protecting health as we get older
Immunization is one of the most powerful tools for protecting health throughout the lifespan. Although vaccines are often associated with childhood, their importance as adults is more than scientifically proven: they not only prevent serious diseases, but also play a fundamental role in promoting healthy aging and preventing medical complications and disabilities. In 2019, the Public Health Commission of the Interterritorial Council of the National Health System (SNS) approved Lifetime vaccination schedule in Spain. This calendar is revised every year, as in other European countries. Its introduction represented a true paradigm shift, moving from a pediatric perspective to a longitudinal approach in step with the progressive aging of the population. With this new vision, vaccinations are no longer limited to children and adolescents and are being included in all age groups as a responsible self-care practice.
The ABC Salud – GSK meeting “Vaccinating Adults: Immunizing for a Full Life: Protecting Health as You Age” highlighted current strategies and priorities to prevent and control vaccine-preventable diseases in Spain. Thus, Elena Andradas, Director General of the Public Health Directorate of the Community of Madrid, emphasized that one of the pillars is innovation. “The goal is to take innovations where they can really benefit people to ensure maximum protection against disease.”
Andradas acknowledged that in Spain, vaccination programs have been consolidated, mainly in the early stages of children’s lives, “but we are now well aware of the benefits they bring in adulthood and older people; In this sense, we are fundamentally working to ensure that all citizens have access to the best vaccination programs. Because in recent years the concept of vaccination has changed, acknowledged Maria Fernandez Prada, head of preventive medicine and public health at the Vital Alvarez Buya Hospital in Mieres (Asturias) and secretary of the Spanish Association of Vaccinology (AEV). “Autonomous communities participate in the same idea of promoting vaccines throughout life, from the prenatal period to very old age, but never forget that there are risk situations that require additional protection. “There are also work-related scenarios that require personal protection.” This means that “today, vaccines are present in different stages, aspects and situations of our lives that we cannot forget.”
In this regard, Inmaculada Cuesta, Secretary of the National Association of Nurses and Vaccines (ANENVAC), mentioned an important aspect: capital“It is worth remembering that when we talk about vaccines, we are talking about health benefits, so that everyone can live longer and better.” For this reason, he noted that “all autonomous communities must make an effort to reach the most vulnerable people, those who are most difficult to vaccinate. “This is a problem of health determinants, vulnerability, and we must take a step forward because this is still an unsolved problem.”
Implementation of common calendar lines Ministry of Health It is the responsibility of each autonomous community to acquire vaccines and make them available to its citizens.
This situation, Cuesta noted, can “create some confusion when there are some differences between communities, but it is the health workers who must provide scientific data, knowledge, accessibility and explain to the population the benefits of immunization.” And this calendar, which is agreed upon by all the autonomous communities, Andradas explained, “is updated every year based on innovations and new scientific data.”
Close cooperation between authorities and health workers is essential in this process, Andradas stressed. “We are counting on health workers and the media.”
Before the Covid-19 pandemic, the Ministry of Health’s Vaccination Information System (SIVAMIN) was implemented, allowing for a comprehensive twice-yearly study of vaccination coverage data from 2017 to 2022, using accumulated information from the Autonomous Communities. This system allowed the analysis of one or more types of vaccines depending on the Autonomous Community. However, with the onset of the pandemic, there was a need for a more comprehensive and flexible national vaccination registry. This is how it’s born REGVACU, the first national vaccination registry, which enabled tracking of the Covid vaccination process and automated analysis of the information in real time. Based on this experience, the System for Vaccination and Immunization Information (SIVAIN) is being designed, which aims to consolidate and expand capabilities for registration and monitoring of vaccination at the national level, as well as the use of medicines, thereby facilitating informed decision-making and effective coordination between health authorities.
Andradas explained that the new SIVAIN information system will ensure that “all the autonomous communities can be connected and thus exchange information.” He added that this monitoring “is fundamental to understanding how vaccination programs are working.”
Fernandez Prada misses “an opportunity to look deeper into vaccination coverage information in specific groups. This is very useful when we do group vaccination., that is, for people born in the same year. However, when we want to analyze vaccination coverage in specific groups due to disease, treatment, or another denominator other than age, we encounter certain difficulties.
For example, he explained, if we wanted to know now what the vaccination coverage is for pneumococcus or herpes zoster in kidney transplant patients, “we wouldn’t be able to know it easily, at least not from a global perspective.” For that, he said, “we need tools common to all autonomous communities or national databases that we can know.” For Andradas, this is already a reality, but at the autonomous community level, not the national level. “Vaccination records have been around for decades. We need to take a step at the state level and make them more accessible.”
In this sense, Inmaculada Cuesta noted the pedagogical role that sharing these national data could have. “If I see in Aragon that in Madrid the coverage for pneumococcus or the first and second dose of shingles is much higher than in my autonomous community, I can learn from what they have done. In my opinion, this would also be useful for stimulating health workers.
In July 2023, the Ministry of Health published a document prepared by the “Vaccination Program and Registry Presentation”, which, for the first time in our country, set targets for adult vaccination coverage to be achieved by autonomous communities in 2025. Specifically, targets have been established for the recommended age groups in each case against: pneumococcus ≥75%, diphtheria tetanus ≥75%, influenza ≥75 and herpes zoster ≥50%.
Barriers to vaccination
Regarding the obstacles that vaccination programs face, Cuesta noted that sometimes “a major obstacle in vaccinating adults is that some health workers, many citizens and many media outlets believe that vaccines are a child’s business. “They have not learned that vaccination and immunization are also for adults, that they prevent diseases and, above all, prevent complications.”
An ANENVAC representative noted that health workers need to training and information about adult vaccination, but also about citizenship. “A young and healthy adult never thinks about the fact that he can get sick, and a sick adult with a certain risk factor does not realize that if he gets infected with this disease, then in addition to the main disease, he can develop complications. Vaccination and immunization are a guarantee of a long and better life. “This message must be processed in the media.”
In this sense, added Fernández Prada, AEV proposed more than a year ago “a new orientation of work from different points of view. On the one hand, the implementation of campaigns aimed at providing the population with positive information about vaccination, a public health strategy that is safe, that works and saves lives, and that is supported by scientific data. On the other hand, for many years, AEV has been working on a plan to educate health workers, promoting initiatives that promote vaccination coverage, as well as supporting the continuous improvement of care for the most vulnerable patients by achieving excellence in the vaccination department.
The truth is that, as Andradas noted, in Spain vaccination covers almost all programs included in the calendar. much higher than the average in any neighbouring country in the European Union“The level of knowledge, information and trust in vaccines is quite high. Now we need to continue the fundamental work with health workers, including not only accredited training programs, but also, of course, the transition to more innovative models.
Experts have drawn attention to a fact that has come to light this year: primary care nursing. “We have seen lower vaccination coverage among primary care nurses this year than in previous years, and we are looking into the reasons and doing qualitative research to find out what may have happened this season,” Andradas said. For Cuesta: “approximate attitude is importantAs a nurse, I am very concerned that the vaccination coverage in my group this year was much lower than the average for all health workers. In this sense, Fernandez Prada emphasized the importance of training professionals.
In conclusion, the Director General of Public Health of the Community of Madrid recalled that vaccination is one of “the best investments in health that we can make in our lives.” Therefore, we must work directly with professionals to continue to enhance the benefits provided by vaccination programs. This is a priority for us.
It is also true, as Fernández Prada commented, that “all citizens must at some point ask the people in charge of our primary health care service whether we need the vaccine given our personal situation.” For the AEV representative, there is a shared responsibility: “the responsibility of the health worker to convey information to the patient at risk, but also the responsibility of the patient to worry about his or her well-being and health.”
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