‘Tis the Season to be Vaccinated

January 8, 2019 | Disease

Melanie senior

The influenza season illustrates the value of preventative medicine, and how pricing dynamics and vaccination strategies can influence population health.

Preventing ‘flu and the complications that can arise from ‘flu-related infections, especially among the elderly and vulnerable, can save significant health system costs. That is critical as such systems come under increasing pressure, including from ageing populations and the approval of new, high-priced medicines.

In mid-December 2018, ‘flu rates were still low across most of the European Union. The virus doesn’t usually show itself fully until about that time, peaking in January and February before declining in March and April. But the European Centre for Disease Control and Prevention is warning nevertheless that few countries are achieving the 75% vaccine coverage target set by the European Union.

Key variables affecting vaccine uptake are the incentives used to promote vaccination, and the type of vaccine used. Intra-nasally-delivered vaccines generally go down better than injectable, particularly with young children. Vaccines covering a broader range of influenza strains have the best chance of beating off the pathogen happens to prevail that particular season.

Flu vaccine purchasing and vaccination strategies have a massive impact on how well protected the population is. In the UK, the government buys an intranasal flu vaccine for children directly from manufacturers. It is administered to children in schools. This ensures that a maximum number of children are protected. And protecting children has a knock-on effect on the rest of the population, according to a UK physician and key opinion leader interviewed by Datamonitor. “We showed in a pilot that when children aged 5-10 years were vaccinated at school, not only was ‘flu reduced among them, as judged by doctor visits, but the same happened to everyone over 18 – people at work, parents, the elderly.” Kids spread bugs – that’s familiar to many parents with school-aged children. So protecting them, first and foremost, makes sense.

For the rest of the population – in particular the elderly and those with chronic conditions like COPD or other respiratory diseases – vaccination needs to be as easy and cheap as possible. Incentivizing the vaccinators is the best approach to ensuring maximum coverage, according to the UK KOL. In the UK, doctors’ practices buy the vaccine (for adults) from the manufacturer, often with a discount, and are reimbursed at the list price, plus a fee for each successful vaccination within at-risk groups. So it is in their financial as well as their professional interest to vaccinate as many patients as possible. They will call patients in, and remind them as many times as it takes.

The result: the UK percentage coverage is in the high 70s – one of the few European countries that appears to meet the ECDCP’s target. (Another implication of this system for manufacturers is that lower-priced vaccines don’t necessarily mean greater uptake: doctors’ practices make less money by getting a discounted price for a cheaper vaccine than a more expensive one.)

In countries where vaccinators are not incentivized, but instead have the medicine available to those who want it (or in countries where patients have to buy the vaccines themselves), then “your vaccination rate would be very low,” warns the KOL.

Quadrivalent vaccines (covering four important ‘flu strains) are now used in the UK, after the 2017-18 season saw the spread of an important influenza B strain that was not covered in the prior trivalent vaccine. Other aspects of vaccine technology are advancing, but influenza vaccines are still far from perfect. “If you are lucky [the ‘flu vaccine] will be 50% effective, depending on your age, the year and the mismatch of the virus that is circulating,” says the UK KOL.

For more details on the progress in vaccine coverage, technology, and vaccination policies and incentives in the UK, Europe and the US, please see the related content links below.