Looking to close the gap in health inequities? Imagine an “Immunity Community” driving vaccination

Life expectancy varies by 34 years worldwide. A shocking statistic, I know.

It ranges from 50 years in some low-middle income countries up to 84 years for the highest life expectancy in some high-income countries.[1] That’s an enormous gap. Even within developed countries, health status varies widely depending on your age, gender, ethnicity, education, and income levels.

While vaccines can’t address all of these factors, innovative development and delivery of vaccines can prevent diseases more equitably, thus providing the strongest possible start life for all. ?

A more equitable baseline for health

It goes without saying that vaccines are designed to prevent the morbidity and mortality associated with infectious diseases. But vaccines also deliver broader benefits in terms of education and economic development.

For example, up to 90% of infants are infected with Respiratory Syncytial Virus (RSV) by the age of 2 and 70% of babies that end up in the hospital were otherwise healthy before infection.[2,3] RSV is responsible for a significant burden on healthcare systems & families, flooding hospitals in the winter along with flu and COVID, a phenomenon recently dubbed the “tripledemic.” Depending on where you live – your access to a local hospital or that hospital’s capacity to treat your child – can influence the outcome of severe RSV quite dramatically. And until recently, the only preventive immunization for RSV was restricted to a narrow population of pre-term infants, or those with serious heart and lung conditions.?

In partnership with AstraZeneca, we developed the first immunization designed to protect all infants against RSV, whether born at term or premature, healthy or with underlying health conditions. This levels the playing field for all babies – no matter what community they live in or whether they’re healthy or already living with a pre-existing condition. ???

Closing the gap by focusing on those at greatest risk with targeted solutions

Closing the gap on inequities means supporting underserved or at-risk populations. And the COVID-19 pandemic clearly underlined that more can – and must – be done to keep our vulnerable seniors healthier, out of the hospital, and able to live their best lives.

Seniors are 10x more likely to suffer a heart attack after a flu infection.[4] And older adults in nursing homes have a 23% risk of never fully recovering independence after a flu infection.[5] These statistics are in large part avoidable with vaccines.?At Sanofi, we’ve developed a flu vaccine specifically formulated to protect older adults “beyond flu”.

This higher-dose vaccine is proven to reduce the risks of influenza-related complications. A decade of this vaccine use in the US translated to more than 500,000 avoided hospitalizations, and savings of US$4.6 billion.[6]

But we need to make sure all seniors have equitable access to this level of care.

A 2021 US study showed significant racial and ethnic disparities in rates of severe influenza-associated diseases in people aged 65+ that lead to increased hospitalization and death. And Medicare beneficiaries in ethnic minority communities are 30% less likely to receive a high-dose vaccine.[7]

Without clear and equitable recommendations for use of vaccines like the high dose influenza shot, we cannot reach our full potential in reaching all those at risk of the disease. ???

As my much-missed colleague Michael Watson used to say, “A vaccine without policy is of little use.”?

An Immunity Community driving vaccine equity

Indeed, to equitably reach the entire targeted population for a vaccine, multiple immunization stakeholders must work together to work on licensure, recommendation, financing, procurement, and implementation.

This will only happen if manufacturers, governments, healthcare professionals, patient organizations and civil society play their part and work together on it.?I believe we can solidify the bonds we’ve already forged across public and private organizations already working together around the world in different countries and health contexts.

So, I encourage us all to imagine these entities as an “immunity community”. A group where the whole is considerably stronger than the sum of its parts, and that is dedicated to accelerating health equities wherever gaps remain. Together, we can build a better world.?

References:

[1] World Health Organization (2018). Health inequities and their causes. Accessed online April 2023.

[2] Glezen WP et al. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986; 140(6):543-546

[3] Collins PL et al. Viral and host factors in human respiratory syncytial virus pathogenesis. J Viral. 2008 Mar; 82(5); 2040-55. doi: 10.1128/JVI/01625-07.Epub 2007 Oct 10. PMID:17928346; PMCID: PMC 2258918

[4] 1.Warren-Gash C, et al. Eur respir J. 2018

[5] Andrew MK, et al. J Am Geriatr Soc. 2021

[6] Net, et al. Vaccine. 2021

[7] Salaheddin, Mahmud et al. Effect of race and ethnicity on influenza vaccine uptake among older US Medicare beneficiaries: a record-linkage cohort study. The Lancet Healthy Longevity. February 18, 2021 DOI: https://doi.org/10.1016/S2666-7568(20)30074-X