ADULT VACCINATION, NEED OF THE HOUR.ARE WE LAGGING BEHIND ?

 

At the outset I must admit that I am not going to give a list of adult vaccines, which is readily available in CDC latest recommendations, Association of physicians of India or other sources ( in fact there is no consensus on this point. No national schedule OR consensus)

In this write up I am stressing on the need of a system parallel to the existing system for childhood vaccinations and utilizing the COVID vaccination experiences. Even for those who are convinced about the need for getting these and who can afford to buy , it is difficult to get it in the present situation. 

🔼There is lack of clarity ,and lot of questions still unanswered for a person who is trying to take it

⏶Where can I get this ? 

⏶Where is it available ?

⏶Can I rely on it, meaning is there a system to ensure the safety and efficacy ?

⏶Who ll be responsible for the follow up ?

There is a well established system under the universal immunization program from 1985 which ensures efficacy , safety of vaccines manufacture , storage transportation administration and follow up including the remote possibility of adverse events and monitoring system in a transparent manner.. Except for pregnant ladies, vaccination for adults was provided in selected situations. ( Japanese B vaccine for North east when more and more cases of Japanese B encephalitis reported and of course recent Covid Vaccination)

Developed countries started addressing this issue long back. We can't lag behind for long 

1. Need for adult immunisation ,waning of immunity (please click the link for source of this data and figure )

2. Aging population in Kerala

3. Newer agents , newer strains against which older population are susceptible and likely to succumb, eg COVID

How to face this challenge ?

With a well established and present system which is excellent can the Govt take up this challenge ? 

“NO “ 

👅Reasons ?

🔺Cost involved. Many of these vaccines are too costly 

🔺Lack of uniformity in the need for these vaccines. Need is different for different category 

🔺But it is not totally impossible . 

When it is implemented on a large scale , the cost of vaccines can be brought down drastically  and may be possible. We have seen examples in the recent past about the implementation of pneumococcal vaccine and plans to implement the HPV vaccine , both from serum institute 

👅So what is the way out ?

Private sector should take up this task. At present this is happening ,there may be scattered incidents . Not even corporate hospitals in Kerala at present have a dedicated system to address this issue 

What may be pulling them back from addressing this issue 

🔺Unlike other drugs , vaccine is a delicate issue in many ways. Few of these vaccines costing thousands of rupees if not handled properly , become useless .The challenge is huge to execute the different task involved in doing justice to the customer at the same time lot of technical responsibilities to the authorities 

Of course if done properly it is profitable for the private sector . 

🔺 Rare adverse event , which is inherent in the vaccine ( with due care in  storage  and administration and other technical errors minimizing) the system to tackle the social issue follows may be worse than when it happens in a govt set up.   

👅What the Govt should be doing ? 

Try to take up this challenge to establish a Universal Immunization program for Adults But in the preset situation it will remain a dream. We ll do in a phased manner , in second phase 

In the first phase ,We can encourage the private sector to take up the challenge of setting up Adult vaccination section and provide all support for them 

What all support ( How can public private participation work here 

🔺Incorporate the system of storage ,transport of vaccines and monitoring the safety and efficacy of vaccines 

🔺Either train the vaccinators of provide manpower for administration 

🔺Documentation of vaccine usage , beneficiaries 

🔺Other technical expertise needed 

👅Role of Private sector 

Need to consider the beneficiary group. 

Majority will be senior citizens.

Age group between 18 to 50 who are high risk categories. Eg on immunosuppressives, chemotherapy ,malignancies, uncontrolled diabetic, Organ recipients, chronic liver kidney lung diseases 

A minority ll be coming for special vaccination for tour and travel , Hajj pilgrimage, 

Adolescent and young adults going for study outside state or countries and need vaccine according the country they choose 

👅SO How to set up the vaccination area ?

Before we answer this question just consider the difficulties encountered by people trying to get a vaccine for any of the above situations 

🔺We won't know whether this vaccine is available before visiting the institution . Remedy is simple . we ll have this details from the website of the institution .which is updated. Brands,expiry date and the contents of the vaccines too need to be updated. Why the contents ? Few vaccine recommendations are to give the latest strain. Influenza vaccine need to be updated depending on the zone and the month of the year 

🔺Institutional formalities. We have to wait at the registration counter for our turn . 

🔺Fitness to be certified by qualified person for which we need to wait in the queue ,again in another OP 

🔺 purchase of costly vaccine from pharmacy 

🔺Again to the administration point queue 

🔺 Computer for documentation

🔺 waiting after receiving vaccine , for monitoring adverse events 

All these difficulties need to be anticipated and remedial measures taken. All the problems can be solved if everything is arranged in a section earmarked for these. Considering the high risk status of the above group this is not a favor but their rights 

Before ending , just consider the difficulty for a person to take yellow fever vaccine or a meningococcal B vaccine at present in our state 

We need not adopt all the recommendations in CDC Adult guidelines, but customize for our country priorities 

We ll encourage Annual influenza for above 50 

We ll encourage Pneumococcal vaccines and Annual influenza too to above 65 ( if possible for younger 

Those who can afford we can encourage shingles (recombinant vaccine two doses)

Older vaccines like Hepatitis B , Tdap and MMR too for adults . Just consider the fact that our middle aged are also not immune to the diphtheria, whooping cough, measles or mumps 

Chicken pox vaccine, Typhoid vaccine, AND Hepatitis vaccines are all cost worthy 

👅Last point 

We need to protect our health workers .. 
What about our future generation? Our medical students ?
We should be giving most of the vaccines even those who had all of them in child hood because they wont be immune and they are more likely to get it 
Can we include Anti rabies vaccine prophylactically to medical students? It is cost worthy if provided intradermally , at least five students can share a dose.
If we follow WHO protocol just two doses are enough