On September 25, 2020, the press center of MIA “Russia today” hosted an online expert discussion “Culture and immunoprophylaxis system: development focus amidst global challenges” which took place shortly before government’s plans to approve the strategy for immunoprophylaxis of infectious diseases until 2035 (hereinafter referred to as the Strategy).
The discussion was focused on following main topics: development of immunoprophylaxis planning and implementation measures, efforts to enhance commitment of citizens to vaccination. The discussion was attended by representatives of the Federation Council and the State Duma, experts of the Ministry of Health, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), representatives of the pharmaceutical industry.
“Prevention of infectious diseases, like any other system, is based on planning, organization, implementation and control,” said Alexander Plakida, discussion’s moderator, Executive Director of the “Effective healthcare” platform and adviser to the vice rector of RANEPA. However, I believe the red line in our conversation is the issue of vaccination culture as the focus of strategic development of the entire system.”
Vladimir Chulanov, the chief freelance expert on infectious diseases of the Russian Ministry of health, dwelled on the development of the National preventive vaccination calendar (NPVC). He particularly emphasized the interdepartmental communications between the representatives of Rospotrebnadzor, Roszdravnadzor, the Ministry of Industry and Trade and leading industry experts. Joint activities resulted in preparation of a draft Strategy.
Priority areas for improving the NPVC are the universal use of inactivated polio vaccine, ensuring vaccination of all children against Haemophilus influenzae type B, vaccination against rotavirus infection, human papillomavirus (hereinafter referred to as HPV), chickenpox, meningococcal infection and revaccination against pertussis, quadrivalent influenza vaccine. The Strategy also aims to ensure the availability and affordability of high-quality vaccines, pharmacoeconomic research, budget planning, and enhanced commitment to immunoprophylaxis.
Ayrat Farrakhov, member of State Duma, stressed the importance of planning efforts for immunoprophylaxis. According to Mr. Farrakhov, legislative regulation today can do a lot to improve people’s trust in vaccination. Besides, the expert pointed out that in previous years the budget included higher expenses for vaccination. He also expressed confidence that the budgetary framework will remain the same in 2021 and the planned period.
In the opinion of Alexander Gorelov, Deputy Director of the Central Research Institute of Epidemiology of Rospotrebnadzor, adopting a National vaccination calendar for adults and post-vaccination status monitoring measures have become a particularly urgent issue. Leila Namazova-Baranova, President of the Union of pediatricians of Russia and a member of the Working party on immunoprophylaxis of infectious diseases under the Ministry of health, supported the statement on the development of the NPVC through expansion of the list of infections against which Russian citizens are vaccinated, age and professional groups, e.g. health care workers not included in the pneumococcal disease risk groups. The expert also spoke in favour of efforts aimed to accelerate changes to the vaccination plan amidst epidemiological challenges.
Frederic Jumel, Head of Sanofi Pasteur Business Unit in the Eurasian region, noted the importance of partnership between the government, businesses, expert communities and society on the development of the immunoprophylaxis system. The main goal of this partnership should be children’s health as the main investment in the future of our nation. In particular, the expert paid special attention to vaccine supply issues, with due consideration of long-term planning opportunities. The implementation of this tool will ensure continuity of supplies and timeliness of vaccination. According to him, when solving strategic tasks in healthcare, the implementation of long-term contracts has a positive impact on the timely production of vaccines in the required amounts and sustainability of supplies. The use of modern multicomponent combined vaccines helps increase the vaccination coverage and effectively control the spread of infectious diseases as well as reduce the number of injections and the number of visits to healthcare centers, which is especially important during a pandemic.
According to Vladimir Khristenko, President of NANOLEK, the COVID-19 pandemic has unveiled systemic response and planning issues: “The more responsible-minded approach we take in planning, the easier it will be for us to address the challenges. It normally takes at least 5 years from the idea to regular production provided that the necessary technology is available (if we talk about a vaccine). And in some extreme cases, planning turns into a critical process. Under these circumstances, a vaccine production development roadmap could be of great assistance as a hands-on document to specify a timeframe for inclusion of infections in the NPVC. This will ensure the stability and most transparent planning of the system.”
Anton Katlinsky, science adviser at Natsimbio, elaborated on the theme and mentioned estimates based on WHO data pointing out the impossibility to guarantee sufficient production volumes and availability of vaccines without planning in a 5-7 years perspective: “Manufacturers must have an agreement on long-term cooperation and sales guarantees for a period of five or more years with their main customer - the state - if they wish to to reach fundamentally new production targets in Russia and update the NPVC.”
Following on the discussion of a long-term cooperation, Andrey Lomakin, First Deputy General Director of the FORT biopharmaceutical company, shared the details about a joint project with MSD: “In 2019, we agreed that we will launch a joint project to localize the production of vaccines for the prevention of rotavirus infection, chickenpox and HPV using the facilities of the FORT plant. This project aims to upgrade the plant and boost production capacity so as to start over the next few years global supplies of modern vaccines which have proven their effectiveness and safety.”
When we are talking about the vaccination culture, we can not sidestep a new wave of speculations about immunization.
The Ministry of health will soon add a special vaccination section to its website. This resource is very important when it comes to increasing awareness among citizens. Vladimir Chulanov said that the working party on immunoprophylaxis of infectious diseases, the independent expert committee of the Union of experts in immunoprophylaxis, representatives of pharmaceutical companies are expected to get involved in the development of this communication channel. There are also plans to conduct a study to explore the causes of public wariness towards vaccines.
Tatyana Kusayko, representative of the Federation Council, drew attention to the importance to increase awareness among all age groups as the formation of a vaccination culture begins in childhood, and parents’ informedness plays a significant role. Research “Perfect calendar: development of the immunization program as a public healthcare priority” revealed that physicians are the core group to influence the decision-making in vaccination issues. The participants of discussion also agreed on the need to review educational standards for physicians so that people learn from the aspects and importance of vaccination mainly from the qualified professionals.
Regarding the responsibility for spreading false information about vaccination, Ayrat Farrakhov, member of State Duma, said both the source of information and resources publishing it must assume such responsibility. According to Farrakhov, it is important not to spiral into censorship, to ensure the openness of the discussion, including about possible post-vaccination side effects.
While commenting on the main Strategy development areas, the experts made the following conclusions:
· The mechanism of long-term contracts being a part of immunoprophylaxis planning measures guarantees the timely supplies of required vaccine amounts.
· It is necessary to accelerate the process of making changes to the NPVC to have the ability of rapid response to epidemiological challenges and to create a unified procedure for justification of decisions on such amendments.
· Verified and unbiased information about immunoprophylaxis should be easily accessible to citizens. Skilled medical professionals only should conduct awareness-raising activities.
· An implementation of digital registration mechanisms will make it easier to record, collect and analyse data on the coverage and progress of immunoprophylaxis and post-vaccination follow-up efforts.
· Prevention of infectious diseases is one of their priority goals in maintaining good public health. We should also explore the issue of responsibility for spreading false adverse information about vaccinations that endangers the viability of prevention projects.
· We should not cut the current funding for the vaccine prevention program within the three-year budget horizon.