oday marks World Health Day, as well as the 75th anniversary of the World Health Organization’s founding in 1948. As a global health community, we have made great strides in reducing the mortality and morbidity rates of populations across the world.
For instance, life-course immunization is one of the most cost-effective public health interventions and underpins global health security. Between 2000 and 2015, the greatest reduction in child mortality was attributed to vaccinations to prevent vaccine-preventable diseases, and more than 51 million deaths can be prevented between 2021 and 2030 through immunization.
We also have much to be optimistic about the future for immunization. International organizations have committed to increase vaccine equity, so everyone, everywhere, at every age can benefit from vaccines. The ‘Immunization Agenda 2030 (IA2030)’ envisions a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and wellbeing.
Vaccinations For All, Not Just for Some
The theme of this year’s World Health Day, ‘Health for All’, is very fitting because more can be done to help us achieve our ambition of bringing life-saving vaccines to people in all communities, in any situation and at any stage of life.
The benefits of life-course immunizations are unevenly shared, and coverage varies widely among and within countries. The poorest, most marginalized, and vulnerable often have inadequate access to immunization services. Beyond childhood, the elderly population is more exposed to health risks, experiences more health problems, and often faces more challenges in accessing health-related services.
Yet, the low uptake rates of vaccines, such as influenza among the elderly is a reflection that we need to increase access to vaccines for them. For example, in 2021, the uptake rates of influenza vaccines among adults aged 65 and above in Malaysia and the Philippines are about 3% and 26.6%, respectively. In Vietnam, it is even lower at 1%. These figures are far below the target set out by the WHO at 75% to prevent annual epidemics.
Subsidies are available for indigent senior citizens to access free or discounted vaccination, for example, pneumococcal and influenza vaccines in the Philippines, but more than 75% of older adults there do not have access to them due to the limited doses offered under the program.
More than two-thirds of senior citizens in Asia Pacific do not receive a pension, and may not have the financial capacity to seek healthcare independently. The elderly may not be motivated to pay for life-course immunization services, as the costs will be largely borne out-of-pocket.
As life-course immunization costs are largely borne out-of-pocket, the access to improved vaccines that offer better protection may only be available to those who can afford it. Using influenza as an example, trivalent influenza vaccines (TIVs) contain two influenza A antigens and one B antigen while quadrivalent influenza vaccines (QIVs) contain an additional B antigen, making QIVs more protective against influenza. While QIVs should be the standard of care, they are only available in private health institutions, which limit their access to only those who can afford it.
Learning From Past Successes
The race toward developing COVID-19 vaccines and subsequent mass vaccination drives have illustrated that a government-led whole-of-society approach is key in times of public health crises, and we can unite to solve a common goal. For a region as diverse as Asia Pacific, a granular focus on the specific challenges faced by different communities in each country is needed.
Positive changes are already underway to increase immunization among marginalized communities, including ethnic minorities and populations in rural and hard-to-reach areas, and we can take learnings from these solutions to improve the uptake rates among the elderly in those populations.
During the COVID-19 immunization program, mobile clinics were deployed across Malaysia and Thailand to reach communities in rural areas–such existing infrastructure could be used for life-course vaccination programs beyond the COVID-19 vaccines.
There are also last mile delivery considerations when reaching rural communities, which consist of cold-chain logistics, safe handling and storage of vaccines and effective healthcare delivery to communities. Strong partnerships and knowledge sharing from countries with such capability will be crucial to assist others in delivering vaccines safely to every corner of the country.
Innovative financing mechanisms should be explored. These innovative approaches have played an important role in introducing new vaccines to low- and middle-income countries. For example, the purchase and inclusion of new vaccines, including the pneumococcal vaccine, in the National Immunization Program were made possible in the Philippines, following the introduction of the Sin Tax Law to earmark taxes on tobacco and alcohol for health. Such funds can be allocated to high-risk and marginalized populations that will most benefit from these vaccines.
Improving Health Outcomes for All
In the past few years, health equity has persisted as a concern from global health leaders, spurred by unequal access to care highlighted during the pandemic. To make the dream of achieving health equity a reality, we need a whole-of-society approach to tackle the persisting challenges and close the remaining gaps. We need to be agile and analyze ongoing systemic challenges that exist within each country and develop tailored and evolving plans for different population groups.
Populations in Asia Pacific are aging rapidly, with a projected increase from 670 million individuals aged 60 years or older in 2022 to 1.3 billion people by 2050. We are at a critical juncture to future proof the health of communities and ensure there is adequate access to cost-effective preventive interventions, such as vaccination throughout the life-course.
The time is now to leave no one behind in our life-course immunization strategies—and we must all play a part.
a global affairs media network
Toward a World Where We Leave No One Behind in Immunization
Photo by charlesdeluvio on Unsplash
April 7, 2023
World Health Day this year is also the 75th anniversary of the World Health Organization's founding. Sanofi's Ada Wong argues that while immunization has proven its centrality to global health, structural barriers to getting vaccinations to the most vulnerable remain-but we know how to overcome them
T
oday marks World Health Day, as well as the 75th anniversary of the World Health Organization’s founding in 1948. As a global health community, we have made great strides in reducing the mortality and morbidity rates of populations across the world.
For instance, life-course immunization is one of the most cost-effective public health interventions and underpins global health security. Between 2000 and 2015, the greatest reduction in child mortality was attributed to vaccinations to prevent vaccine-preventable diseases, and more than 51 million deaths can be prevented between 2021 and 2030 through immunization.
We also have much to be optimistic about the future for immunization. International organizations have committed to increase vaccine equity, so everyone, everywhere, at every age can benefit from vaccines. The ‘Immunization Agenda 2030 (IA2030)’ envisions a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and wellbeing.
Vaccinations For All, Not Just for Some
The theme of this year’s World Health Day, ‘Health for All’, is very fitting because more can be done to help us achieve our ambition of bringing life-saving vaccines to people in all communities, in any situation and at any stage of life.
The benefits of life-course immunizations are unevenly shared, and coverage varies widely among and within countries. The poorest, most marginalized, and vulnerable often have inadequate access to immunization services. Beyond childhood, the elderly population is more exposed to health risks, experiences more health problems, and often faces more challenges in accessing health-related services.
Yet, the low uptake rates of vaccines, such as influenza among the elderly is a reflection that we need to increase access to vaccines for them. For example, in 2021, the uptake rates of influenza vaccines among adults aged 65 and above in Malaysia and the Philippines are about 3% and 26.6%, respectively. In Vietnam, it is even lower at 1%. These figures are far below the target set out by the WHO at 75% to prevent annual epidemics.
Subsidies are available for indigent senior citizens to access free or discounted vaccination, for example, pneumococcal and influenza vaccines in the Philippines, but more than 75% of older adults there do not have access to them due to the limited doses offered under the program.
More than two-thirds of senior citizens in Asia Pacific do not receive a pension, and may not have the financial capacity to seek healthcare independently. The elderly may not be motivated to pay for life-course immunization services, as the costs will be largely borne out-of-pocket.
As life-course immunization costs are largely borne out-of-pocket, the access to improved vaccines that offer better protection may only be available to those who can afford it. Using influenza as an example, trivalent influenza vaccines (TIVs) contain two influenza A antigens and one B antigen while quadrivalent influenza vaccines (QIVs) contain an additional B antigen, making QIVs more protective against influenza. While QIVs should be the standard of care, they are only available in private health institutions, which limit their access to only those who can afford it.
Learning From Past Successes
The race toward developing COVID-19 vaccines and subsequent mass vaccination drives have illustrated that a government-led whole-of-society approach is key in times of public health crises, and we can unite to solve a common goal. For a region as diverse as Asia Pacific, a granular focus on the specific challenges faced by different communities in each country is needed.
Positive changes are already underway to increase immunization among marginalized communities, including ethnic minorities and populations in rural and hard-to-reach areas, and we can take learnings from these solutions to improve the uptake rates among the elderly in those populations.
During the COVID-19 immunization program, mobile clinics were deployed across Malaysia and Thailand to reach communities in rural areas–such existing infrastructure could be used for life-course vaccination programs beyond the COVID-19 vaccines.
There are also last mile delivery considerations when reaching rural communities, which consist of cold-chain logistics, safe handling and storage of vaccines and effective healthcare delivery to communities. Strong partnerships and knowledge sharing from countries with such capability will be crucial to assist others in delivering vaccines safely to every corner of the country.
Innovative financing mechanisms should be explored. These innovative approaches have played an important role in introducing new vaccines to low- and middle-income countries. For example, the purchase and inclusion of new vaccines, including the pneumococcal vaccine, in the National Immunization Program were made possible in the Philippines, following the introduction of the Sin Tax Law to earmark taxes on tobacco and alcohol for health. Such funds can be allocated to high-risk and marginalized populations that will most benefit from these vaccines.
Improving Health Outcomes for All
In the past few years, health equity has persisted as a concern from global health leaders, spurred by unequal access to care highlighted during the pandemic. To make the dream of achieving health equity a reality, we need a whole-of-society approach to tackle the persisting challenges and close the remaining gaps. We need to be agile and analyze ongoing systemic challenges that exist within each country and develop tailored and evolving plans for different population groups.
Populations in Asia Pacific are aging rapidly, with a projected increase from 670 million individuals aged 60 years or older in 2022 to 1.3 billion people by 2050. We are at a critical juncture to future proof the health of communities and ensure there is adequate access to cost-effective preventive interventions, such as vaccination throughout the life-course.
The time is now to leave no one behind in our life-course immunization strategies—and we must all play a part.
