Implementing a Life-Course Approach to Immunization: Lessons Learned from International Best Practice in Policy and Programming

"As ageing populations put increasing pressure on health systems,...vaccine hesitancy is on the rise...and the toll of AMR [antimicrobial resistance] continues unabated,...implementing effective life-course immunization strategies remains a critical policy priority and opportunity."

The United Nations reports that the global over-60 population is set to more than double between 2017 and 2050, growing to more than 2 billion people. Despite these demographic trends and the acknowledged value of life-course immunisation, the emphasis on childhood immunisation over the last decade has arguably sent the message, even if unintentional, that adult vaccines lack importance. This report aims to guide policymakers and other stakeholders looking to implement sustainable life-course immunisation policies and programmes. Drawing from desk research and expert interviews in 6 countries, it includes 15 case studies with implementation lessons and highlights 5 key policy components that are built into a policy framework. The report was commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and produced in collaboration with the Health Policy Partnership (HPP).

After defining and reviewing the benefits of a life-course approach to immunisation, the report notes that the World Health Organization (WHO) Global Vaccine Action Plan (GVAP) 2011-2020 recommended implementing a life-course approach to immunisation; this is in line with the WHO General Programme of Work, which advocates for a life-course approach to health. However, most countries have not yet implemented policies to support this approach. According to HPP and IFPMA, many of the goals will not be achieved by 2020, and there is an urgent need to redress this situation in the decade to come.

Key policy areas outlined in the report include:

1. Comprehensive immunisation programme that supports vaccine availability - For example, all 6 countries included in this report have National Immunization Technical Advisory Groups (NITAGs) that make recommendations on immunisations across the life course. In addition, approaches to providing immunisations for underserved groups have been trialled in some of the countries assessed: In Brazil, for instance, high levels of vaccine coverage among indigenous communities have been achieved through a dedicated annual immunisation campaign.
2. Public demand for immunisation:
   • Awareness-raising campaigns represent opportunities to promote immunisation across the life course. This involves educating individuals and communities about the importance and benefits of immunisations for all groups; increasing public confidence is necessary to reduce vaccine hesitancy and support vaccine acceptance. Different approaches to reaching specific groups have been used, such as a tailored rubella communication campaign using manga (comic or graphic novel) characters thought to resonate with men in Japan aged 49-56 (see case study 4) and the use of the social media platform WhatsApp in Brazil to address "fake news" and to promote yellow fever vaccine acceptance (see case study 5).
   • Civil society organisations - e.g., patient organisations, professional societies, and non-profit associations - are well positioned to engage in a range of activities to support vaccine uptake. For example, in Japan, cross-sectoral collaboration supported the establishment of travel clinics to improve access to travel vaccines; key drivers behind the project's success included an educational manual and training for healthcare professionals (see case study 6).
3. Engaged healthcare professionals - Multiple studies have found that healthcare professional (HCP) recommendation or endorsement significantly influences vaccine uptake. Therefore, it is important that HCPs understand the benefits of immunisation across the life course - not just in childhood - and that they communicate this effectively with their patients. For example, in the United States (US), the 4 Pillars Practice Transformation Program is an evidence-based guide that aims to increase adult immunsation in primary care settings through convenient vaccination services, communication with patients, enhanced office systems, and motivation via an office Immunization Champion. A cluster randomised controlled trial showed that the programme was effective (see case study 8).
4. Multidisciplinary and cross-sectoral coordination - In all 6 countries, convenient access to immunisation has been enhanced through delivery in non-clinical settings, such as pharmacies. For example, the Reaching Carers influenza vaccination campaign in United Kingdom (UK) pharmacies featured workshops, an online training tool, and a flowchart outlining a 60-second conversation to have with those customers who could be considered unpaid carers, a hard-to-reach group. The number of carers vaccinated increased by 61% (see case study 12).
5. Robust data informing policies and programmes - Immunisation information systems (IISs) are databases that record all immunisations given to individuals in a population. The Australian Childhood Immunisation Register (ACIR) was expanded in 2017 to include people of all ages and is now the Australian Immunisation Register (AIR); it can be accessed by both individuals and HCPs. On a smaller scale, France's MesVaccins.net is a web- and smartphone-based electronic vaccination record that provides individuals and HCPs with access to dashboards containing personalised immunisation recommendations that are designed to empower individuals to take ownership of their immunisations and support HCPs to give correct and consistent advice (see case study 14).

The Annexes to the report include country profiles of each of the 6 countries studied: Australia, Brazil, France, Japan, the UK, and the US.

In conclusion, HHP and IFPMA "call on all stakeholders to consider the policy changes needed to improve population health and promote health system sustainability through increasing vaccination coverage across the life course."