Key policy and programmatic factors to improve influenza vaccination rates based on the experience from four high-performing countries

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Authors
George Kassianos MD, Ashis Banerjee MD, Florence Baron-Papillon MD, Alan W Hampson MD, Janet E McElhaney MD, Allison McGeer MD, Thierry Rigoine de Fougerolles MSc, Mitch Rothholz MD, Holly Seale MD, Litjen J Tan MD, Angus Thomson PhD, Olivier Vitoux MSc

Article Type
Review

DOI
10.7573/dic.2020-9-5

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Abstract

Background: Many countries consistently fail to achieve the target influenza vaccine coverage rate (VCR) of 75% for populations at risk of complications, recommended by the World Health Organization and European Council. We aimed to identify factors for achieving a high VCR in the scope of four benchmark countries with high influenza VCRs: Australia, Canada, UK and USA.

Methods: Publicly available evidence was first reviewed at a global level and then for each of the four countries. Semistructured interviews were then conducted with stakeholders meeting predefined criteria. Descriptive cluster analyses were performed to identify key factors and pillars for establishing and maintaining high VCRs.

Results: No single factor led to a high VCR, and each benchmark country used a different combination of tailored approaches to achieve a high vaccine coverage. In each country, specific triggers were important to stimulate changes that led to improved vaccine coverage. A total of 42 key factors for a successful influenza vaccination programme were identified and clustered into five pillars: (1) Health Authority accountability and strengths of the influenza programme, (2) facilitated access to vaccination, (3) healthcare professional accountability and engagement, (4) awareness of the burden and severity of disease and (5) belief in influenza vaccination benefit. Each benchmark country has implemented multiple factors from each pillar.

Conclusion: A wide range of factors were identified from an evaluation of four high-performing benchmark countries, classified into five pillars, thus providing a basis for countries with lower VCRs to tailor their own particular solutions to improve their influenza VCR.

Keywords: benchmark, influenza vaccine, vaccine coverage rate.

Citation: Kassianos G, Banerjee A, Baron-Papillon F, Hampson AW, McElhaney JE, McGeer A, Rigoine de Fougerolles T, Rothholz M, Seale H, Tan LJ, Thomson A, Vitoux O. Key policy and programmatic factors to improve influenza vaccination rates based on the experience from four high-performing countries. Drugs in Context 2021; 10: 2020-9-5. DOI: 10.7573/dic.2020-9-5

Contributions: AB: Participated in data interpretation and reviewed and approved the manuscript. FBP: Participated in the study design, highlighted key data and report for sourcing, interpreted the findings, structured the key messages and comparative overview, outlined, reviewed and approved the manuscript. AH: Participated in data acquisition and analysis and reviewed and approved the manuscript. GK: Participated in the study design, highlighted key data and report for sourcing, interpreted the findings, structured the key messages and comparative overview, outlined, reviewed, and approved the manuscript. JEM: Participated in country-specific interviews related to the influenza vaccination program in Canada. Highlighted reports from the Public Health Agency of Canada on a recent survey of current contributors and barriers to vaccine uptake in Canada. Reviewed and approved manuscript and added key references. AMcG: Participated in data acquisition and analysis and reviewed and approved the manuscript. TRdF: Structured and performed the comparative analysis across the four high-performing countries, sourced and reviewed the available evidence, carried out the interviews and codeveloped the 5-pillar framework and the list of factors. Interpreted the findings, structured the key messages, reviewed, and approved the manuscript. MR: Participated in country-specific interviews related to the influenza vaccination programs in the United States. Highlighted the work of the National Adult and Influenza Summit (NAIIS), CDC, HHS – National Vaccine Advisory Committee, coalitions and the engagement of pharmacists as members of immunisation neighbourhoods. Reviewed and approved the manuscript. HS: Participated in data analysis and interpretation and reviewed and approved the manuscript. LJT: Participated in data acquisition and analysis and reviewed and approved the manuscript. AT: Participated in the study design, highlighted key data and report for sourcing, interpreted the findings, structured the key messages and comparative overview, outlined, reviewed, and approved the manuscript. OV: Structured and performed the comparative analysis across the four high-performing countries, sourced and reviewed the available evidence, carried out the interviews and codeveloped the 5-pillar framework and the list of factors. Interpreted the findings, structured the key messages, reviewed and approved the manuscript. All authors are accountable for the accuracy and integrity of the manuscript.

Disclosure and potential conflicts of interest: No author received any direct payment from Sanofi Pasteur with regard to their contributions to this manuscript but could receive expenses for conference attendance for the presentation of data from this study. AT and FBP are employees of Sanofi Pasteur. AT currently works with UNICEF but the views expressed in this article are of AT and not UNICEF. AB has participated in advisory boards (Sanofi Pasteur), educational events (Sanofi Pasteur and Seqirus), and telephone interviews (Parexel). AB is an employee of Public Health England (PHE) but the views expressed in this article are of AB and not PHE. AH is a member and former Chairperson of the Immunisation Coalition (formerly the Influenza Specialist Group), an independent Australian not-for-profit organisation receiving financial support from influenza vaccine manufacturers, including Sanofi Pasteur. GK is President of the British Global and Travel Health Association and National Immunisation Lead of the Royal College of General Practitioners and has participated in advisory boards or lectured at meetings organised by Sanofi Pasteur, MSD, Seqirus, Pfizer, AstraZeneca, European Scientific Working Group on Influenza (ESWI) and UK’s National Health Service. He chairs the RAISE Pan-European Influenza Group and is Member of the ESWI Board of Directors. Additionally, GK is a former Editor in Chief of Drugs in Context and is currently Associate Editor for Primary Care. JMcE’s institution has received on her behalf honoraria and consulting fees from Sanofi for scientific presentations/participation in advisory boards and data monitoring boards (DMBs) and related travel costs, and holds an NIH R01AG048023 grant (independent of industry) comparing high-dose versus standard-dose fluzone in older adults. Her institution has also received honoraria for her presentations and participation in advisory boards and travel costs from GSK, Merck, Pfizer, ResTORbio, and Medicago for her role as a clinical trial lead from VBI and Jansen, and consulting fees for participation in DMBs for GSK and Merck. AMcG has received grants and personal fees from Sanofi Pasteur, GlaxoSmithKline, and Seqirus, outside the submitted work. TRdeF and OV are employees of Corporate Value Associates, Paris. MR’s wife is an employee of Merck. HS has received funding for investigator-driven research and fees to present at conferences/workshops and develop resources (bio-CSL/Sequiris, GSK and Sanofi Pasteur). LJT has no conflicts of interest to disclose. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/10/dic.2020-9-5-COI.pdf

Acknowledgements: The authors would like to thank all interviewees for their time and valuable insights into vaccination practices. This manuscript was prepared with the assistance of a professional medical writer, Dr Andrew Lane (Lane Medical Writing, Lyon, France), in accordance with the European Medical Writers Association guidelines and Good Publication Practice and funded by Sanofi Pasteur.

Funding declaration: The work was funded by Sanofi Pasteur, Lyon, France.

Copyright: Copyright © 2021 Kassianos G, Banerjee A, Baron-Papillon F, Hampson AW, McElhaney JE, McGeer A, Rigoine de Fougerolles T, Rothholz M, Seale H, Tan LJ, Thomson A, Vitoux O. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Kassianos G, Banerjee A, Baron-Papillon F, Hampson AW, McElhaney JE, McGeer A, Rigoine de Fougerolles T, Rothholz M, Seale H, Tan LJ, Thomson A, Vitoux O. https://doi.org/10.7573/dic.2020-9-5. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/key-policy-and-programmatic-factors-to-improve-influenza-vaccination-rates-based-on-the-experience-from-four-high-performing-countries

Correspondence: George Kassianos, National Immunisation Lead, Royal College of General Practitioners and British Global & Travel Health Association President, 61 Plough Lane, Wokingham, Berkshire, RG40 1RQ, UK. gckassianos@icloud.com

Provenance: Invited; externally peer reviewed.

Submitted: 2 July 2020; Accepted: 2 October 2020; Publication date: 5 January 2021.

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