Adult vaccinations: There will be no revolution

The Ministry of Health, in information prepared for the subcommittee meeting, reminded that recommended vaccinations are performed in medical entities (vaccination of children and adults) and in pharmacies open to the public (vaccination of adults). A doctor's prescription is needed before vaccination. The prescription can be issued by a pharmacist, but only for the vaccine without reimbursement (full-price). COVID-19 vaccination is performed without a prescription, on the basis of an automatically issued referral at IKP. The list of recommended vaccinations for the elderly includes vaccination against influenza, COVID-19, respiratory syncytial virus (RSV), pneumococcal, hepatitis B, among others. The vast majority of adult vaccinations are paid, with reimbursement available only to selected groups and only for selected vaccines.

Ernest Kuchar, MD, representing the National Program for Combating Infectious Diseases and the Polish Society of Vaccinology, noted that we have low rates of flu vaccination among seniors in Poland. This can be changed, but on the condition that we set targets to strive for. The WHO's goal is 75 percent vaccination coverage. - In the UK, the Netherlands, Portugal, flu vaccination rates are above 90 percent. I say Portugal on purpose, because that country has made a huge leap. They jumped from a vaccination rate of 40 percent to over 90 percent in two or three years. So it can be done," he stressed.

Developing immunization of seniors will not succeed, said the chairwoman of the subcommittee, Professor Alicja Chybicka, without organizational changes, including simplification of the system and the patient pathway. - Here the goal, in my opinion, is to shorten the patient's path in such a way that if he or she wants to get vaccinated, he or she will be able to do it during one visit to the POZ or pharmacy," stressed Igor Grzesiak of the Institute for Patient Rights and Health Education. At the moment, the primary care doctor issues a prescription, but the patient cannot use the reimbursed vaccine in the office, while the pharmacist - although he has the vaccines - cannot issue a reimbursed prescription. - This could be changed if the pharmacist, after the patient provides his PESEL, could access the Internet Patient Account. By this means, he would receive information about co-morbidities, and could, based on the PESEL algorithm, issue the vaccine as reimbursed in whole or in part," said Mikolaj Konstanty, vice president of the pharmacists' self-government. Such a solution was presented by the NRA as an amendment to the current law on benefits. - With such a solution, during one visit we collect data, we can issue a prescription, and the patient receives the benefit, the NRA vice president said.

Chief Sanitary Inspector Dr. Pawel Grzesiowski, in turn, pointed out that the system of financing vaccinations, including for seniors, is not uniform. - Whether a vaccine is free or not is determined by either the Reimbursement Law or the Free Medicine for Seniors Law. This creates confusion, because some of the vaccines are fully reimbursed, while some are partially reimbursed. For example, the pneumococcal vaccine in some groups is covered by a 50 percent reimbursement. The herpes zoster vaccine also has a 50 percent reimbursement in a certain narrow group of people. So there is a problem here, because adult vaccines, as a rule, are mostly paid for," he admitted.

There have also been calls to expand reimbursement, or simply to include, at least for seniors and groups of patients particularly susceptible to infection, full funding for a much longer list of vaccines. Among those that should - because of the price, which is a barrier for a huge portion of seniors - be covered by full reimbursement for people over 65, the herpes zoster vaccine was pointed out. - Herpes zoster and viraemia in children with cancer and in seniors are extremely dangerous, often taking their lives. We are able to achieve remission and cure a cancer patient, and he then dies from a complication of an infectious disease. This is one of the worst situations for an oncologist," agreed Prof. Chybicka with the experts.

Representatives of the Ministry of Health assured that work is underway to increase accessibility to adult vaccinations, but, as Joanna Kujawa of the Department of Public Health at the Ministry of Health said, changes should not be expected in a flash. - I can assure you that on the part of the Minister of Health - and I have authorization here from Minister Konieczny - we have the green light for these changes. Only we also need to prepare them rationally," Dr. Pawel Grzesiowski, Chief Sanitary Inspector, said in turn.