Adult vaccination: can technology help improve access and uptake?

Technologies are transforming our lives by connecting us to information and to one another. Could the fast-moving world of digital health help to improve uptake of vaccination among older people?

That’s the question that researchers, patients and policymakers are aiming to address as part of a process led by the International Longevity Centre – UK (ILC-UK). The group has published a report on the future of adult immunisation ahead of a meeting in Brussels on 26 June 2018. The event, along with feedback on the new paper, will inform a final report to be published in the autumn.

“Innovation and new technology could play a part in helping protect more of us from vaccine preventable diseases,” says David Sinclair, Director, ILC-UK. “Yet policy and practice are too often a barrier to change. We hope that industry, innovators and policymakers will come together to raise awareness and find new ways to increase the uptake of vaccination amongst adults.”

Read the ILC-UK think piece here and provide your feedback to David Sinclair by August

The need for new solutions is plain: uptake of recommended vaccination among adults is low and the burden of vaccine-preventable diseases – on individuals, families and the health system – remains stubbornly high.

More adults in the US die from vaccine preventable diseases each year than children. Flu remains one of the chief culprits. In the EU, between 40,000 and 220,000 deaths per year might be attributed to influenza infection.

Older adults are hit hardest. They face a higher risk than younger adults of ending up in hospital due to flu. In France, around 2.9 million medical consultations, 30,000 emergency room visits, and more than 3,100 hospitalisations have been attributed to flu or flu-like illnesses in the 2014-2015 season – 47% of flu-related hospitalisations were in over 65s.

New data from ILC-UK shows that more than six million ‘at risk’ individuals in England – where flu vaccination rates are better than most of Europe – were not vaccinated against flu last year.

Older people are also at most risk from other vaccine-preventable diseases. The rate of invasive pneumococcal disease was highest in those aged over 65 years, while the risk of shingles is also highest in older people.

How could tech help?

Daphne Holt, Chair of the Coalition for Life-Course Immunisation (CLCI) says digital approaches could hold the key. “The increasing use of technology across all ages and stages of life means that there is huge potential to be realised in this area for increasing vaccine uptake,” she says. “The Coalition for Life-Course Immunisation welcomes this initiative.”

One of the key barriers to better vaccination rates is awareness. Technology provides new opportunities to inform those at risk that they should be vaccinated and offers novel ways to send reminders via SMS alerts and dedicated health apps. This approach can also be used to ‘nudge’ people to think about vaccination or point them towards their nearest clinic.

Technology can also tap into the wisdom of the crowd by encouraging the public to report disease outbreaks. By sharing information about their symptoms, artificial intelligence algorithms can spot potential outbreaks early, allowing health professionals and authorities to roll out targeted awareness and vaccination campaigns.

Philip Weiss, founder of ZN consulting and a speaker at the ILC-UK event, said social media play an important role in vaccine advocacy. While Facebook, Twitter and other channels have been used to spread disinformation about vaccines, they are increasingly seen as tools to be embraced by health professionals and pro-vaccine citizens. “We have to recognise online vaccine champions and the impact they can have by advocating for immunisation,” he says.

Weiss believes investment in communication should go hand in hand with vaccine development and supporting technologies. “A huge amount of time and effort is spent on research but without investment in communication, this will not have the desired effect,” he says. “If you don’t communicate people won’t vaccinate.”

Patches, drones and digital necklaces

Other ideas floated in the new ILC-UK paper include using nano-patches to deliver vaccines, deploying humanoid robots to distract from the pain of injections, digital necklaces to store vaccination records, drones for delivering vaccines to health professionals, and online communities to support people in at-risk groups.

Some people also face practical challenges in getting to local clinic to due time constraints, mobility issues or lack of transport. The so-called ‘sharing economy’ can connect people through life-sharing apps, allowing drivers to bring older neighbours to their doctor in return for a small fee or goodwill.

Sophisticated algorithms could also play a role in addressing vaccine hesitancy. Just as Amazon and Netflix are adept at suggesting products and movies that ‘people like you’ might enjoy, health systems could build individually tailored messages most likely to resonate with individuals.

‘Older people’ – like any age group of the population – is a highly heterogenous group. Some are rule followers, others are anti-establishment; some rise early, others sleep until late; many are tech savvy, others much less so. This kind of information is relevant to the type and timing of information shared with older people.

Do what works

One of the big advantages of digital tools is that they can be cost-effective and allow rapid testing of new approaches. By piloting technological approaches to improving vaccination rates, it could swiftly become clear what works – and what doesn’t.

For health authorities and policymakers, this information can be highly valuable. The first step is to identify technologies with potential to solve the challenge of vaccine uptake, test them, and share the results widely. Through this approach, Europe could become a testbed for the digital tools of the future.