A major position paper was launched recently outlining the need for a strategic approach to adult immunisation. Pat Kelly reports
A position paper was launched recently in the RCPI in Dublin that emphasised the need for a multidisciplinary approach to adult immunisation. Titled Vision and Strategic Approach to Adult Immunisation in Ireland, the paper outlines the current landscape of adult immunisation in Ireland, as well as existing challenges and the priorities for the development of a comprehensive, effective adult immunisation programme.
The paper was prepared by EY Ireland for GSK and includes expert perspectives and global best practice case studies in approaches to immunisation. It also outlines strategic goals and key recommendations for developing a targeted approach to adult immunisation in Ireland, as well as a roadmap for implementation.
The panel of speakers at the launch comprised Dr Ronan Glynn, Partner and Health Sector Lead at EY; Prof Colm Bergin, Consultant in Infectious Disease at St James’s Hospital in Dublin; Prof Karina Butler, Clinical Professor of Paediatrics and former Chair of the National Immunisation Advisory Committee; and Ms Kathy Maher, pharmacist and Chair of the Pharmacy Contractors Committee at the Irish Pharmacy Union.
The meeting was opened by Ms Eimear Caslin, General Manager with GSK Ireland, who welcomed the attendees and the panel, which was chaired by Dr Glynn. He provided a brief overview of the development of human vaccination and pointed out that the report proposes a vision where the whole adult population benefits from vaccines, despite their age or location.
Vaccination programmes to date have focused on preventable diseases in paediatric populations, but changes over time in the population demography, disease epidemiology and vaccine development have led to a greater recognition of the need for a similar focus in adults, he said.
Ageing population
“In broad terms, we are doing relatively well in Ireland [with vaccination],” said Dr Glynn. “We have uptake levels of adult vaccines that, broadly speaking, are comparable with anywhere in the world… but we cannot be complacent.” Ireland has a rapidly-growing ageing population, he pointed out, and the numbers of people aged over 65 years is expected to double by 2051. “There is some uncertainty around how to meet those challenges,” Dr Glynn told the meeting.
“But there is very little doubt about the potential positive impact that vaccines can have for our adult population.”
The report, which is the first of its kind, makes a number of specific recommendations. These include enhanced resourcing for the National Immunisation Office, and a standardised approach to training and accreditation for all vaccinators. The report also calls for more vaccination points worldwide, including pharmacies, hospitals, mobile clinics and workplaces. Policy-makers are also urged to adopt a consistent approach to education on the benefits of immunisation, and the report suggests it be included in school curricula in a whole-of-Government approach to adult immunisation. A comprehensive immunisation IT system should be implemented, and a faster decision-making process should be developed for funding adult vaccination. This model should be sustainable, the authors wrote.
Other recommendations include recognition of the National Immunisation Advisory Committee (NIAC) as a National Immunisation Technical Advisory group to align with world standards, and reconvening the National Vaccine Alliance, which was designed to boost uptake of vaccines.
Despite paediatric vaccination being the current focus of most health systems, 80 per cent of the vaccines currently in development worldwide are targeted at the adult population. In terms of economic benefits, the authors point out that a 2024 report by the Office of Health Economics estimated that full implementation of the NIAC recommendations for influenza, pneumococcal disease, herpes zoster and RSV would result in a return of €23 in socioeconomic benefit for every €1 spent. This equates to approximately €4.8 billion in net monetary benefits.
Information
Dr Glynn’s presentation was followed by a lively interactive panel discussion, where attendees and the Chair had the opportunity to put their questions to the panel. Prof Butler emphasised the lessons that can be learned from Covid in terms of how a vaccination programme can be quickly established and how the public can be informed.
“We have a public that is willing to be informed, and now it’s time to look at how we can expand that so that people have — in line with the WHO — the benefit right across age groups,” she told the meeting. “We know that vaccine- preventable disease cause widespread morbidity and mortality, as well as economic losses, that can be prevented.”
Ms Maher discussed the role that pharmacists can play in the programme: “The standard messages through the media don’t reach all of our population — they don’t reach people who are marginalised and they don’t reach people who may have poor health literacy.” She emphasised the need to better understand vaccine hesitancy. “People may be hesitant around one particular vaccine, or they may be hesitant because of the setting,” said Ms Maher. “We need to meet the public where they are, to allow them to be fully informed to make the right decision about the right vaccines at the right time, and in the right place.” Trust is important in terms of public perception, and Ms Maher pointed out that pharmacists are consistently ranked among the most trusted healthcare professionals by members of the public, along with doctors and nurses. “So we need to find out where that hesitancy is coming from, and address it from there.”
Prof Bergin and the panel spoke about the importance of surveillance systems, and it was suggested that they should be adapted to capture all vaccine- preventable diseases. On surveillance systems, Prof Bergin said: “I think it has a role to play in time-sensitive vaccine evaluation. Not all vaccines will have
their effect within a short time period… but for those that are time-sensitive and of a shorter duration, and where we can access the efficacy data, there would be a contribution to be made.”
Prof Bergin stressed the need for agility in the healthcare system, not only to prepare for future pandemics and epidemics, but also to enhance the opportunities that are available now to protect against vaccine- preventable diseases.
The panel concluded by reiterating the need for good educational communication on vaccines and building trust, as well as ensuring equitable access to vaccinators.
Support
Speaking to Irish Pharmacist (IP) at the launch, Ms Maher commented on the accessibility of community pharmacies, and what supports can be provided to pharmacists to enable effective access to a vaccination programme. “We need to make sure pharmacists are supported in terms of staffing and infrastructure,” she said. Such infrastructure includes the appropriate refrigeration facilities in pharmacies if their role in vaccination is to increase. “Vaccinations are going to increase in the [age] range and cohort, as we are all living longer, so pharmacists need these supports and the right staff to continue the operability of the pharmacy and deliver a really good vaccination service.”
She stressed that it is not an “either/ or” scenario when it comes to delivering vaccinations. “It’s about opening up access and supporting all of the vaccinators, and allowing people to get the right vaccine, at the right time and in the right place that suits them, in an equitable way. All vaccinators should be funded and resourced to provide all the vaccines that they need to.”
Also speaking to IP at the launch, Dr Glynn commented on his hopes for the report and the need for healthcare professionals to team-up on adult vaccination. “This report calls for a strategy cross the life course, with a focus on adult immunisation and why that’s important… a key part of the recommendations in this report is around the vaccinator workforce.
“It’s about a multidisciplinary workforce, it’s about multiple different access points for immunisation and vaccination, which means making the best use of existing facilities,” he told IP. “That means our
GP and primary care network, our pharmacies, mobile clinics, workplaces, and opportunistic vaccinations in hospital settings. It’s about bringing all our potential resources to bear to ensure that people are able to access vaccines in a convenient way, when they need them.
“To me, the ‘why’ of this report is important. With our rapidly-ageing ageing population and mounting morbidity, there are very few tools that we can be absolutely confident will have a significant impact on that and bring a return on investment, and we have that with adult vaccination. It is incumbent on us to do all we can to take advantage of that.”
The full paper can be accessed here.
