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1
Seasonal Influenza Vaccination in Seasonal Influenza Vaccination in EuropeEurope
2007/8 Coverage Rates in 11 European Countries
THOMAS SZUCSInstitute of Social- and Preventive Medicine
University of Zurich
2
Overview
• Study objectives• Methodology• Vaccination recommendations• Key findings• Motivations and barriers for
vaccination• Lessons learned
3
Study Objectives
To analyse and determine:
• Influenza vaccination coverage rates (2007/8) in 11 European countries
• Understand motivations and barriers for vaccination
• Identify approaches to improve vaccination coverage
• Compare vaccination levels and intentions with previous year
4
Methodology
• A sample of 22,000 (approximately 2000 individuals per country), representative of the adult population aged 14 and over
• 9 countries with similar questionnaires: Austria, Czech Republic, Finland, Germany, Ireland, Italy, Portugal, Spain and UK
• Community-based survey via computer-assisted telephone interviews (conducted by TNS healthcare)
• French data collected via a postal questionnaire by GEIG (Groupe d’Etude et d’Information sur la Grippe)
• Polish data collected via a face-to-face questionnaire
5
Methodology
• Focus on populations recommended for vaccination
• Quantitative data is shown per country; qualitative data is aggregated across all countries
• Polish data is shown for 2007/8 only due to a methodology change
• Publication for full data set is in preparation
6
Influenza vaccination recommendations in Europe and WHO coverage objectives
Vaccination recommendations• Age-based: all people above a defined age-limit
– Generally from 65 years of age upwards
• Risk-based: all people under the age-defined limit suffering from underlying/chronic illnesses
– People with cardiovascular, respiratory, metabolic and/or renal disease & the immuno-compromised
• Health care workers*
Vaccination coverage rate objectives• As determined by the World Health Organisation for the elderly**
– 50% by 2006– 75% by 2010
• And supported by the European Parliament***
*Recommended in a number of EU countries **WHA resolution 56.19 – 28 May 2003***European Parliament resolution [P6_TA(2005)0406] on the strategy against an influenza pandemic, 26 October 2005
7
Key Findings:
Elderly (≥65 years)
8
78
69 67 6561 60
5451
3732
16
0
10
20
30
40
50
60
70
80
90
100
UK France Spain Ireland Germany Italy Finland Portugal Austria CzechRepublic
Poland
Influenza vaccination rates for the elderly (≥65 years) differ widely across Europe
20
07
/8 i
nfl
ue
nza
va
cc
ina
tio
n r
ate
(%
)
(392) (402) (246) (266) (495) (348) (312) (312) (394) (325) (327)
9
78
69 67 6561 60
5451
3732
16
0
10
20
30
40
50
60
70
80
90
100
UK France Spain Ireland Germany Italy Finland Portugal Austria CzechRepublic
Poland
Few countries meet the WHO target level2
00
7/8
in
flu
en
za v
ac
cin
ati
on
ra
te (
%)
(392) (402) (246) (266) (495) (348) (312) (312) (394) (325) (327)
WHO 2010 target = 75%
10
70 6871
63
53
66
51 53
3730
78
69 67 6561 60
5451
3732
16
0
10
20
30
40
50
60
70
80
90
100
UK France Spain Ireland Germany Italy Finland Portugal Austria CzechRepublic
Poland
2006/7
2007/8
There was little improvement on last year (2006/7)
Infl
ue
nza
va
cc
ina
tio
n r
ate
(%
)
(384) (392) (400) (402) (246) (246) (241) (266) (481) (495) (348) (348) (299) (312) (384) (400) (419) (394) (326) (325) (-) (327)
WHO 2010 target = 75%
11
Key Findings: <65 years at risk
12
54
42 4138
3328 26 24
19 19
11
0
10
20
30
40
50
60
70
80
90
100
UK Italy Spain France Portugal Germany Ireland Finland Austria CzechRepublic
Poland
Vaccination rates for <65s at risk are considerably lower than the WHO elderly target
(186) (127) (214) (198) (234) (284) (150) (331) (165) (232) (319)
20
07
/8 i
nfl
ue
nza
va
cc
ina
tio
n r
ate
(%
)
WHO 2010 elderly target = 75%
13
56
47
37 35 3428
39
17
24
17
54
42 4138
3328 26 24
19 19
11
0
10
20
30
40
50
60
70
80
90
100
UK Italy Spain France Portugal Germany Ireland Finland Austria CzechRepublic
Poland
2006/7
2007/8
…again, with little or no improvement on last
year
(176) (186) (166) (127) (186) (214) (204) (198) (185) (234) (287) (284) (130) (150) (332) (331) (159) (165) (247) (232) (-) (319)
Infl
ue
nza
va
cc
ina
tio
n r
ate
(%
) WHO 2010 elderly target = 75%
14
Key Findings:Healthcare professionals
15
29 28 28 26 24 23 22 21 2017
9
0
10
20
30
40
50
60
70
80
90
100
UK CzechRepublic
Portugal Spain France Germany Austria Finland Ireland Italy Poland
Coverage rates for healthcare professionals are very low
(171) (101) (75) (133) (121) (170) (184) (135) (174) (75) (60)
20
07
/8 i
nfl
ue
nza
va
cc
ina
tio
n r
ate
(%
)
WHO 2010 elderly target = 75%
16
2024 25 24 25
2217
13
2216
29 28 28 26 24 23 22 21 2017
9
0
10
20
30
40
50
60
70
80
90
100
UK CzechRepublic
Portugal Spain France Germany Austria Finland Ireland Italy Poland
2006/7
2007/8
Rates remain at levels similar to last year
(130) (171) (106) (101) (74) (75) (98) (133) (134) (121) (170) (170) (205) (184) (162) (135) (141) (174) (84) (75) (-) (60)
Infl
ue
nza
va
cc
ina
tio
n r
ate
(%
) WHO 2010 elderly target = 75%
17
Key Findings:Intention to get vaccinated versus
actual vaccination
18
7570
75 73
6165
57 57
4247
78
67 6561 60
5451
3732
16
69
0
10
20
30
40
50
60
70
80
90
100
UK France Spain Ireland Germany Italy Finland Portugal Austria CzechRepublic
Poland
Intentions for 2007/8
2007/8
Intentions tend to be higher than actual vaccination for the elderly (≥65 years)…
Infl
ue
nza
va
cc
ina
tio
n r
ate
(%
)
(384) (392) (384) (400) (402) (400) (246) (246) (246) (241) (266) (241) (481) (495) (481) (348) (348) (348) (299) (312) (299) (384) (400) (384) (419) (394) (419) (326) (325) (326) (-) (327) (-)
WHO 2010 target = 75%
19
68
4346
41 4348
63
24
39 37
54
42 4138
3328 26 24
19 19
11
0
10
20
30
40
50
60
70
80
90
100
UK Italy Spain France Portugal Germany Ireland Finland Austria CzechRepublic
Poland
Intentions for 2007/8 2007/8
…but the gap is even greater for <65s at risk
(176) (186) (176) (166) (127) (166) (186) (214) (186) (204) (198) 204) (185) (234) (185) (287) (284) (287) (130) (150) (130) (332) (331) (332) (159) (165) (159) (247) (232) (247) (-) (319) (-)
Infl
ue
nza
va
cc
ina
tio
n r
ate
(%
) WHO 2010 elderly target = 75%
20
Key Findings:Motivations and barriers to
vaccination
21
78
69 67 6561 60
5451
3732
16
54
3841
26 28
42
24
33
19 19
11
0
10
20
30
40
50
60
70
80
90
100
UK France Spain Ireland Germany Italy Finland Portugal Austria CzechRepublic
Poland
Elderly <65 at risk
Lack of funding correlates with dramatically lower vaccination rates
20
07
/8 i
nfl
ue
nza
va
cc
ina
tio
n r
ate
(%
)
(392) (402) (246) (266) (495) (348) (312) (312) (394) (325) (327)
WHO 2010 target = 75%
Little or no funding / reimbursement
22
56
49
3126
64 6359
40
33
51
0
10
20
30
40
50
60
70
80
90
100
<65 yrs at risk (705)
65 yrs + (2103)
Becau
se o
f my
age
Becau
se I
am n
ot in
ver
y go
od h
ealth
Several key factors encouraged vaccination… %
1. Pro-active HCW
2. Education on the seriousness of the disease and role of vaccination
3. Adequate funding in place
23
56
2926 28
60
22 20 21 21
0
10
20
30
40
50
60
70
80
90
100
<65 yrs at risk (2440)
65 yrs+ (3906)
1. Pro- active HCW
2. Education on the vaccine and disease
3. Adequate funding of
vaccination
…and would encourage future vaccination in all recommended groups…
24
56
2926 28
25 25
60
22 20 21 21 20
0
10
20
30
40
50
60
70
80
90
100
<65 yrs at risk (2440)
65 yrs+ (3906)
4. Lifestyle factors
…as would lifestyle factors
1. Pro- active HCW
2. Education on the vaccine and disease
3. Adequate funding of
vaccination
Mor
e in
form
atio
n on
vac
cine
effi
cacy
If m
y do
ctor
(nur
se) r
ecom
men
ded
it
Mor
e in
form
atio
n on
the
dise
ase
Mor
e in
form
atio
n on
vac
cine
tole
ranc
e
If it
were
chea
per o
r rei
mbu
rsed
25
Lessons learned
• Influenza vaccine coverage has not improved in recommended groups since last year
– Elderly coverage does not meet the WHO objective yet in the vast majority of countries surveyed
– Coverage of at-risk under 65s continues to be much lower than in the elderly
– Coverage amongst healthcare workers is extremely low
– All groups have positive intentions but these do not translate into actual coverage
26
Improving coverage in major target groups
1. Healthcare professionals should proactively recommend vaccination to at-risk patients and introduce ‘reminder’ systems
2. Broad & effective communication campaigns should educate the public on influenza and influenza vaccines
3. Healthcare systems should enable free / reimbursed vaccination
4. Life style factors should be considered such as making vaccination available in alternative settings (at work etc)
• Several factors would encourage vaccination and break down barriers to immunization:
27
Acknowledgments
• TNS Healthcare • Study participants
• The European Vaccine Manufacturers group which supported the study via an educational grant