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%

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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%

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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

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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