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Vaccination: Regulatory and information strategies to increase vaccination coverage

Austrian Vaccination Day 2020 on 18 January in Austria Center Vienna with the theme "Vaccination: for everyday and exceptional situations"
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from left: Rudolf Schmitzberger (Austrian Medical Association), Ursula Wiedermann-Schmidt (MedUni Vienna) and Gerhard Kobinger (Austrian Chamber of Pharmacists)

(Vienna, 11 December 2020) For decades now, general vaccination coverage in Austria has been too low and this has led to the resurgence of serious infectious diseases such as measles and whooping cough (pertussis) and also resulted in too many flu-related deaths. In a joint press conference held by MedUni Vienna, the Austrian Medical Association and the Austrian Chamber of Pharmacists to mark Austrian Vaccination Day on 18 January 2020, new strategies were outlined for achieving higher vaccination coverage in future, thereby closing the "vaccination gaps".

"In the case of measles, we are maintaining good vaccination coverage of nearly 95% for the first vaccination of 2 – 5-year-olds," says Ursula Wiedermann-Schmidt, Head of MedUni Vienna's Institute of Specific Prophylaxis and Tropical Medicine and medical director of Vaccination Day 2020. "However, when it comes to the crucial second vaccination, coverage falls to around 81% in young children.  Barely 70% of 15 – 30-year-olds benefit from the complete protection provided by two vaccinations. This keeps the highly infectious disease alive and puts young children, the weak, elderly and those with compromised immune systems at risk. Herd protection is compromised." 

To eliminate measles, the World Health Organization (WHO) recommends that at least 95% of the total population should be given both vaccinations. The situation regarding the flu vaccination is quite dire: "Vaccination coverage for influenza is below 10% in Austria, even though people are well aware that flu causes hundreds of deaths every year," she points out. "We know that healthcare professionals play a central role when it comes to explaining about vaccinations and setting an example. Therefore, vaccinations, which have previously only been recommended, should become compulsory for healthcare professionals. The OSR (Austrian Supreme Health Council) has now unanimously agreed this position, which it will put before the next government." 

This will apply to Austrian healthcare professionals, that is to say groups who are constantly in contact with patients and/or patient material: doctors, carers and nurses but also medical assistants and midwives. Says Wiedermann-Schmidt: "Compulsory vaccination should not only take place when people enter the healthcare profession but should also apply to people already working in the healthcare system, who need booster vaccinations." One of the main themes on Vaccination Day is how measures operate in other countries, including improved information about compulsory vaccination – recently introduced in Germany. Another demand for improving vaccination coverage relates to social institutions. In future, before children are admitted into a nursery or primary school, parents should be given a mandatory talk by a doctor about vaccination and again, a legal basis must be created for this and it must be included in the Mother-and-Child Pass (Mutter-Kind-Pass).

According to Wiedermann-Schmidt, the introduction of electronic vaccination certificates is essential, if we are to permanently improve the vaccination situation and related documentation in Austria. A pilot phase should be started in 2020, with nationwide roll-out by 2022. The main benefit is that it provides a reminder system for patients and establishes a vaccination register, which can be used to determine vaccination coverage and also to allow vaccination programmes to target the age groups where the greatest vaccination gaps exist.

Medical Association calls for comprehensive package of measures
"The Austrian Medical Association is committed to a comprehensive package of measures to increase vaccination coverage, which clearly includes compulsory vaccination for free vaccinations, especially the measles-mumps-rubella vaccination," says Rudolf Schmitzberger, Head of the ÖÄK's vaccination division. "We also think that more information should be provided about vaccinations, especially during the examinations for the Mother-and-Child Pass. However, this time-consuming information session must be a paid session. It is no longer acceptable that doctors waive their fees for the Mother-and-Child Pass examination, which has been the case for years now. We are also appealing to the ethical responsibility of the general public: being vaccinated is not just about protecting yourself but also about protecting those around you, in keeping with the motto: 'Little ones protect big ones – big ones protect little ones'. The selfishness of a small minority should not be allowed to endanger the entire population."

"That is why we think regulatory interventions are necessary," says Schmitzberger: "There has to be a downside to refusing vaccinations. A conceivable option would be to link it to the Mother-and-Child Pass: if parents cannot provide proof of the age-appropriate free vaccinations up to the age of 16 months, the childcare allowance will be cut by 50%." This works reasonably well for the statutory ten examinations in the Mother-and-Child Pass during pregnancy and up to the child’s first birthday. "We are also calling for mandatory proof of vaccination protection or immunity through previous illness before a child can attend childcare institutions," says Schmitzberger. If vaccination was compulsory for all, this would naturally cover all healthcare workers as well. "This professional group has a special ethical responsibility to be protected against diseases that are preventable through vaccination. This equally applies to all teaching staff. We think it is also important to carry out continuous positive PR campaigns, especially to win over parents who are sceptical about vaccination and convince them that children have a right to be vaccinated. Indeed, the basic human right of access to the best possible health also includes the right to be protected against diseases that are preventable through vaccination.

Pharmacists an important source of advice
"EU health commissioner, Vytenis Andriukaitis, recently called for compulsory vaccination in countries with falling vaccination coverage and called upon all countries to do more to combat misinformation and scepticism about vaccinations. We pharmacists are happy to support this call. With more than 400,000 patient and customer contacts per day, local pharmacies are the public's first port of call in health matters. This gives pharmacists a huge responsibility but also a great opportunity to have a positive influence upon people's health awareness.

This is particularly true in the case of vaccination, a topic which is highly controversial and about which there is huge uncertainty among the population, due to lack of information. Even with the best possible information, we are unlikely to convince the 1 – 3% of the population that represent the anti-immunisation lobby but we probably can persuade the 20 – 30% of vaccination sceptics to allow themselves to be vaccinated by providing targeted advice and answering their questions," says Gerhard Kobinger, member of the Executive Committee of the Austrian Chamber of Pharmacists.

“The e-vaccination certificate will provide an accessible record of vaccinations received and facilitate the scheduling of upcoming vaccinations.
In addition, the e-vaccination certificate is a central tool and provides an opportunity for pharmacists to motivate people to be vaccinated, thereby increasing vaccination coverage within the population and helping to prevent infectious diseases. Comprehensive use of the e-vaccination certificate also helps pharmacists to make an active contribution in support of the most cost-efficient and most effective preventive measure known to science, namely immunisation. Because prevention is always better than cure."

Austrian Vaccination Day 2020: Saturday, 18 January 2020, "Vaccination: for everyday and exceptional situations" (Austria Center Vienna, Bruno-Kreisky-Platz 1, 1220 Vienna, 8:00 – 17:00 hrs). Austrian Vaccination Day is the largest forward-looking vaccination event for doctors and pharmacists and is organised by Österreichische Akademie der Ärzte GmbH in collaboration with the MedUni Vienna, the Austrian Medical Association and the Austrian Chamber of Pharmacists. For more information and to register: