Abstract
IntroductionAs SARS-CoV-2 disproportionately affects adults, the COVID-19 pandemic vaccine response will rely on adult immunisation infrastructures.AimTo assess adult immunisation programmes in World Health Organization (WHO) Member States.MethodsWe evaluated country reports from 2018 on adult immunisation programmes sent to WHO and UNICEF. We described existing programmes and used multivariable regression to identify independent factors associated with having them.ResultsOf 194 WHO Member States, 120 (62%) reported having at least one adult immunisation programme. The Americas and Europe had the highest proportions of adult immunisation programmes, most commonly for hepatitis B and influenza vaccines (> 47% and > 91% of countries, respectively), while Africa and South-East Asia had the lowest proportions, with < 11% of countries reporting adult immunisation programmes for hepatitis B or influenza vaccines, and none for pneumococcal vaccines. In bivariate analyses, high or upper-middle country income, introduction of new or underused vaccines, having achieved paediatric immunisation coverage goals and meeting National Immunisation Technical Advisory Groups basic functional indicators were significantly associated (p < 0.001) with having an adult immunisation programme. In multivariable analyses, the most strongly associated factor was country income, with high- or upper-middle-income countries significantly more likely to report having an adult immunisation programme (adjusted odds ratio: 19.3; 95% confidence interval: 6.5–57.7).DiscussionWorldwide, 38% of countries lack adult immunisation programmes. COVID-19 vaccine deployment will require national systems for vaccine storage and handling, delivery and waste management to target adult risk groups. There is a need to strengthen immunisation systems to reach adults with COVID-19 vaccines.
Highlights
As SARS-CoV-2 disproportionately affects adults, the COVID-19 pandemic vaccine response will rely on adult immunisation infrastructures
We chose five routine vaccines licensed for adult immunisation—hepatitis B vaccine (HepB), herpes zoster vaccine (HZV), influenza vaccine, pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) (Table 1)—and accessed the 2018 Joint Reporting Form on Immunisation (JRF) database on 12 February 2020 to collect country data on the presence of adult immunisation programmes for these vaccines
Our review of European Centre for Disease Prevention and Control (ECDC)’s country-level policy information for the European Economic Area (EU/EEA) identified 20 immunisation policies that were not reported in the 2018 JRF
Summary
As SARS-CoV-2 disproportionately affects adults, the COVID-19 pandemic vaccine response will rely on adult immunisation infrastructures. We described existing programmes and used multivariable regression to identify independent factors associated with having them. The most strongly associated factor was country income, with high- or upper-middle-income countries significantly more likely to report having an adult immunisation programme (adjusted odds ratio: 19.3; 95% confidence interval: 6.5–57.7). COVID-19 vaccine deployment will require national systems for vaccine storage and handling, delivery and waste management to target adult risk groups. Authorisation and manufacture of COVID19 vaccines has been a public health imperative, rapid and global vaccine deployment is required to provide the greatest impact. The global vaccine response will rely on existing immunisation infrastructures to reach these target groups [2].
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