Vaccination 'a civic duty' according to new report

“Getting vaccinated is a civic duty, warn health experts,” The Independent has reported. 

The news is based on a new report on adult immunisation in the UK produced by the International Longevity Centre.

The report's main message is that there needs to be greater focus on adult immunisation and it calls for increased adult vaccination against infectious diseases such as flu.

This, they argue, will help reduce the burden of infection on an ageing population (who are more vulnerable to infection), combat the growing menace of antibiotic resistance and save the NHS money.

This report provides useful information about adult immunisations in the UK as well as useful recommendations for increasing immunisation coverage, particularly among social care workers. However, it does not replace current guidelines for recommended vaccines. Currently recommended vaccines for adults in the UK are described below.

Who produced the report?

This report, titled ‘Immune response. Adult immunisation in the UK’ was written by the UK’s International Longevity Centre (ILC-UK). According its website, the ILC-UK is a registered charity and independent think tank dedicated to addressing issues of longevity, ageing and population change.

The report itself is based on new research recently published by SAATI (Supporting Active Ageing Through Immunisation). SAATI is a voluntary group of individuals from across Europe who are reported to share a commitment to tackle low public awareness of vaccine-preventable diseases.

In November 2013, SAATI published a report on adult vaccination across Europe (Adult vaccination: a key component of healthy ageing. Benefits of life-course immunisation in Europe (PDF, 4.3MB)) which focused on the following seven infectious diseases that can be prevented by vaccination:

• flu – caused by the influenza viruses; this includes seasonal flu as well as swine flu
• pneumonia – lung infection, which may be caused by various bacteria, viruses and sometimes other organisms (such as fungi)
• herpes zoster (shingles) – a painful blistering skin rash, caused by the same virus that causes chickenpox
• invasive pneumococcal disease – a potentially life threatening disease caused by the bacteria Streptococcus pneumoniae (pneumococcus). ‘Invasive’ means infection may be in the lungs (pneumonia), bloodstream (septicaemia) or outer layers of the brain or spinal cord (meningitis)
• pertussis (whooping cough) – a highly contagious respiratory infection caused by the bacteria Bordetella pertussis
• diphtheria – a highly contagious and potentially life-threatening infection of the upper respiratory tract caused by the bacteria Corynebacterium diphtheriae
• tetanus – a serious and potentially life-threatening illness caused by contamination of wounds, for instance with soil, containing Clostridium tetani bacteria

The latest report by ILC-UK includes evidence from the SAATI report, but takes a UK perspective of the findings. It is also based on a review of evidence in the area of immunisation and immunisation experts are said to have also informed the findings through focus groups.

As noted on the ILC-UK website, the ILC-UK report was funded through an unrestricted educational grant from Pfizer International Operations, a drug company, which manufactures a wide range of products, including vaccines.

Why is adult vaccination important?

The report says that despite a common perception (with the exception of the flu jab) that immunisation is only for children, it is beneficial for people of all ages.

According to the World Health Organization, immunisation prevents between 2 and 3 million deaths a year across all age groups.

This report says vaccination remains an underused public health strategy for adults in the UK and across Europe. It highlights that the growth of antibiotic resistance, the challenges of gradual deterioration of the immune system with increasing age (called immunosenescence) and the effects of migration, mean greater focus should be placed on improving adult vaccination in the UK.

Another important factor to consider is herd immunity, where immunising a large proportion of the population leads to a reduction of an infection or disease among people that are not immunised. 

The report also highlights that there is ‘strong evidence’ for the cost effectiveness of adult immunisation as a public health intervention. It says cost-effectiveness was found for four of the seven vaccine-preventable diseases focused on in the report (herpes zoster, influenza, invasive pneumococcal disease, pneumonia). It says, for the other three vaccines (pertussis, diphtheria, tetanus), a lack of studies meant that a cost-effectiveness analysis could not take place.

What are the current recommendations?

Currently in the UK, the following vaccines are recommended for adults and elderly people:

• Pneumococcal vaccination (also known as pneumonia vaccine or pneumo vaccine) for adults aged 65 years or over, or adults under the age of 65 with certain medical conditions such as chronic heart failure. The vaccine is usually given to adults as a one-off vaccine which is used for life protection and is not given annually like the flu jab. However, people with a long-term condition may need a single one-off vaccine or five-yearly vaccination depending on their medical condition.
• Flu vaccination (also known as flu jab) for adults over the age of 65, and adults under the age of 65 with an underlying health condition (particularly long-term heart or respiratory disease). The flu vaccine is given free on the NHS as an annual injection to adults over the age of 18 at risk of flu which includes everyone over the age of 65. Each year flu vaccines are given to cover the virus strains most likely to be circulating that year.
• Shingles vaccine is available on the NHS to adults aged 70 or 79 as a single injection. The vaccine is expected to reduce the risk of getting shingles, or if you are unlucky enough to go on to have the disease, your symptoms may be milder and the illness shorter.

If travelling outside the UK and depending on the areas being visited, some additional travel vaccinations are recommended. Some countries require an international certificate of vaccination or prophylaxis (protection) before entering. The following travel vaccinations are currently offered free on the NHS:

• polio (given as part of a tetanus, diphtheria and polio booster)
• typhoid
• the first dose of hepatitis A
• cholera

What are the main recommendations of the report?

This report sets out more than 30 recommendations. Among these, it calls for:

• the piloting (testing) of a voucher system for adults eligible for the seasonal flu vaccine which could be used in GP surgeries and high street pharmacies
• Public Health England and the Department of Health to review the current approach to the vaccination of social care workers in England
• The Quality and Outcomes Framework (the yearly reward and incentive scheme of GP practice achievements and results) to include a yearly check on the immunisation status of all GP registered patients
• healthcare professionals carrying out health check-ups of older people to check whether their patients are up-to-date with their vaccines

The report also sets out a number of proposed ideas to support these recommendations. These include:

• the introduction of an adult vaccination record card which could be used throughout a lifetime
• a simplified adult vaccination checklist for people over 18
• encourage people to include a record of their immunisation history to be carried with their passport
• GPs to be allowed to privately prescribe approved vaccinations (in addition to travel vaccines) to their adult patients

Conclusion

The report certainly makes a compelling case. The combination of an ageing population, increased antibiotic resistance and migration from abroad could increase the burden of infectious diseases. So the old adage “Prevention is better than a cure” is more relevant than ever.

The challenge is how to encourage people to sign-up to an adult vaccination programme? Options range from appealing to people’s sense of civic duty to offering them money or some sort of tax break.

It is a difficult question to answer, but it is a question politicians and policy makers will have to deal with in the near future.