Decreasing vaccine preventable diseases in adults

Bruce Gellin, MD, MPHDeputy Assistant Secretary for Health

Director, National Vaccine Program OfficeUS Department of Health and Human Services

Joint Regional Meeting For the Americas and Europe

Madrid, SpainFebruary 1, 2017

https://www.hhs.gov/nvpo

The vision for the Decade of Vaccines (2011–2020) is of a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. The mission of the Decade of Vaccines is to extend, by 2020 and beyond, the full benefit of immunization to all people, regardless of where they are born, who they are or where they live.

13. CONSIDERS that an evidence-based, cost-effective, safe and efficient immunization system is an integral part of a well-functioning health system.

December 2014

14. POINTS OUT that, given the changes in the demographic structure of the European population, there must be a greater focus on preventing infectious diseases by means of vaccination of all age groups where this improves the epidemiological control of the disease.

December 2014

SEASONAL INFLUENZA VACCINE

DOSES DISTRIBUTED 2004-2013 (PER 1,000)

Palache 2015

SEASONAL INFLUENZA VACCINE

DOSES DISTRIBUTED 2004-2013 (PER 1,000)

Palache 2015

SEASONAL INFLUENZA VACCINE

DOSES DISTRIBUTED 2004-2013 (PER 1,000)

Palache 2015

SEASONAL INFLUENZA VACCINE

DOSES DISTRIBUTED 2004-2013 (PER 1,000)

Palache 2015

SEASONAL INFLUENZA VACCINE

DOSES DISTRIBUTED 2004-2013 (PER 1,000)

Palache 2015

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POLICIES THAT ENABLE SEASONAL INFLUENZA

VACCINE UPTAKE

• Vaccine advocacy and education

• Building public trust

• Real-time management of the vaccination program

• Political commitment

• Improving access to vaccination

Palache 2015

POLICIES THAT ENABLE SEASONAL INFLUENZA

VACCINE UPTAKE

• Vaccine advocacy and education– For general public, high risk groups, vaccinators

• Building public trust– Adverse event monitoring

– Disease surveillance

– Program impact assessment

– Communication

• Real-time management of the vaccination program– Monitor coverage in real time

– Continuous quality improvement

• Political commitment– Prioritize influenza within health portfolio

• Improving access to vaccination– Reduce restrictions to access

– Reduce financial disincentives

– Reconsider age limits of older populations

– Provide monetary incentives to vaccinators

Palache 2015

Member States Recommending Seasonal Influenza Vaccination for Adults

Recommended Adult Immunization ScheduleUnited States - 2016

0

50

100

150

200

250

300

1964 1974 1984 1994 2004 2006 2008

Year

Mill

ion

s

HR Adults 19-49

Adults > = 50 years

Children 6mo-18 yrs

24-59 mos. of age

6-23 mos. of age

50-64 year healthy individuals

Household contacts

Health care workers

Nursing home residents

Pregnant women

<65 years with a high risk

condition

> =65 years

Evolution of Seasonal Influenza Vaccination Recommendations – United States

2010: Flu vaccine recommendedfor all > 6 months of age

Impact of Policies (and their adoption) Seasonal Influenza Vaccine Production, Distribution: United States 1979-2010

(millions of doses)

Outreach and Reminder Recall

“We ask that you confirm your risk category for flu….”

Recommended Adult Immunization ScheduleUnited States - 2016

Surveillance of Vaccination Coverage

Among Adult Populations — United States,

2010-2014

February 5, 2016

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448406/hpr2615_ppv.pdf

Percentage PPV coverage –ever vaccinated, by age group, England, 2005/06 to 2014/15

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448407/hpr2615_shngls.pdf

Cumulative shingles vaccine coverage in England by age cohort, September 2014 to May 2015 (year 2), and September 2013 to August 2014 (year 1)

United States

• Assess• Recommend• Administer or Refer• Document

Assess

Recommend

Administer or Refer

Document

Adult Vaccination Finder

Available at http://www.vaccines.gov/

National Immunization

Awareness Month

• In August; third week focuses on adults

• Highlights value of vaccines across the lifespan

Toolkit available at: www.nphic.org/niam

http://www.izsummitpartners.org/

Maternal Immunization

Sobanjo-ter Mullen (VRBPAC, 2015)

Global Impact of AMR by 2050

300 million people are expected to die prematurely because of drug resistance

GDP will shrink by 2 to 3.5%

Global economy will lose between 60 and 100 trillion USD worth of economic output

http://amr-review.org/

Vaccines prevent infections and so reduce the need to use antibiotics

This is true for vaccines that prevent bacterial infections, and it is also true for vaccines that prevent viral infections, such as the flu, which should not be treated with antibiotics but often are anyway. This may be for lack of rapid diagnostic tests to inform prescription or because patients buy them over the counter.

Vaccines also have the potential to reduce the use of antibiotics in agriculture

February 2016

Recommendations

• Use existing products more widely in humans and animals

• Renew impetus for early research

• Sustain a viable market for needed products

February 2016

Four Overarching Goals

THE NATIONAL VACCINE PROGRAM OFFICE

Epilogue….

…and Prelude

16. RECOGNISES the importance of the general public understanding the value of vaccinations and NOTES that the occasional lack of awareness of the benefits of some vaccines and the increasing refusal of vaccination in some Member States may lead to under-vaccination in some populations resulting in public health problems and costly outbreaks.

December 2014

Vaccine hesitancy, acceptance and demand

Howard takes all of the flu shots that other employees refuse to take