A new immunisation information system will be a key element of Spain’s efforts to address vaccine hesitancy. The planned ‘data lake’ will bring together information from several health databases to provide insights on vaccine uptake and health outcomes.
Background briefing
- Regional authorities in Spain deliver immunisation programmes
- Regions follow a common immunisation calendar, but authorities can choose where and how to deliver vaccines
- Connecting data on vaccination, disease outbreaks and hospitalisation would allow regions to learn from one another
- Public and private collaborations may accelerate sharing of insights that would improve vaccination rates
Dr Mario Fontán Vela, a public health researcher at the Spanish Ministry for Health, says the new approach will allow experts to study the ‘social determinants of health’. Speaking to Vaccines Today, he highlights the potential to compare approaches taken by regional authorities across Spain and to adapt services accordingly.
‘Education and income, where people live and work – these factors affect physical and mental health outcomes in various ways,’ Dr Fontán Vela explains. ‘They also shape beliefs about health, risk of infectious disease and vaccination. But it can change over time and may depend on the disease or the vaccine in question.’
Read more: Spotlight on Spain: building life-course vaccination on a strong foundation
For example, he points to the years before the COVID-19 pandemic during which vaccine hesitancy was more frequently found among middle-class, higher educated people – albeit only in a minority of this group. ‘During COVID, that changed. We saw greater hesitancy among those who identified as right wing and economically liberal.’
Whether that hesitancy persists today is yet to be established, but researchers may be better equipped to understand trends in hesitancy by connecting the dots between existing datasets.
‘We need to conduct more studies using data on vaccine uptake, as well as socio-demographic information, migration status, and health outcomes related to various diseases,’ Dr Fontán Vela notes.
Spanish regions provide opportunities for ‘natural experiment’
As responsibility for health, including vaccination, is decentralised in Spain – with regional authorities taking the lead in delivering vaccines – there are opportunities to learn from the variety of approaches deployed across the country.
‘One positive thing about having a decentralised system is that it allows for natural experiments,’ he explains. ‘If one region delivers vaccines through primary care and another uses the hospital setting, we can study the results to see which achieves the best outcomes. This could inform future strategies at a regional level.’
Some of this work may be done in partnership with academic researchers who would apply for access to the data lake under certain conditions. This kind of research could reveal the wider impact of some vaccines beyond preventing infectious disease.
‘Flu vaccine, for example, appears to improve health results beyond reducing influenza – we’d like to understand this better,’ Dr Fontán Vela says. ‘And where vaccine uptake is low, we want to know whether it is a question of [vaccine hesitant] beliefs – or practical barriers, such as needing time off work or difficulty travelling to clinics.’
Connecting the dots between databases
Making the most of the opportunities provided by the ‘data lake’ could mean greater collaboration between a wide range of health stakeholders. At a meeting in Madrid earlier this year, policymakers, public health experts, academics and industry explored ways of studying vaccine effectiveness and the impact of immunisation programmes.
Dr Jaime Pérez, President of the Spanish Vaccinology Association, who chaired the discussion, says collaborations can deliver a ‘win-win’ for all parties if the result is higher uptake of recommended vaccines.
The event heard about a pilot initiative in NHS England which is testing a new partnership model. ‘The UK experience is something we can learn from to improve how we evaluate the impact and effectiveness of new vaccines,’ he says. ‘For RSV, for example, collaboration between public and private partners can ensure we have comprehensive data on the impact of new vaccines and monoclonal antibodies.’
Dr Pérez says the multistakeholder meeting could become an annual event organised by scientific societies and companies. He would like to see the implementation of a concrete action plan based on collaborative efforts to improve public health.
Spotlight on Galicia: How collaboration can boost vaccination
Galicia, a region in the northwest of Spain, has embraced public-private partnerships in several areas: clinical research, studies on vaccination coverage, training of healthcare professionals, and buying vaccines based on health outcomes. The region has a four-year collaboration strategy designed to improve cooperation between stakeholders.
Carmen Duran, Director of Public Health of the Galicia region, says the success of vaccination programmes relies on several parties. These include health administrators, healthcare professionals, the pharmaceutical industry, and citizens.
‘Public-private partnerships in the field of vaccines bring multiple benefits such as innovation, improved efficiency of logistical processes, synergy in research and training, as well as the sustainability of the healthcare system through, for example, sharing financial risk,’ she says.
‘On the other hand, relationships with private companies must be managed appropriately to minimise conflicts of interest, optimise transparency, and avoid excessive dependence on this sector.’
Read a detailed interview with Carmen Duran, Director of Public Health of the Galicia region
