Adult vaccination: Can we do better? Volume 3 - Issue 1

Zoi Tsimtsiou*

• Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Greece

Received: February 11, 2021   Published: February 25, 2021

Corresponding author: Zoi Tsimtsiou, MD, MSc, PhD, Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Greece

DOI: 10.32474/JCCM.2021.02.000154

Abstract PDF

Vaccination is widely considered as one of the most cost-effective public health interventions, that has succeeded in eradicating life-threatening diseases and improving significantly global health. Although the increasing effectiveness and safety of vaccines has been repeatedly investigated and reported, insufficient vaccination coverage rates still constitute an international challenge. Some vaccines are still underutilized and one of the major underlining reasons is the opposition in the population against immunization, commonly addressed as vaccine hesitancy. According to the report of the World Health Organization (WHO) SAGE working group on vaccine hesitancy it “refers to delay in acceptance or refusal of vaccines despite availability of vaccination services” and it “is complex and context specific, varying across time, place and vaccines”, “influenced by factors such as complacency (not perceiving the need for a vaccine and/or not valuing the vaccine), convenience (access issues)and confidence (level of trust in vaccine or healthcare professional)”[1]. WHO has recently declared vaccine hesitancy as one of the ten biggest threats to global health in 2019 [2].

Although there are suboptimal vaccinations coverage rates in both children and adults, adult population clearly lags behind the vaccine uptake. Addressing effectively under-vaccination in adults requires an adequate understanding of the determinants of the situation, since numerous factors may influence whether a person gets vaccinated or not [3], according to the «Increasing Vaccination Model» (proposed by the WHO global expert group entitled «Measuring Behavioral and Social Drivers of Vaccination», BeSD). Based on this model, motivation to get vaccinations may be affected by “what people think and feel” and social processes (provider’s recommendation, social norms, gender, rumors, information sharing). Additionally, a person’s ability to get vaccinated may be affected bya number of practical factors, such as vaccine availability, quality of services, convenience, cost, satisfaction, incentives, requirements, and intervention fatigue [3].In line with this model, previous research has shed some light in what drives people motivation to get vaccinated mainly regarding specific well-known vaccines, like the vaccines for seasonal influenza or Pneumo coccus. Among the barriers that have been previously associated with low vaccine uptake are: concerns about vaccines’ safety, doubts about their effectiveness, low perception of personal susceptibility to the disease due to perceived good health status, fear of the needle and previous negative experiences with vaccination (either personal or within one’s social context).Moreover, significant knowledge gaps about adult vaccination, distrust in government and pharmaceutical companies, and absence of healthcare professionals’ recommendations or even discouragement have been reported to have a negative impact on adults’ decision to get vaccinated [4].

Addressing the knowledge gaps on the availability, necessity, effectiveness and safety of adult vaccination constitutes an issue of great significance. Evidence reveal that are still adults who believe that vaccines are available and important only during childhood, while others state unaware of the recommended vaccines for them [4]. It seems important to spread the knowledge that adults also need vaccinations to prevent them from getting and spreading infectious diseases that could result in poor health outcomes, missed work and medical bills. Moreover, it is of high significance to make publicly known which specific vaccines are recommended for all adults based on their age, medical history, occupation, travel, lifestyle and their prior vaccination record.

Public health has a significant role to play in communicating properly the messages of availability, necessity, effectiveness and safety of adult vaccination with the population. Developing public health programmes that aim to increase vaccine uptake at the population level is especially demanding, since the effect of vaccine hesitancy is not always clear. First of all, hesitancy may be not directly related to vaccine uptake, since it has been observed that hesitant people may accept to get the recommended vaccines, but still retain significant doubts. Moreover, hesitancy can vary according to the vaccine involved, with newer vaccines usually engendering more hesitancy [5], often under the strong influence of anti-vaccination arguments appearing in the media, especially on the Internet. Inaccurate information spreads widely and speedily, making it more difficult for the public to distinguish false and potentially harmful information from the verified facts and advice from trusted sources. Special efforts are made to raise awareness of misinformation around COVID-19, during the global pandemic, since even under these special circumstances the online anti-vaccine movement refuses to retreat. It is apparent that addressing low vaccination requires an adequate understanding of the determinants of the problem and tailored evidence-based strategies to improve vaccine uptake. Developing these public health interventions in collaboration with communication experts seems to be an effective way to ensure that their messages, while being scientifically rigorous, can also be adequately communicated to the public and to healthcare professionals.

On the other hand, the role of healthcare professionals, seems to be extremely important in influencing their patients’ decision to get vaccinated, especially in the context of primary health care [1]. Physicians and other healthcare professionals can play a crucial role in providing evidence-based, individualized information to their patients about the recommended vaccines for their age, health status and lifestyle, responding to their personal queries. Offering patient-centered consultations to their patients and including adult vaccination in their routine agenda will give them the opportunity to elicit each patient’s attitudes, concerns about adverse events and effectiveness, and other possible personal barriers. Tailoring the communication during the consultation to each patient’s needs will enable them to actually see vaccination “through their patients’ eyes” and contribute in the development of well-informed, autonomous patients that actively choose to get vaccinated.

Although health professionals, and especially physicians, are generally strong supporters of vaccination, they have been often found to not prioritize the inclusion of adult vaccination in the routine consultation agenda, or to hold similar misperceptions with the public, or even to publicly condemn vaccination. Although the proportion of hesitant healthcare workers world-wide remains unknown, their existence is well-illustrated by the reluctance of a significant proportion to receive the seasonal influenza vaccine each year despite the strong international recommendations to protect themselves. Previous research in healthcare professionals’ hesitancy has mainly revealed concerns relating to the risks of vaccination and lack of trust in health authorities [6]. Since this group of professionals are the most trusted source of information on vaccination, there is a severe risk that hesitant healthcare workers might spread concerns about immunization to the general population, recommend vaccines less frequently to their patients, and reduce vaccine confidence and uptake by their patients.

Since the interaction between healthcare professionals and patients could be the corner stone of increasing confidence in adult vaccination, providing continuous education about the national immunization schedules, as well as tools and tips on how to deal with patient’s vaccine hesitancy could be effective in helping physicians in their every practice. It has been also reported that physicians’ involvement in mixed-methodology studies on adult vaccination could result in increasing their awareness of their patients’ needs, placing adult vaccination higher on their consultations’ agenda, and also planning of alternative ways to increase community awareness in this field [7]. Furthermore, in an effort to counter hesitancy both in the public and healthcare professionals, transparency in policymaking decisions regarding vaccination programs, publication of the rigorous processes that lead to the approval of vaccines, as well as the disclosure of the results of the intensive post-marketing surveillance of the available vaccines, could act synergically.

In conclusion, since increasing adult vaccination uptake is vital for vaccines to achieve their success, multi-component interventions are required to improve confidence in vaccines and increase vaccination coverage.Addressing low vaccination requires an adequate understanding of the determinants of the problem, tailored evidence-based public health strategies to improve uptake, and monitoring and evaluation to determine the impact and sustainability of the interventions. Taking into consideration the newly introduced vaccines against SARS-CoV-2, it seems that to allay healthcare professionals’ concerns, high quality, peer-reviewed research publications are needed. On the other hand, in order to allay the public’s concerns an effective way is required to communicate to people what is reported in the published research papers on the safety and effectiveness of the vaccines, and especially the newest ones.Further research is needed in an effort to bring to light the wider range of possible attitudes and barriers that may constitute determinants of low adult vaccination rates, both in the population and also in healthcare professionals, as well as effective strategies to address hesitancy in different settings. Finally, improving vaccine confidence among healthcare professionals is crucial, as they can play a significant role in providing tailored information to their patients, empowering them to actively choose to get vaccinated and therefore contributing significantly to the success of the vaccination programs. The provision of patient-centered care by healthcare professionals, that strongly support vaccination, seems to be the gold standard for the elimination of patient-related barriers in the universal effort to increase vaccination uptake in adults and achieve higher vaccination coverage rates in the general population.

1. World Health Organization (WHO) (2015) SAGE Vaccine Hesitancy Working Group, Summary of WHO SAGE conclusions and recommendations on Vaccine Hesitancy.
2. World Health Organization (WHO) (2019a)Ten threats to global health in 2019.
3. World Health Organization (WHO) (2019b) Improving vaccination demand and addressing hesitancy.
4. Tsimtsiou Z, TsiligianniI.Papaioannou A, Gougourelas D, Kolokas K, Gkizlis V, et al. (2021) Understanding what people think and feel about adult vaccination and associated barriers: Development and validation of the Attitude Towards Adult VACcination (ATAVAC) scale. Health and Social Care in the Community.
5. DubéE, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J (2013) Vaccine hesitancy: An overview. Human Vaccines &Immunotherapeutics 9: 1763-1773.
6. European Centre for Disease Prevention and Control (ECDC) (2015) Vaccine hesitancy among healthcare workers and their patients in Europe: A qualitative study. Vaccine 34(41): 5013-5020.
7. Tsiligianni I, Oikonomou N, Papaioannou A, Tatsioni A, Gougourelas D Birka S, et al. (2020) Exploring primary care physician experiences conducting practice-based research on adult vaccination: a qualitative evaluation study in Greece. Family Practice 37: 828-833.