World Vaccines Congress DC: "How to tackle lowering routine immunization rates going forward?"

One of the unintended consequences of the global focus on the COVID-19 pandemic has been the precipitous drop in immunization rates across pediatric, adolescent, and adult populations for other vaccine-preventable diseases. Early in the pandemic, this was driven by the inability or unwillingness of people to go to a healthcare provider to get their scheduled shots. However, another factor, especially in Low and Middle income countries, has been the redirection of a finite pool of immunization funds away from these diseases (like Malaria, etc.) towards COVID. This has had a devastating impact globally. Data from UNICEF from July 2021 suggests that 23 million children missed out on basic childhood vaccines through routine health services in 2020, the highest number since 2009 and 3.7 million more than in 2019.

Day 2 of the World Vaccines Congress featured an interesting discussion on this topic on “how to address the lowering routine (read non-COVID) immunization rates going forward”. The discussion involved an elite group of panelists from the government (leaders from the CDC & HHS), public health (G20 Health and Development partnership) and manufacturers (vaccine heads from Merck, GSK, and Pfizer).

The group discussed several interesting and innovative approaches (albeit with a greater US focus), to raise vaccination rates overall, in co-existence with COVID.

• One set of approaches focused on the importance of “local community outreach” to supplement any national efforts. Some vaccines manufacturers have partnered with organizations (including non-traditional ones) that have a strong connection to, and awareness of, the nuances of a local community, to foster trust and drive meaningful impact that is customized to their needs.
• Other solutions focused on the importance of using “stories and parables” to convey the public health benefits of vaccines and to counter misinformation. The anti-vaxxers seem to get this and have spun horror stories to convince a mistrusting public in today’s politicized environment, and it is critical to counter these with stories of successes.
• There was an interesting discussion on establishing national registries and investing in infrastructure (EMR, etc.) to track vaccination status beyond COVID, to enable measuring the impact and ROI of these programs. Of course, this would necessitate multiple entities within a healthcare ecosystem to closely collaborate (for instance payers in the US who can track the vaccination status) and their willingness to share this information. ?
• There were also other ‘aspirational’ ideas discussed including making vaccines free for the public in terms of their out of pocket spend (a challenge for some vaccines covered by Part D in the US), while also ensuring that the reimbursement to vaccinators is meaningful enough to cover their administrative costs and incentivize them to drive higher rates.

One topic that was not discussed was the reality of making “tradeoffs”, which many global markets with finite budgets need to grapple with. The WHO has a target to vaccinate 70% of the population in every country for COVID-19, and many rich countries including the US are backing this number in terms of pledges and actual donations to reach this threshold. Is it time to have a healthy debate if this historical herd immunity threshold remains realistic? What if the emerging science suggests that a lower number might actually be acceptable for countries with younger populations, with the implication that the resources “saved” in doing so be redirected to other vaccine-preventable diseases? Not an easy question to answer, but one that needs to be top-of-mind for public health bodies to make a meaningful impact in restoring the non-COVID immunization rates back to pre-pandemic levels.