Success and high participation in vaccination schemes by the population is a multi-layered issue. A solid reimbursement regulation and the mere availability of vaccines will not guarantee that there will be a high uptake or vaccination coverage. Two other equally important drivers to success are the supra-structural organization responsible for vaccination and the legal framework regarding vaccination.
First lets highlight how supra-structural organizations for vaccination can contribute to a high coverage.
By this we mean all facilities that assure the successful functioning of a vaccination program.
In Belgium, the government guarantees access to vaccination for all children. Three supra-structural organizations oversee the administering of vaccines: Kind & Gezin in Flanders, ONE in Wallonia and Kaleido DG in Ostbelgien. Working in close collaboration with the maternity department in the hospitals, these organizations assure basic vaccination and the follow-up according to the vaccination scheme for young children set by the government. The presence on the field of this supra-structural organizations leads to a vaccination coverage among newborn babies of over 93% in both Flanders and Wallonia for the most essential recommended vaccination.
In Wallonia nearly 55% of these vaccines are given to children by the ONE, 35% by private pediatricians, 5% by general practitioners, 5% by hospital services. (Groupe de réflexion scientifique Vaccinations, 2016) In Flanders a totality of 85.4% of the children were vaccinated by Kind & Gezin, 9.5% by the pediatrician, 4.4% by the general practitioner and 0.7% by other authorities, for example vaccination programs overseas. (Vandermeulen C, e.a., 2017)
In Flanders, Wallonia and Ostbelgien a supra-structure of medical supervision works in schools themselves (CLB, PSE and Kaleido- DG). Every two or three years each pupil visits this medical service. The visit of school children to these facilities gives a unique access to vaccination. Flanders started with HPV vaccination for girls through this medical school supervision supra-structure in 2010, which led to a vaccination coverage of 90%.
In Wallonia this supra-structure was not offering this possibility. Only approximately 35% of the eligible female target population is vaccinated. Luckily since 2019 with new HPV-vaccines on the market, both in Flanders and Wallonia this supra-structure will now offer HPV- vaccination to all boys and girls.
The coverage of vaccination against measles, is different in the two parts of our country: in Wallonia and Brussels, 75% of the adolescents are vaccinated, while in Flanders 93% is vaccinated. A recent rapport (Devos C, 2019) on the Belgian health system, showed however the necessity that not only actions are needed to attain a high level of vaccination in children, but also for the detection and vaccination of non-vac- cinated adults in order to prevent outbreaks.
Reaching the elderly is a challenge.
How can we establish a dedicated supra-structure to reach the elderly population easily in terms of pro-active vaccination? In contrary to the maternity wards and the schools where the eligible target population flocks together, the major part of the elderly population is scattered all over the geographical area, except for elderly homes. An interesting option to study is whether a dedicated team in a home nursing service could take up this role similar to the supra-structural organizations to ensure pro-active vaccination in this population.
A second driver for vaccination might be to make it compulsory by law. In 1966 the Belgium government made poliomyelitis vaccination obligatory for each newborn child. Today, with a coverage of 97,2% Belgium is at the point of eradication.
An obvious question is: why not make all vaccinations obligatory?
An advice on the matter by the Belgian Advisory Committee on Bioethics expresses a pragmatic and valuable approach regarding this question: “It is ethically unacceptable for a parent to deny his / her child a vaccine that is effective against a serious and preventable disease such as poliomyelitis or tetanus. On the other hand, it is ethically acceptable to refuse the vaccination of his / her child if the balance of vaccination / disease risks is not scientifically decisive. Parents must always make their decisions in the best interest of the child, and it is legally and ethically unacceptable for them to make decisions that are manifestly to the detriment of their child.” (Belgian Advisory Committee on Bioethics, 2015) This conclusion undoubtfully will be used as a benchmark in the debate should the anti-vax movement keep growing.
Summing up, making vaccination complementary by law, should be a last resort. However, when the public health is at stake, such drastic measures need to be considered. The priority is to invest in common sense of the citizens and to ensure supra-structural organizations that can facilitate and contribute to pro-actively vaccinate the population. Especially in adult and older populations, there is a gap to fill.