1. 1 Seasonal Influenza Vaccination in Europe Seasonal Influenza Vaccination in Europe 2007/8 Coverage Rates in 11 European Countries THOMAS SZUCS Institute of Social- and Preventive Medicine University of Zurich

2. 2 Overview Study objectives Methodology Vaccination recommendations Key findings Motivations and barriers for vaccination Lessons learned

3. 3 Study Objectives To analyse and determine: Influenza vaccination coverage rates (2007/8) in 11 European countries Understand motivations and barriers for vaccination Identify approaches to improve vaccination coverage Compare vaccination levels and intentions with previous year

4. 4 Methodology A sample of 22,000 (approximately 2000 individuals per country), representative of the adult population aged 14 and over 9 countries with similar questionnaires: Austria, Czech Republic, Finland, Germany, Ireland, Italy, Portugal, Spain and UK Community-based survey via computer-assisted telephone interviews (conducted by TNS healthcare) French data collected via a postal questionnaire by GEIG (Groupe d’Etude et d’Information sur la Grippe) Polish data collected via a face-to-face questionnaire

5. 5 Methodology Focus on populations recommended for vaccination Quantitative data is shown per country; qualitative data is aggregated across all countries Polish data is shown for 2007/8 only due to a methodology change Publication for full data set is in preparation

6. 6 Influenza vaccination recommendations in Europe and WHO coverage objectives Vaccination recommendations Age-based: all people above a defined age-limit –Generally from 65 years of age upwards Risk-based: all people under the age-defined limit suffering from underlying/chronic illnesses –People with cardiovascular, respiratory, metabolic and/or renal disease & the immuno-compromised Health care workers* Vaccination coverage rate objectives As determined by the World Health Organisation for the elderly** –50% by 2006 –75% by 2010 And supported by the European Parliament*** *Recommended in a number of EU countries **WHA resolution 56.19 – 28 May 2003 ***European Parliament resolution [P6_TA(2005)0406] on the strategy against an influenza pandemic, 26 October 2005

7. 7 Key Findings: Elderly (≥65 years)

8. 8 Influenza vaccination rates for the elderly (≥65 years) differ widely across Europe 2007/8 influenza vaccination rate (%) (392)(402) (246) (266) (495) (348)(312)(312)(394) (325)(327)

9. 9 Few countries meet the WHO target level 2007/8 influenza vaccination rate (%) (392)(402) (246) (266) (495) (348)(312)(312)(394) (325)(327) WHO 2010 target = 75%

10. 10 There was little improvement on last year (2006/7) Influenza vaccination rate (%) (384) (392)(400) (402) (246) (246) (241) (266) (481) (495) (348) (348)(299) (312)(384) (400)(419) (394) (326) (325)(-) (327) WHO 2010 target = 75%

11. 11 Key Findings: <65 years at risk

12. 12 Vaccination rates for <65s at risk are considerably lower than the WHO elderly target (186)(127)(214)(198)(234)(284)(150)(331)(165)(232)(319) 2007/8 influenza vaccination rate (%) WHO 2010 elderly target = 75%

13. 13 …again, with little or no improvement on last year (176) (186)(166) (127)(186) (214)(204) (198)(185) (234)(287) (284)(130) (150)(332) (331)(159) (165)(247) (232)(-) (319) Influenza vaccination rate (%) WHO 2010 elderly target = 75%

14. 14 Key Findings: Healthcare professionals

15. 15 Coverage rates for healthcare professionals are very low (171)(101)(75)(133)(121)(170)(184)(135)(174)(75)(60) 2007/8 influenza vaccination rate (%) WHO 2010 elderly target = 75%

16. 16 Rates remain at levels similar to last year (130) (171)(106) (101)(74) (75)(98) (133)(134) (121)(170) (170)(205) (184)(162) (135)(141) (174)(84) (75)(-) (60) Influenza vaccination rate (%) WHO 2010 elderly target = 75%

17. 17 Key Findings: Intention to get vaccinated versus actual vaccination

18. 18 Intentions tend to be higher than actual vaccination for the elderly (≥65 years)… Influenza vaccination rate (%) (384) (392) (384)(400) (402) (400) (246) (246) (246) (241) (266) (241) (481) (495) (481) (348) (348) (348)(299) (312) (299)(384) (400) (384)(419) (394) (419) (326) (325) (326)(-) (327) (-) WHO 2010 target = 75%

19. 19 …but the gap is even greater for <65s at risk (176) (186) (176)(166) (127) (166)(186) (214) (186)(204) (198) 204)(185) (234) (185)(287) (284) (287)(130) (150) (130)(332) (331) (332)(159) (165) (159)(247) (232) (247)(-) (319) (-) Influenza vaccination rate (%) WHO 2010 elderly target = 75%

20. 20 Key Findings: Motivations and barriers to vaccination

21. 21 Lack of funding correlates with dramatically lower vaccination rates 2007/8 influenza vaccination rate (%) (392)(402) (246) (266) (495) (348)(312)(312)(394) (325)(327) WHO 2010 target = 75% Little or no funding / reimbursement

22. 22 Because of my age Because I am not in very good health Several key factors encouraged vaccination… % 1. Pro-active HCW 2. Education on the seriousness of the disease and role of vaccination 3. Adequate funding in place

23. 23 1. Pro- active HCW 2. Education on the vaccine and disease 3. Adequate funding of vaccination …and would encourage future vaccination in all recommended groups…

24. 24 4. Lifestyle factors …as would lifestyle factors 1. Pro- active HCW 2. Education on the vaccine and disease 3. Adequate funding of vaccination More information on vaccine efficacy If my doctor (nurse) recommended it More information on the disease More information on vaccine tolerance If it were cheaper or reimbursed

25. 25 Lessons learned Influenza vaccine coverage has not improved in recommended groups since last year –Elderly coverage does not meet the WHO objective yet in the vast majority of countries surveyed –Coverage of at-risk under 65s continues to be much lower than in the elderly –Coverage amongst healthcare workers is extremely low –All groups have positive intentions but these do not translate into actual coverage

26. 26 Improving coverage in major target groups 1.Healthcare professionals should proactively recommend vaccination to at-risk patients and introduce ‘reminder’ systems 2.Broad & effective communication campaigns should educate the public on influenza and influenza vaccines 3.Healthcare systems should enable free / reimbursed vaccination 4.Life style factors should be considered such as making vaccination available in alternative settings (at work etc) Several factors would encourage vaccination and break down barriers to immunization:

27. 27 Acknowledgments TNS Healthcare Study participants The European Vaccine Manufacturers group which supported the study via an educational grant