Most people think about the seasonal influenza (more commonly known as flu) as a bad cold that one can recover from within a week or two. Flu is not a simple cold. It’s a highly contagious disease caused by a virus and does not spare anyone. WHO estimates that there are as many as 3 to 5 million cases of seasonal influenza each year, resulting in 250,000 – 500,000 deaths worldwide.
The skeptics may say these numbers don’t seem too high when compared to the disease burden and deaths caused by other communicable and non-communicable diseases. There’s a catch though: Flu aggravates the underlying medical conditions, leading to increased hospitalization and rising healthcare costs. Complications arising from influenza are particularly frequent and severe in adults with chronic conditions, such as chronic obstructive pulmonary disease, cardiac disease, cerebrovascular conditions and diabetes. If two comorbid conditions are present (old age and high-risk), influenza-related deaths are over 100 times greater than in healthy adults.
Other high risk groups include the elderly, the immunocompromised (e.g. HIV/AIDS), pregnant women and young children (under five years of age).Healthcare workers are also considered a vulnerable group at high risk of both acquiring and transmitting the virus.
The good news is that the vaccine to prevent influenza is available, safe and inexpensive. It is also effective: According to WHO, vaccination against influenza can reduce influenza-related morbidity by 60% and mortality by up to 80%. And there are even more public health and economic benefits. For example, vaccination reduces healthcare costs by reducing influenza-related hospitalizations and staff absenteeism. Vaccinating pregnant women helps protect not only expectant mothers but also their newborn children up to 6 months of age. Immunization of school children has a fringe benefit of protecting their households and even reducing mortality rates among elderly individuals, since children are commonly the virus transmitters. Immunization of people with chronic diseases is an effective way to reduce the high disease burden among them. One study found that vaccination against influenza was beneficial for old people with cardiac disease and reduced the adjusted risk of winter mortality by 37% during four influenza seasons.
Immunization of health workers is particularly important not only for occupational health reasons but also for protecting their patients and families. There is evidence that vaccination of healthcare workers decreases influenza infections among them by 88% and reduces patient mortality by as much as 50%. Immunization of home-carestaff has been found to reduce mortality in at-risk groups. Despite these benefits, immunization rates of healthcare workers globally remain unacceptably low. The US CDC recommends 100% vaccination coverage of all healthcare workers, while in Europe, most countries recommend the immunization of healthcare professionals without a minimum coverage rate and it is not mandatory with some exceptions.
Not surprisingly, the vaccination coverage in many European countries is very low, ranging from 48% in France to 14% in the UK. Lack of knowledge has been cited as one of the possible explanations for the low coverage of healthcare workers. Restricted access to vaccination guidelines and other relevant information among healthcare workers in hospitals was found to contribute to their not recommending the vaccine to elderly patients.
To overcome the barriers and increase the immunization coverage among healthcare workers and particularly physicians, who can act as role models to their patients, the World Medical Association (WMA), with the support of IFPMA, launched a global campaign in 2013 to increase the awareness of physicians on the importance of the topic and help fill knowledge gaps to improve the immunization practices. The campaign information and materials can be found at:
The campaign has just entered its second phase and aims to enhance physicians’ communication skills to promote influenza immunization among vulnerable groups (the elderly, people living with chronic conditions, pregnant women and children). As part of this campaign, IFPMA and WMA produced an infographic that demonstrates the linkages between influenza and non-communicable diseases (NCDs) and beneficial effects of immunization in people with NCDs. For example, evidence indicates that flu vaccination reduced the risk of hospital admissions of patients with diabetes by 79%. The infographic is available at:
It is clear that the implementation of a targeted vaccination strategy towards NCD patients and other vulnerable groups is very complex and will require a commitment of many stakeholders at multiple levels. Currently, no WHO targets have been set for the vaccination coverage level for patients with chronic conditions or other vulnerabilities, and health promotion campaigns are also lacking for healthcare professionals to council those patients and encourage them get vaccinated. The WMA campaign is just a start, and by involving physicians as role models in the campaign, the possibility of achieving adequate vaccination coverage, particularly in high risk groups, can become a reality.