European ADULT IMMUNISATION HUB

Premier event of the Coalition for Life‐Course Immunisation: The role for vaccines in the fight against antimicrobial resistance

 

25.000 people in Europe dying in airplane crashes per year would rightfully make headline news and the public would understandably demand solutions from policymakers to stop this death toll. Luckily, this figure is pure fiction. However, around 25.000 deaths actually occur each year in Europe due to Antimicrobial Resistance (AMR) -­‐   and go largely unnoticed by the media and the public.  Karin Kadenbach MEP pointed out this rather disturbing situation at the policy round table she co-­‐hosted alongside colleague Julie Girling MEP and the newly formed Coalition for Life Course Immunisation (CLCI), at the European Parliament on 27 June 2018, on the “Role for Vaccines in the fight against antimicrobial Resistance”.

Despite this general lack of awareness of AMR, Julie Girling pointed out that more and more people can tell the frightening story of when a prescribed antibiotic did not work in the first instance because the bacteria causing the infection had developed a resistance to it and a different antibiotic had to be chosen in the hope that it would be more effective.

AMR, one of the greatest threats to public health, cannot be stopped, it can only be slowed down, as Martin Seychell, Deputy Director General of the European Commission Public Health Service, DG SANTE, pointed out. Therefore it is all the more important to identify and implement solutions to prevent future deaths. Vaccination is one of the most effective weapons in the public health armoury, highlighted Seychell. In spite of their clear benefits, however, vaccines are currently both underused and undervalued in the fight against AMR.

While the exact value of vaccines in fighting AMR is hard to measure, as explained by Dr. Charles Clift from the Centre on Global Health Security at Chatham House, London, they can help curb the AMR related death toll in different ways:

  1. By preventing bacterial infections in the general population, such as pneumococcal diseases which are otherwise treated by antibiotics;
  2. By preventing bacterial infection where the antibiotic is the primary treatment and resistances have had (e.g. gonorrhoea, E.coli) or will have (e.g. TB, typhoid) a major impact on treatment;
  3. By preventing hospital-­‐acquired bacterial infections in high-­‐risk populations, such as the elderly or chronically ill;
  4. By preventing viral infections, such as influenza, where either antibiotics are prescribed unnecessarily and hence cause AMR or which can lead to bacterial infections;
  5. By preventing disease in livestock.

Being vaccinated is always better than not being vaccinated, explained Professor Heidi Theeten from VAXINFECTIO, the Centre for the Evaluation of Vaccination at the University of Antwerp. Vaccines are more evolution-­‐proof than drugs, since they work prophylactically. Drugs and vaccines both impose substantial pressure on populations of bacteria and viruses to evolve resistance, however vaccine resistance is rare. Vaccines tend to induce immune response against multiple targets on a pathogen while antibiotics and antivirals tend to target very few. Consequently pathogenic organisms generate less variation for vaccine resistance than they do for drug resistance, and the evolutionary process of selection has fewer opportunities to act on that variation. Vaccines are safe and vaccine resistance is rare and, even better still, some vaccines may prevent more than just their main focus.

Despite these obvious benefits, vaccines and immunisation are regarded increasingly more critically in Europe. The continent’s Polio-­‐free status is again now at stake and, contrary to the global trend, vaccination rates for measles are in decline resulting in alarming outbreaks in a number of EU Member States.

It would be too easy to find explanation for this vaccination hesitancy with the prolific dissemination of fake news. Instead, a more complex and multi-­‐facetted picture emerged during the discussion, resulting in some recommendations on how to boost vaccination:

  1. Develop real-­‐life stories to support a convincing pro-­‐vaccination narrative. Vaccines have become a victim of their own success in the sense that disastrous impact of those diseases are no longer visible, e.g. the polio-­‐related mortality and disability.
  2. Improve the organisation of vaccination in order to serve the needs of the target group, such as the elderly, who currently find access difficult.
  3. Focus research on gender-­‐specific dosages of current vaccines and on how to boost the pipeline to support vaccine development in the future.
  4. Generate reliable data using real time information, instead of historic reporting records, which is all the more important in times of greater mobility.
  5. Establish a common understanding for a vaccination calendar amongst Member States on what a baseline could look like. Based on this, differences in schedules can be better explained.
  6. Engage the public health community: both patient advocates in specific chronic diseases as well as healthcare professional representations need to step up their support of vaccination as a crucial horizontal issue to improve public health.
  7. Overcome the misconception of vaccination as being important only in the first three years of our lives. Instead promote life-­‐course approach to immunisation as a key component of national vaccination and action plans on AMR, as highlighted in the current European Parliament draft report.

The CLCI, which includes vaccination expert members, civil society, public health officials, advocacy groups, academics and leading professionals from across Europe, is ready to help these recommendations with informed passion, helping to identify and share good practice.