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The benefits of digital tools for improving immunisation programmes

By Krista KIURU, Finnish Minister for Family Affairs and Social Services

Immunisation programmes are one of the most cost-effective public health interventions, saving millions of lives every year.

In addition to protecting individuals, vaccines can also protect the whole population against epidemics as well as significantly reduce healthcare and societal costs. A unique benefit of high vaccination coverage is herd immunity population-level protection for individuals who cannot be vaccinated because they are too young or have pre-existing medical conditions.

While many new effective and safe vaccines have been introduced in national immunisation programmes in recent years, vaccines are still underused and vaccine hesitancy is posing a threat to the high vaccination coverage needed to stop the spread of communicable diseases in communities and internationally.

Council Recommendation (2018/C 466/01) on strengthened cooperation against vaccine- preventable diseases is a comprehensive and ambitious commitment from the Member States and the Commission to jointly ensure that European citizens have the full benefit of existing and new vaccines. The recommendation highlights eHealth and digital innovations as important new tools for improving immunisation programmes.

Comprehensive immunisation information systems are essential

Electronic vaccination registries or immunisation information systems (IIS) can show up-to-date vaccination coverage across all age groups and sub-populations, as well as in different geographic or healthcare-providing areas. Full interoperability of different electronic systems and registries is essential.

For example, the IIS data can be analysed together with the disease-surveillance data to monitor the real-time impact of vaccines, both in terms of effectiveness and safety. The IIS data combined with vaccine procurement data can show the supply situation in real time and reduce vaccine wastage. The IIS can also provide new opportunities to inform those at risk that they should be vaccinated. This can be achieved through automated reminders via email, SMS alerts and dedicated health apps.

When integrated with electronic healthcare records, the reminders can also target healthcare professionals, so that every time a patient visits any healthcare facility, the visit can be utilised as an opportunity to administer vaccine doses missed during previous visits.

All individuals should have easy access to the data on vaccines they have received. The IIS can generate individual electronic vaccination cards that can be accessed online  while respecting data protection and privacy requirements, naturally.

Some EU countries already have an operational IIS. However, more effort is still needed both at EU and Member State level to develop operational guidelines and remove infra- structural, legal and standardisation barriers in order to facilitate interoperability and electronic immunisation-data-sharing. The feasibility of developing a common EU vaccination card should also be explored as a matter of priority.

Internet and social media as tools to improve vaccination coverage

Never before has the creation, distribution, use and, unfortunately, manipulation of information been this easy. Ideally, the internet should provide fast and easy access to reliable information on vaccination to the public. However, the experience so far has been that misinformation from anti-vaccine groups may spread even faster than science-based information provided by healthcare professionals and public-health authorities. New digital information tools could correct the trend by using different context-based strategies to counter the spread of misinformation and create partnerships with civil society and other relevant stakeholders.

Modern website algorithms seek to determine which information a user would like to see, based on their previous internet activity. This might be harmful to both individuals and society if it leads to increasing hesitancy and mistrust concerning vaccines or information provided by health authorities.

On the other hand, sophisticated search algorithms could also play an important role in addressing vaccine hesitancy. Health systems could be developed to individually tailor messages most likely to resonate with citizens. The real-time analysis of internet and social- media discussions and networks could also be utilised in vaccine confidence monitoring and to identify possible safety concerns.

Sustainable EU-level collaboration to improve vaccination programmes

Immunisation programmes are the responsibility of the Member States. However, it is clear that we should also enhance EU-level collaboration. Pursuant to Article 168 of the Treaty on the Functioning of the European Union (TFEU), a high level of human health protection is to be ensured in the definition and implementation of all Union policies and activities. Union action, which complements national policies, is to be directed towards improving public health, preventing physical and mental illness and disease, and obviating sources of danger to physical and mental health.

The EU Joint Action on Vaccines and other initiatives provide important platforms for the creation of EU-level added value for immunisation programmes. In addition to initiatives and networks, we should also strengthen the role of the European Centre for Disease Prevention and Control (ECDC) as an EU agency responsible for providing scientific advice and support to Member States on the development and adaption of new tools to improve vaccination programmes.