Opinion: Vaccinating health workers builds crucial vaccine systems

During the COVID-19 pandemic, we all learned the meaning of essential workers — those community members whose jobs and roles are critical to the functioning of our global society.

While there can be no hierarchy to the value of essential workers, the vital importance of health workers serving on the global front lines was clearly demonstrated during the pandemic. The health of health workers is critical to medical systems, the health of a community, a nation, and the world.

Because health workers play such a central role in protecting communities during epidemics and pandemics, keeping them safe from vaccine-preventable diseases is not only necessary, it is a moral imperative. Ensuring that health workers are vaccinated protects them and benefits society by:  

• Keeping them healthy so they can support and protect their communities.

• Reducing the chance that a sick health worker transmits infection to their patients, who are more likely to be at high risk for severe complications.

• Reducing health worker absenteeism, which weakens health systems and degrades the quality and availability of clinical care.

• Creating strong and impactful proponents for vaccination. Vaccinated health workers consistently recommend vaccination. Their endorsement is among one of the most influential predictors of vaccine acceptance, increasing vaccine coverage in communities.

• Limiting the economic impacts on countries due to increased medical costs, and loss of productivity due to illness and premature death.  

And importantly, building and strengthening vaccination programs for health workers not only immediately protects from infection, but also creates robust vaccination systems for timely and efficient delivery of vaccines during pandemics. Data from the 2009 H1N1 pandemic demonstrated that countries with health worker influenza vaccination programs were better able to respond to the pandemic efficiently with appropriate vaccines. Early reports from our Partnership for International Vaccine Initiatives, PIVI, partner countries are showing some exciting data findings — countries with influenza vaccine systems in place were able to more quickly deploy the COVID-19 vaccine, saving countless lives. Analyses of global data is underway that will likely confirm the value of strengthening global health worker vaccination programs, both to protect them from illness and as a pandemic readiness tool.

We must keep our edge

While most countries had robust vaccine delivery systems for children before the COVID-19 pandemic thanks to the decades of work by ministries of health and the Essential Program on Immunizations led by the World Health Organization, substantially less progress has been made globally to ensure that adults have that same access to life-saving vaccines. Systems to vaccinate adults during a pandemic or epidemic must be built on routine adult vaccination programs as adults are likely to be vaccinated in different settings and using different approaches than children.  

Building these systems requires time, money, and a wide variety of capacities, capabilities, and skills. It involves gathering reliable information on who and where target groups are, and building the supply chain and cold chain for delivery and maintenance of vaccines and materials. Maintaining a trained vaccination workforce, creating effective advocacy programs, and maintaining surveillance systems to track vaccine adverse events are also some of the crucial components of a strong vaccine delivery system.

Today we've reached a watershed moment where, because of COVID-19, nearly every country in the world has systems capable of distributing vaccines to both children and adults and gained important experience on how to distribute vaccines to adults. We must protect and integrate these systems — we must keep our edge. While maintaining them will certainly require resources, the costs will be balanced by the benefits of having a vaccinated health workforce as well as systems ready to respond to the next pandemic, rather than one that degrades from lack of use and must be rebuilt during an emergency.

Respiratory virus vaccination programs are a blueprint for readiness

Health worker vaccination programs — and vaccine delivery systems at large — can be maintained through regular use, such as the provision and deployment of routine influenza and COVID-19 vaccines.  These vaccines are ideal as they provide cost-effective disease reduction annually, target health workers, and provide an ongoing real-life experience that mirrors pandemic and epidemic vaccination campaigns.  

Recognizing the benefits of influenza vaccination programs for annual disease reduction and pandemic vaccine readiness, the Partnership for International Vaccine Initiatives was formed in 2013 as the Partnership for Influenza Vaccine Introduction to support the expansion and sustainability of influenza vaccination in low and middle-income countries. The COVID-19 pandemic showed that PIVI’s value was not limited to influenza programs. As a result, PIVI’s mission and name expanded beyond influenza to reflect the broader mission of reducing the global disease burden from influenza and other respiratory viruses, while improving national and global responses to pandemics and other epidemic threats.

PIVI is a public-private partnership composed of ministries of health, technical subject matter experts, global public health partners, and vaccine industry members. It is based at The Task Force for Global Health, in collaboration with United States Centers for Disease Control and Prevention.

Influenza vaccine program managers in PIVI partner countries were among the first to report that the skills and public health programs they built or strengthened through influenza vaccination programs supported the planning, deployment, and evaluation of COVID-19 vaccination.

Window of opportunity for global health systems

We have a window of opportunity to act. We must preserve and strengthen the systems that were created during the COVID-19 pandemic to protect health workers — and communities at large — before national and global leaders’ interest in pandemic threats inevitably wanes. WHO has developed a new initiative for pandemic readiness for respiratory pathogens and has increased its attention on adult and health worker vaccination. Gavi, the Vaccine Alliance, is discussing a new investment in health worker vaccination that would be game-changing for resource-restricted countries. And partnerships such as PIVI are working with countries while using lessons learned to provide a roadmap for other low- and middle-income countries as they develop or strengthen their programs. These are all needed and welcome.

We know from the COVID-19 pandemic that any solution requires collaboration and broad consensus. We think we can all agree on the value and ethical obligation to protect health workers and health systems and commit as global partners to get to work. Now is the time.

Visit www.pivipartners.org for more information on the importance of building and maintaining vaccination systems.