1
Introduction
Life course immunisation (LCI) policies provide multi-generational, population-wide
disease prevention. Mass COVID-19 vaccination campaigns around the world have shown
that this is an effective approach. By expanding LCI practice and infrastructure,
introduced in the COVID vaccination campaigns, governments can protect everyone from
vaccine preventable disease (VPDs) to build health system and population resilience.
Looking to the future, LCI has a place now more than ever. COVID-19 will likely not
be eradicated but move to endemic status, continuing to circulate in pockets within
the population [1]. This may see COVID vaccinations delivered seasonally in National
Immunisation Programmes (NIPs), similar to influenza vaccinations.
Increasing vaccine coverage rates (VCR) reduces the risk of coinfection. Infection
by viruses like influenza or COVID-19 impairs the host’s immune defences, creating
an attractive environment for viral and bacterial pathogens to exploit and cause secondary
infections [2]. Coinfection can complicate diagnosis and treatment, ultimately resulting
in more lives lost and more healthcare resources utilised.
We must address suboptimal VCRs, compounded by COVID-related service interruptions,
which have left many unprotected and vulnerable. Vaccine recommendations in NIPs vary
globally, making it difficult to achieve international coverage targets (Fig. 1
). Not achieving targets universally results in ongoing disease circulation and reintroduction,
challenging health systems and communities. Increasing VCRs is key to sustainable
management of influenza, COVID and other vaccine preventable diseases (VPDs).
Fig. 1
Influenza VCR varies greatly, and most countries do not meet the WHO-recommended 75%
target [3].
2
Life-course immunisation to build resilience
Realising the benefits of vaccination for all, not just children or the elderly, holds
significant value in building population and health system resilience. By not segmenting
by age or stage, LCI policies focus on providing convenient, accessible vaccination
to all. Disease prevented through vaccination reduces health care utilisation and
saves resource, which can be redirected to the fight against COVID-19 or future pandemics.
Complete and well-maintained immunisation throughout life, along with nutrition and
physical activity, helps individuals build and maintain their unique functional capacity
(Fig. 2
), enabling them to do what they value throughout life.
Fig. 2
Trajectory of functional capacity and the impact of interventions across the life
course [4].
Widening vaccination access, communicating value to all and standardising policy is
important for the health and stability of the European region. We call on policymakers
to build on the vaccination systems, attitudes and expertise developed during the
COVID-19 pandemic to implement effective LCI policy. We look across 5 areas for action
published in 2019 by members of this writing team and Tate et al. [5] to demonstrate
progress made towards multi-generational vaccination policy.
3
Refine integrated data and systems infrastructure
Developing digital infrastructure for vaccination delivery and surveillance allows
orderly distribution to priority groups, efficient billing processes, real-time pharmacovigilance
and VCR surveillance. Infrastructure has been key to COVID vaccination campaigns:
21 European countries now have Immunisation Information Systems capable of monitoring
individual and population-level uptake and 23 countries have cold chain infrastructure
[6].
Pharmacovigilance infrastructure, such as the EU EudraVigilance database, now receives
monthly COVID vaccine safety reports from companies, instead of every 6 months, utilises
batch traceability tools and collaborates with researchers to rapidly respond to safety
issues [7]. This is an improvement from some previous vaccination campaigns (e.g.
HBV, H1N1 or HPV) where there was a time lapse between safety concerns raised and
response.
Some countries have set-up patient databases to target messaging and interventions
during the COVID-19 pandemic. England’s Shielded Patient List has been iteratively
improved since 2020 and is on version 46. Development involved interrogation and analysis
of multiple national databases; standardisation of data format and disease coding;
using algorithms to identify high-risk individuals and outreach through GP surgeries,
patient associations and mass media [8].
Most countries have created public-friendly, national booking websites, like France’s
Doctolib, linked to data collection, analysis and visualisation platforms.
4
Develop coordinated, multidisciplinary leadership
Collaborative leadership has been key to infection control, for example, polio incidence
has been reduced by 99% due the efforts of the largest private–public partnership:
The Global Polio Eradication Initiative.
Effective vaccination deployment needs multi-disciplinary, collaborative working.
This was recognised by European countries that reported collaboration across Ministries
of Defence, Education, Health and Security services, NGOs and businesses to deliver
the COVID-19 vaccination campaigns [6].
For us All Campaign is a partnership between Ireland's Health Service Executive (HSE)
and dating apps, to increase VCR in young people. Users could add a vaccination badge
to their profiles, free 'Super Likes' and other features to show their support for
vaccines.
5
Build a diverse body of trained, confident vaccinators
Expanding the vaccinator workforce has been used to increase VCR before the pandemic;
In Ireland pharmacists have been vaccinators since 2011, delivering the influenza
vaccination to 19,000 customers in the 2012–13 season and 185,000 in 2019–20 season,
representing a 817% increase [9]. Many of whom were unvaccinated and from high-risk
groups.
This further expanded during COVID, with many European countries training pharmacists,
midwives, nurses, nursing associates, operating department practitioners, paramedics,
physiotherapists, dentists, retirees and students to deliver COVID and influenza vaccinations
[6]. This diversity brings a greater range of advocacy voices into the vaccination
space, improving trust, demystifying vaccination and providing more delivery capacity.
Vaccinators must be trained in evidence-based communication methods to approach vaccination
conversations proactively and confidently. Motivational Interviewing is one communication
approach which has helped vaccinators engage confidently with the public to improve
trust and confidence. This approach garners change by using open-ended questions and
cultivating a culture of partnership and compassion; fostering engagement in the relationship
and focusing discussion on the target of change by affirming and reiterating statements
back to the interviewee; and using reflective listening to understand and address
the individual’s root concerns [10].
6
Change public perceptions of vaccination
COVID-19 led to innovative health communications across the world as governments,
businesses, NGOs and media outlets collaborated to communicate the impact of COVID,
value of vaccination and combat misinformation.
#TeamHalo train and support healthcare professionals (HCPs) and scientists (Team Halo
guides) to share their knowledge of the COVID-19 vaccination to counter misinformation.
Team Halo guides invite questions from the public and share cutting-edge research
to increase vaccine confidence. This initiative was endorsed by the United Nations
and the Vaccine Confidence Project, giving them the credibility to work directly with
TikTok to ensure verification of Team Halo guides and expedite access to advanced
features. Team Halo ensure organic growth by supporting HCPs and scientists already
active on social media to amplify their messages through training and tools. It is
a key part of their approach that Team Halo guides maintain their independent, diverse
voices, which brings language and cultural diversity to advocacy messages. Ensuring
HCPs and scientists show themselves as real people, not just ‘the professional’ is
essential to building public trust and engagement.
Innovations to counter vaccine misinformation and distrust before COVID were expanded
upon during the pandemic, for example, analysing sentiments and trends on social media,
removing misinformation from recommendation algorithms, and establishing reliable
public information resources, like the WHO
Vaccine Safety Net
.
7
Making vaccination more convenient and community-based
Bringing vaccination and vaccinators closer to the public increases equitable, convenient
access which is important for increasing VCRs across the life course. This has worked
well previously through school and pharmacy-based vaccination delivery. However, global
mass vaccination campaigns saw this become more widespread, with many European countries
delivering COVID vaccines in GP surgeries, pharmacies, workplaces, schools, prisons,
football stadiums and mobile clinics [10].
8
Conclusion
The pandemic response has pushed governments, healthcare systems and society to realise
the benefits of vaccinating people across the life course. We have the tools, expertise
and infrastructure in place to turn the tide on declining VCR and to realise the full
potential of vaccination throughout life. We hope that the learning presented in this
paper can support innovators to improve VCR in their context by delivering and advocating
for LCI policy and practice.
It is time to elevate our response, move away from age-segmented approaches and look
to protect all to ensure health equity and global stability. By building on the precedent
set during the ongoing COVID-19 pandemic and expanding the COVID-19 adult vaccination
infrastructure to other vaccinations, governments can support communities to nurture
and develop their internal capacity for health throughout life. Utilising vaccination
for health promotion from birth to death can help achieve a more equitable society
where everyone lives longer, healthier, more independent lives. Ultimately, this saves
society and healthcare vital resources which could be directed to other fragile health
sectors or used to prepare for novel or unknown future threats.
We call on policymakers to build health system and population resilience by expanding
the LCI practice and infrastructure introduced in the COVID control and prevention
strategies globally.
The Coalition for Life-course Immunisation acknowledges receipt of an unconditional
educational grant from Sanofi Pasteur to support the writing of this paper. Sandra
Evans was commissioned by CLCI to write the paper; no other author received any honorarium
from CLCI for their contribution. Dr Daphne Holt, Professor Catherine Weil-Olivier,
Mr Gary Finnegan and Professor Vytautas Usonis have no writing support from any source
for this paper, or conflict of interest to report.
Declaration of Competing Interest
The authors declare the following financial interests/personal relationships which
may be considered as potential competing interests: [Sandra Evans reports financial
support was provided by Coalition for Life-course Immunisation.
The Coalition for Life course Immunisation
reports financial support was provided by Sanofi Pasteur.].