Peer Reviewed

Foreword for World Immunization Week

Kristine Macartney MBBS, BMedSci, MD, FRACP

As World Immunization Week draws to a close, it is fitting to reflect on the words of World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus: ‘Vaccines are among the most powerful inventions in history, making once-feared diseases preventable.’ The global theme of this year’s celebration is ‘Humanly possible: Saving lives through immunization’, reminding us of the incredible impact that vaccines and immunisation have on human health. In keeping with this theme, and to extend your focus on the subject beyond World Immunization Week, Medicine Today has assembled a collection of papers discussing the vaccines available in Australia and how to put them to work to save lives and improve health.

This year also marks 50 years of the WHO Expanded Programme on Immunization – now known as the Essential Programme on Immunisation (EPI) – that has galvanised global immunisation activity and progress since its establishment in 1974. A new impact analysis of the programme shows vaccines have saved 154 million lives in the past 50 years, the majority of them among children aged under 5 years. Thanks to vaccines, millions of children are now living to be grandparents without suffering the severe consequences of diseases, such as paralysis from polio, intellectual disability from measles encephalitis, or chronic lung disease following severe pneumonia. As reported by Gavi, the Vaccine Alliance, this analysis showed that for every life saved, 66 years of full health were gained on average, translating to a phenomenal total of 10.2 billion years gained.

It is key to recognise that across the age spectrum life course, immunisation benefits human health at all stages. In Australia, early access to many new vaccines and immunisation programs that span all ages has saved countless lives and improved others. Globally, 25 to 30 diseases are now vaccine preventable; the landscape has changed remarkably from 1974 when only a few vaccines for children were recommended.

Within this Medicine Today collection is an impressive array of articles covering many important topics in immunisation. Packed with helpful updates, key tips and tricks for busy health professionals and links to a range of important resources, this collection underscores how pivotal it is for all of us to put optimising immunisation uptake front and centre in our practice.

Spence et al. cover influenza, highlighting that vaccination remains our best defence against this annual epidemic, with prevention particularly important for individuals at higher risk of poor outcomes from influenza and in healthcare settings.

After decades of new discoveries in vaccinology and breakthroughs in understanding the immune response, new vaccines and passive immunisation strategies to prevent respiratory syncytial virus (RSV) infection are becoming available. Barr discusses this important virus and its impacts at either end of the age spectrum. New preventatives are discussed, including the monoclonal antibody nirsevimab for infants and new RSV vaccines specific to adults aged 60 years and older, as well as a vaccine that can be used in pregnant women to confer passive protection to her infant by transplacental antibody transfer.

Cunningham also provides a comprehensive overview of the new recombinant herpes zoster vaccine, which became available in late 2023 under the National Immunisation Program, covering the latest data on its effectiveness and safety in older individuals, as well as an increasing array of immunocompromised patient groups.

Davies et al. focus on adolescent vaccination. Although school-based immunisation programs are central in Australia, GPs have a critical role in catching up vaccinations in teenagers who have missed doses at school, alongside promoting health vaccine literacy among parents and adolescents. GPs play a key role in helping to boost immunisation coverage rates and thereby achieve public health goals, such as cervical cancer elimination in Australia. Recent sporadic but very serious cases of tetanus and diphtheria in Australia, as well as an increase in pertussis notifications and meningococcal disease, should prompt a review of immunisation needs across all patient age groups.

Van Buynder and Woodward discuss vaccine-preventable diseases in older people, highlighting how they contribute significantly to morbidity, ongoing functional decline and mortality. Vaccines can prevent both acute illness as well as ongoing impacts on physical, social and psychological functioning that can occur over months to years after shingles, influenza, RSV disease and COVID-19 strike.

Woodward et al. present useful tips for talking about vaccines with patients and addressing patient misconceptions on immunisation. This article highlights numerous specific practice strategies that can help GPs increase vaccine coverage, but also suggests that vaccination rates are likely to remain suboptimal unless notification and recall strategies are used.

Streeton and Chu provide an overview of travel vaccines, emphasising the need to review needs that fall into the three categories of routine, required and recommended vaccines, all as part of a comprehensive personalised pretravel health consultation.

Yoon et al. highlight the need to provide vaccines to patients with autoimmune inflammatory rheumatic diseases. This important group is one of many who are immunosuppressed; expanded guidance on this diverse population is under development in the Australian Immunisation Handbook.

Other articles by Armstrong et al. and Norman et al. also provide insightful overviews of seasonal vaccinations and pneumococcal vaccinations.

Throughout this Medicine Today collection, a central theme is the key role of healthcare professionals in supporting our patients in shared, evidence-informed decision-making, while confidently recommending vaccines where beneficial. Unfortunately, exposure to misinformation and having misconceptions about vaccines is now common among people of all ages. These potential barriers to immunisation can be addressed by trusted healthcare providers who are knowledgeable about vaccines and offer a range of practice-based and professional support – such as being a community champion for greater access and quality information – to increase vaccination rates. We know many in our diverse communities across Australia will benefit if we can increase the uptake of vaccines more equitably to prevent serious disease. So, as we celebrate all that immunisation provides across the globe and here at home, it is important to recognise that much remains to be done and better health can be achieved as we work together to improve immunisation across the age spectrum.

COMING SOON: Look out for upcoming articles in Medicine Today on meningococcus, whooping cough and immunisation for all ages.