Hello,

Thank you for your participation in the IFA “Conversation on Adult Influenza Vaccination in Germany” Town Hall.

IFA views vaccination as one of the most powerful public health tools in the fight against influenza (flu) and other vaccine-preventable diseases (VPDs) commonly seen in older adults. Civil society has a unique and considerable responsibility in conveying accurate, up-to-date information on preventative actions that support healthy ageing and a good quality of life. By way of a virtual town hall and a survey, IFA aimed to solicit opinions of key stakeholders on how to move the adult vaccination agenda forward in Germany, where uptake rates are far from adequate.
 
The virtual Town Hall was held in March 2020, and was attended by 9 individuals from across sectors including policy, health, ageing and industry – from Germany, the UK, the Netherlands, and Canada (see "Acknowledgements" for full list of participants). Responses from one anonymous survey participant were also included in the following summary.
To access a recording of the virtual Town Hall, please click the video below:
Virtual Town Hall Summary
Current state of affair

The Town Hall discussion began with an exploration of the current state of affair. Some discussants noted that flu vaccination rates in Germany dropped last year, as vaccine effectiveness was perceived to be low. Participants noted there is a level of ignorance and lack of understanding of the severe impact of flu for individuals with chronic health conditions, and government messages and campaigns alone may not be effective enough to alleviate this. 

Thus, stronger advocacy efforts by civil society in Germany are required. BAGSO and the German Respiratory Society have created campaigns, however, these alone are insufficient. Other organizations with older adult membership should be encouraged to carry the responsibility in promoting the issue to their members.

Another huge barrier is the lack of buy-in from GPs and health insurance companies. These groups are seen as having the authority to promote adult vaccination, however, only ~25% of GPs in Germany vaccinate their patients regularly.

How effective are existing efforts, and what can be done better?

As the discussion moved on to perceived impact and identified gaps of existing promotional efforts and messaging, discussants acknowledged the strong efforts made by BAGSO. However, BAGSO addresses many topics relevant to older people in addition to vaccination, meaning the messages may get buried.

Effective modes of dissemination in Germany included flyers in doctor’s offices, posters, Q&A initiatives via telephone and engaging local media. Discussants cautioned that campaigns that run for a time-limited period in isolated federal states are ineffective – nationwide campaigns with a broader targeted population is warranted.

Discussants from other countries also shared their perspectives. Successful strategies employed include sharing personal narratives and experiences surrounding vaccinations and VPDs on social media. Age UK has found that working on a more local level is effective. The organization has piloted projects with Age UK London to support community organizations to hold flu information clinics, and by using more positive campaign messages (e.g. “9/10 people are getting the flu vaccine, why don’t you join them?”).

Unclear communications with regards to vaccine availability was noted as a barrier. For example, in the UK, flu vaccine messaging often states “people with long term conditions” as an eligible criteria for free vaccination. Also, discussants suggested that misinformation or misconception regarding vaccine safety (e.g. “vaccines will give me the flu”) could be rectified by public education efforts. Short educational clips with clear messaging from experts can be especially impactful. One noted example is a video jointly produced by IFA, IFPMA and the eHealth Digital Media featuring influenza expert, Dr Abraham Palache.

Who are the potential players, and what would be the elements for success?

Health insurance companies should be engaged as they can reach the majority of the adults. To address the most vulnerable target group, BIVA-Pflegeschutzbund – an advocacy organization for people in long-term care – should be engaged. Health professional groups such as GP associations should also be involved to further understand why GPs fail to adequately vaccinate their patients against influenza. Timing wise, discussants suggested that organizations such as BAGSO plan their campaigning efforts around international events such as World Immunization Week. 

As with any campaign, support would be necessary from the Ministry of Health. A supportive immunization policy environment and a clear immunization communication strategy developed by public health authorities would be conducive to the movement. Messages delivered with specific timelines and using multiple tools and channels should be considered. A multi-stakeholder approach is strongly recommended to bring the voices of patients and as many as advocacy organizations and frontline healthcare providers in Germany together to ensure that one strong and aligned message is developed and promoted.
Next Steps
IFA will use the valuable information gained from the Town Hall to conduct ten in-depth interviews with leaders of patient and seniors organizations in Germany, to gain a clearer understanding of the organizational perspectives towards influenza vaccination, and what would help to build their capacity on this matter.

If you are connected with any German seniors or patient organizations who you feel would be valuable for IFA to interview, please contact macton@ifa.ngo .
Acknowledgements
IFA thanks and acknowledges all those who participated in the virtual Town Hall, and looks forward to continued conversations.

Megan Acton, IFA
Jane Barratt, IFA
Mary Chiu, Moderator
Judy Jarvis, Respecting Elders Communities Against Abuse and 50+
Lauren Lovejoy, Age UK
Doris-Ulrike Meyer, GSK
Greg Shaw, IFA
Dorothee Wellman, Sanofi
Ted Van Essen, Dutch Influenza Foundation
Yifan Zheng, IFA