“At this stage, the focus of China’s vaccination schedule is mainly on children, and the promotion of adult vaccination faces five major challenges: a lack of awareness among the public and health administrators; a lack of scientific and comprehensive immunization strategies and guidelines; a lack of funding mechanisms and inputs; a lack of standards and integrated planning; and a lack of effectiveness evaluation of the implementation,” said Dr. Wenzhou Yu, Chief Physician and Deputy Director of the Center for Immunization Planning of the CDC, at VaxLab’s 8th online workshop –Health for All: Immunization Across the Life Course, held on February 19.
This year marks the fiftieth anniversary of the Expanded Programme on Immunization (EPI). The early stages of EPI efforts centered on childhood immunization against six diseases, Presently, efforts are being made to prevent many more diseases and protect everyone across the life course. The Immunization Agenda 2030 (IA2030), promulgated by WHO, UNICEF, the GAVI Alliance, and others, urges countries around the globe to strengthen their immunization efforts across the entire life course, increasing equitable access to and use of new and existing vaccines, and to ensure the health and well-being of everyone.
“Globally, most countries’ have vaccines in the first three stages of life: pregnancy, newborn, and infancy. 2022 data show that about half of all countries currently provide universal or selective vaccine recommendations across the life course,” said Dr. Laura Nic Lochlainn, Technical Officer in the Life Course and Integration Team, Department of Immunization, Vaccines, and Biologicals (IVB), World Health Organization.
Disease risk exists throughout the life course, and some important vaccines do not provide lifelong protection and need to be provided to adults
Dr. Lance Rodewald, Senior Advisor for Immunization Planning at the China CDC, pointed out in the workshop that while certain childhood vaccines provide lifelong protection, such as measles and rubella, varicella vaccine, and Hepatitis B vaccine, there are important vaccines, such as influenza vaccine and pertussis vaccine, that do not. For example, influenza vaccine immunity wanes the year after vaccination, and the prevalent strains often change, requiring an updated flu vaccine every year.
“When we think about vaccination policies, we usually think about vaccinating before the risk of a disease arises,” said Lance Rodewald. He noted that the risk of different diseases varies throughout a person’s life. For example, the risk of shingles is more prevalent in people over the age of 50 and increases with each passing year. Vaccinations are crucial in improving the elderly’s health and quality of life.
In addition, studies have shown a causal link between vaccine-preventable diseases and other diseases. Contracting the flu increases the likelihood of hospitalization in patients with cardiovascular disease, while flu vaccination significantly reduces influenza-related complications of cardiovascular disease. Vaccination can protect special populations with pre-existing underlying diseases. A study by experts from the China CDC showed that receiving either the flu vaccine or the 23-valent pneumococcal polysaccharide vaccine, or a combination of both, reduced disease exacerbation in patients with chronic obstructive pulmonary disease (COPD), pneumonia, and the number of hospitalizations. People in specific occupations, such as healthcare workers, who face a higher risk of influenza infection, benefit from flu vaccination to protect themselves, their patients, and their family members.
“Vaccinations are not exclusive for children, and the risk of disease continues throughout our lives. There are many important times in adulthood when we can be protected from or reduce the severity of disease through vaccination, adult immunization needs to be based on age, disease risk, and occupation, and lifelong vaccination should become a societal norm,” said Lance Rodewald.
Adult immunization planning requires a multipronged strategy
In 2022, the China CDC conducted a survey on the vaccination status of adults in China. From 2019 to 2021, the vaccination rates of PPSV23, HPV vaccine, and influenza vaccine increased yearly but remained relatively low. From the 2021 data, the national vaccination rate across different age groups for various vaccines is as follows: The PPSV23 vaccination rate is only 0.06% for the 18 to 59 age group and 1% for those over 60 years old; the HPV vaccine has a first-dose rate of 2.34% for adult females aged 27-45 years old, while the rate for the full course vaccination (three doses) is less than 1%; influenza vaccine for those aged 18-59 years old is 0.52%, and 4.63% for those aged 60 years old and above. In an eastern province where free influenza vaccination is provided for the elderly, the influenza vaccination rate for this group reached 40-50%, however, the vaccination rate for individuals aged 18-59 years is only 0.6%.
“Another survey found that healthcare organizations face many practical difficulties for the provision of adult vaccination services. Insufficient space and health workforce and a lack of incentives are the main reasons. The workload of routine vaccination work and other public health services is already high. As a result, 54% of the surveyed healthcare organizations believe that they need to invest more resources in order to do a good job in adult vaccination services,” Dr. Wenzhou Yu said.
Singapore has been implementing the Adult Immunization Schedule since 2017 through strategies that include clear vaccination recommendations from the state to healthcare providers and the public; increased vaccination promotion and public awareness through multiple online and offline channels, media campaigns, and reminders on digital platforms; increased accessibility and affordability, with the government subsidizing the delivery of vaccination through primary care clinics; and partnering with schools and nursing homes to promote vaccination coverage.
“Based on Singapore’s experience, it is unlikely that any single effort will dramatically increase adult vaccination rates. We need a multi-pronged strategy and integrated planning,” Lim Soon Kok said. He noted that the COVID-19 pandemic experience has provided a good opportunity to increase the awareness and acceptability of adult immunization, breaking away from the traditional thinking that vaccinations are only for children.
Dr. Wenzhou Yu believes that China needs to pay attention to adult vaccination. The next steps involve: Standardizing and regulating the services of vaccination units to provide convenient services close to home; broadening the financing channels to solve the problem of cost expenditures; strengthening awareness-raising and health education; providing good vaccination appointment systems for the public; and continuously improving monitoring and evaluation.
