training on vaccines must be taken care of. “It is an act of health, scientific and social responsibility,” he said.
Importance of influenza and pneumococcal vaccination
Castrodeza focused on two vaccines: flu and pneumonia. “Talking about the flu is talking about something very well known,” he declared. Flu vaccination has great benefits, as it helps in the prevention of dependency and disability.
The 2020/21 graphs will surely surprise, said the expert, because “this year the flu disease has disappeared.” “We will probably have to establish new evaluation mechanisms to see which part has been due to vaccination , which to the presence of coronavirus or which to other protection mechanisms used,” he said.
On the other hand, pneumonia is the vaccine-preventable infectious disease that causes the highest number of deaths worldwide. And, their mortality in recent years in Spain, far from low, has increased. “The age group where the risk of suffering from severe pneumonia is concentrated is from 65 years of age in both men and women,” he explained.
The challenges of vaccination
The figures for vaccination coverage in adults “are not at all promising,” according to Castrodeza. “We hope to increase them this year. There are communities that have been able to raise vaccination coverage to 12 or 13 points. We’ll see if we get to 75 percent based on the recommendations. It would be desirable, but I have some doubts ”, explained the professor.
The arrival of COVID-19 complicated compliance with vaccination guidelines at all ages. Manuel Méndez Díaz, doctor of health administration in health and vaccination programs of the Department of Public Health of the Government of Aragon, pointed out that in March he found that “he did not have a contingency plan for the vaccination program in Aragon.” Thus, after the initial confusion due to a pandemic that caught everyone off guard, Méndez Díaz assured that the first thing that was done was to prioritize vaccination in the most vulnerable groups.
In this way, at the national level, during the peak of the pandemic and the most rigorous confinement, it was agreed to deprioritize some vaccines, although they were gradually resumed as of June. “Our obligation was to provide security conditions at the vaccination points so that the population would also perceive them as safe,” said the doctor.
María Fernández-Prada, practitioner of the Preventive Medicine and Public Health Area and member of the Spanish Association of Vaccination (AEV), went further. He assured that, although vaccination in general is a challenge, “even more challenging is the vaccination of adults both healthy and with chronic diseases with or without immunosuppression.”
Thus, the member of the AEV raised three challenges:
1. Modification or incorporation of vaccination into healthy lifestyles . “Vaccines accompany us at all ages of life and we must work on the formation of a healthy population from the earliest ages,” he said. Given the increase in chronic diseases, vaccines must become the way to promote healthy aging, reduce dependency rates and preserve quality of life in risk situations, thus contributing to the sustainability of the NHS.
2. Chronicity strategy, a global challenge . “We have an increasingly long-lived population. Life expectancy has increased worldwide and Spain is among the top 10 countries. Aging forces us to respond to the phenomenon known as immunosenescence, and this will lead to the need for vaccines to protect ourselves ”.
3. Study of the causes of acceptance or not of vaccines. “From the AEV we are preparing a research work that we will share with the communities to make an instrumental validation tool on the acceptance of vaccination. I believe that we will be able to identify the variables that best predict that acceptance or not and, therefore, on which we have to influence ”, highlighted Fernández-Prada.
Sustainability of vaccination
While vaccination is challenging, the cost of vaccination is not, per se, a problem, at least in terms of economic impact. “Vaccines do not have a high cost and are the most cost-effective measure of primary prevention in public health,” said David Cantarero, head of the Health Economics R&D Group at the Valdecilla Health Research Institute (IDIVAL).
By contrast, the R&D process for new vaccines is very expensive. The situation derived from COVID-19 has allowed, through a notable increase in investment and the shortening of the required deadlines, that we can have an effective and safe vaccine more quickly. Given this idea, Cantarero asked himself: “Will COVID-19 change the future vaccine development model?”
He emphasized that, in economic terms, an improvement in vaccination coverage in the adult population should be insisted upon, since if it is done, “there is no damage to public accounts” and the cost / benefit ratio is very positive.
On the other hand, Cantarero proposes that this way of advancing investment in vaccines can also be accompanied by “an improvement in the decision-making process through an economic evaluation that requires multidisciplinary collaboration.” In this way, he joins the experts who have recently advocated for the creation of a HispaNICE.
