August 19, 2019

Life Course Vaccination

I was asked to write a commentary on adult vaccination in Singapore, during the course of which I read a number of articles surrounding adult vaccinations in general and Singapore in particular. A handful of things stood out for me:

  • There is no clear or easy way to find the data on vaccination rates among adults in Singapore. Part of this has to do with the methodology: childhood vaccinations are registered on the National Immunization Registry. It is now possible to also do this for adult vaccinations, but it will be quite some time before most adult vaccinations are registered on the registry by their providers, given the extra work required.
  • Adult (age >65 years) influenza vaccination is an OECD (Organization for Economic Cooperation and Development) indicator, and many countries have really impressive vaccination rates (see chart below, which is a screenshot from the OECD website). Based on 2016 data, Singapore would rank in the bottom third of countries.
  • “Life course vaccination” appears to have become an increasingly popular concept. What does it mean? At the most basic and broadest scope, it reframes the issue of vaccinations away from categories such “childhood vaccines”, “travel vaccines” and “adult vaccines” into one where the need for vaccines for an individual are considered throughout that person’s life. Just one example, adults who were not vaccinated against measles in childhood should still be recommended the vaccine if not contraindicated, particularly now when measles has become increasingly prevalent again. This concept is a bit hard to get around, especially with the rather complex vaccination schedules for various vaccines, but UK’s attempt can be seen here.
Screen capture from the OECD website: influenza vaccination rates in those age >65 years

Together with A/Prof Alex Cook from SSHSPH, we had made a number of recommendations for increasing adult vaccine uptake in the commentary, and I reproduce them below. The most important ones, in my mind, are to encourage primary care physicians to recommend vaccines routinely to adults, and also to have these vaccines – especially the influenza vaccine – incorporated into workplace health initiatives.

  • Recurrent and consistent education campaigns directed at different segments of the local population, in particular addressing the major misconceptions, should be conducted by the Health Promotion Board (HPB) and other vaccine advocacy groups. Several studies have shown that prosocial communication of the concept of herd immunity can increase vaccination willingness rather than encourage free-riding, and should be attempted here.
  • Developing or extending current mobile health apps such as HPB’s Healthy 365 app for personalised vaccination reminders and information.
  • Taking concrete steps to encourage primary care physicians to recommend vaccinations for their patients will be critical, given that the public continues to have a high trust in healthcare professionals in Singapore.
  • Incorporate vaccinations – particularly influenza vaccinations – into workplace health initiatives to increase the ease for adults to be vaccinated. This has worked very well in healthcare institutions locally, and should be extended more widely to other non-healthcare workplaces.
  • Perhaps controversially, extending the collaborative prescribing programme (which permits trained public sector nurses and pharmacists to legally prescribe medications without a doctor’s counter-signature) to include vaccines – especially those on the national immunization schedules – and in this regard, to also include experienced pharmacists and nurses in the private sector.

Join the conversation! 1 Comment

  1. Vaccination has ‘positive externalities’, meaning that if I go for vaccination, not only do I benefit but others do too. There is therefore a strong case to be made that the cost of my being vaccinated should be defrayed: if the benefit is shared between me and society as a whole, why should the cost be for me alone? Not subsidising (partially or fully) vaccination leads to the risk of suboptimal coverage, as we see happen in Singapore today.



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Infection control, Infectious diseases, Public Health, Singapore


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