Protecting Healthcare Workers in Low- & Lower-Middle-Income Countries through Vaccination: Barriers, Leverages, & Next Steps

Healthcare workers play a vital role in providing medical care to individuals and communities. Compared to the general public, healthcare workers are at a higher risk of exposure to infectious diseases, including vaccine-preventable ones, due to the nature of their work. The World Health Organization (WHO) recommends healthcare workers be vaccinated against tuberculosis (BCG), hepatitis B, polio, diphtheria, measles, rubella, meningococcal, influenza, varicella, pertussis, and COVID-19; yet, despite clear guidelines, these are not always implemented, especially in less wealthy countries.

Importance of Routine Vaccination of Healthcare Workers

Routine vaccination of healthcare workers not only protects them from contracting infectious diseases but also helps prevent the spread of diseases to their patients, reduce healthcare costs associated with treating infected individuals, and reduce the risk of outbreaks that overburden health systems and increase costs. Moreover, healthcare workers who are protected against vaccine-preventable diseases are less likely to miss work due to illness or infection which can improve confidence and increase overall productivity. This, in turn, is essential for providing quality healthcare and improving the efficiency of the overall healthcare system. Similarly, vaccinated healthcare workers would be more confident in their ability to perform their duties as they are less likely to experience stress and anxiety related to their work.

Despite its importance, the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries faces several challenges. In a recent article published by the researchers of the WFPHA and its International Immunization Policy Taskforce, they analyzed the barriers and recommendations for policy implementation and the role of partnerships.

Main Barriers to the Implementation of Policies for Routine Vaccination of Healthcare Workers

According to the article, lack of funds, lack of specific schedules for healthcare workers, lack of evidence-based data, hesitancy, beliefs, and low literacy are the main barriers to the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries.

Recommendations for the Implementation of Policies for Routine Vaccination of Healthcare Workers

Expanding the COVAX initiative to cover healthcare workers, building partnerships with WHO, GAVI, governments, universities, and communities, mandatory insurance for healthcare workers, including vaccination, utilizing COVID vaccination infrastructures to vaccinate healthcare workers, collecting national data focusing on healthcare workers vaccination, increasing awareness and literacy from the university partnering with health-related student organizations, advocacy at different levels, providing specific schedules and funds addressed to healthcare workers (as done for children and pregnant women), and considering healthcare workers vaccination as part of the Occupational Safety Plan are the main recommendations for the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries.

It is crucial to remember that the primary requirement for implementing the recommendations is the genuine commitment of governments to protect healthcare workers. Regrettably, numerous governments are yet to prioritize the protection of healthcare workers as essential for the well-being and prosperity of their nations. Consequently, this lack of prioritization hinders the successful implementation of the proposed recommendations, despite their potential for positive outcomes.

Health Worker Vaccination Programs in Low, Middle and Upper Middle-Income Countries: A Review

Health workers are at risk of contracting vaccine-preventable diseases while caring for patients and communities. Immunization against commonly encountered pathogens is an effective strategy to protect them. Depending on country-specific circumstances, the World Health Organization (WHO) recommends health workers be vaccinated against tuberculosis (BCG), hepatitis B, polio, diphtheria, measles, rubella, meningococcal, influenza, varicella, pertussis, and COVID-19. However, vaccination coverage amongst health workers in low-income, lower-middle-income, and upper-middle-income countries (LIC, LMIC, and UMIC, respectively) is notably low when compared to higher-income countries. While there may be several reasons for the lower rates of coverage, one could be the lack of programs and policies to vaccinate health workers in LIC and LMIC.

In a recent article by the researchers at the WFPHA, they reviewed the current published data referencing national vaccination policies and programs for LIC, LMIC, and UMIC to understand the programs that are already in place, review the enablers and barriers to health workers vaccination programs, and inform policymakers as they plan for a post COVID-19 health system.

According to the article, the current literature concerning routine vaccination of health workers in low and middle-income countries predominantly emphasized the hepatitis B antigen, with influenza, measles, rubella, and mumps being the subsequent focus. With considerable variability by vaccine and country, in most cases, the vaccination was not offered free to health workers or included in a regular vaccination schedule.

According to the article, economic support for vaccination such as free access to vaccines, vaccines and supplies donated by manufacturers or funded by public-private partnerships, as well as effective management of the vaccination programs such as using existing Expanded Programme on Immunization (EPI) infrastructure, and a robust institutional framework to offer vaccines to health workers, were key facilitators to vaccinating health workers. Lack of awareness and inefficient communication, such as lack of education on vaccines or awareness of availability, lack of funds, difficult access to (i.e., lack of time and/or opportunity to receive vaccines), and lack of vaccines themselves, as well as a lack of baseline data on antigen prevalence rates among health workers, were key barriers to vaccinating health workers.

According to the article, better optimization of available programs and structures developed during the COVID-19 pandemic may be a first step when complemented by effective communication to raise awareness and create a standard of care, whereby health workers vaccination is seen as an integral part of employment safety and occupational health. Comprehensive coverage of health workers against vaccine-preventable diseases is not only a right for workers but also a key element in ensuring that their intervention in health facilities and communities is safe for all.

Internship Opportunity with WFPHA

The World Federation of Public Health Associations (WFPHA) is currently looking for 2 interns.

WFPHA offers a unique environment for an internship for students in international health and development. Interns are given substantial responsibility for performing activities such as researching and writing articles, establishing contact with health and development NGOs around the world, planning international conferences, and fundraising. Each internship is structured to suit the needs and interests of the intern, such as working on an individual research assignment, as well as the requirements of WFPHA.

During the course of the internship, interns will further develop their writing and research skills and become more familiar with the key issues and actors in international health and development. They will have extensive networking opportunities as WFPHA is an international NGO in official relations with WHO, and has extensive contacts with other organizations worldwide.

Qualification and Experience

• Master student or graduate degree in the area of International Relations or health-related faculties.
• Knowledge of MS Office and Adobe.
• Excellent command of English and French.
• Good writing skills.
• Eager to work within a multicultural and international environment.
• A good team player with a “can-do” attitude.
• Good at multi-tasking and working with strict deadlines.

Modality

The intern will work fully remotely.

Compensation

The internship is unpaid but is intended to serve as a career-building opportunity for an early-career academic.

The organization does not cover re-location expenses and does not sponsor international student visas.

Period

Starts as soon as possible for a minimum of 3 months. The internship may be part-time or full-time.

Application Deadline

August 25, 2023

How to Apply

If you are interested in applying for the internship, please send your CV to Razieh Azari: Razieh.azari@wfpha.org

Allocating Sustainable Funding for Resilient Health Systems: A Distant Dream?

The lack of alignment between the economic and healthcare worlds results in an inadequate strategy for sustainable healthcare investments. Numerous decisions affecting health outcomes are made outside the health sector and health budgets, encompassing areas such as transportation, land use planning, and the environment.

On September 18, 2023, at 10:00 (CEST), esteemed speakers from various sectors and regions participated in a comprehensive dialogue, delving into the topic, showcasing real-life examples, and exchanging best practices concerning the effective distribution of budgets across different sectors. The aim is to inspire policymakers and public health professionals globally.

This webinar is available to view by clicking on the link below.

The Alliance of Public Health Associations of the Americas: New Board Members

WFPHA congratulates the new elected board members of the Alliance of the Public Health Associations of the Americas (AASPA), Anulfo Lopez as President, Rosana Onocko as Vice-President, and Fernando Sacoto as Acting Director. WFPHA is looking forward to continuing the fruitful collaboration with the new leadership of AASPA.

Public Health and Emergency Workforce Roadmap: The Third Steering Committee Meeting

In the historic setting of the Istituto Superiore di Sanità (ISS), the third World Health Organization (WHO) Public Health and Emergency Workforce Roadmap Steering Committee meeting took place on July 6 – 7, 2023, in Rome. The Committee considered and endorsed new guidance and tools for countries.

More than 75 members of the Roadmap Steering Committee and Technical Advisory Groups have dedicated several months to reviewing and revising the three interconnected core areas of the Roadmap: Revising the Essential Public Health Functions (EPHFs), Competency-Based Public Health Education, and Measuring the Public Health Workforce, which were presented during this meeting. A general consensus has been reached on the readiness of these documents for release after final coordination editing.

The focus will now shift to implementing the three sections of the Roadmap, aiming to utilize these tools in 100 countries by 2024. Two additional WHO working groups will provide communication and coordination support.

Detailed discussions were held on the training of future generations of professionals involved in public health and emergency response, with a particular emphasis on the tasks performed by public health experts. This highlighted the local knowledge and skills required by students and early-career professionals. Early-career public health professionals have the potential to benefit from the revised and redesigned education framework and play a pivotal role in disseminating the EPHFs.

The WFPHA has endorsed the Roadmap and is actively involved in and supporting this work through the WFPHA Public Health Professionals’ Education and Training (PET) Working Group. The Roadmap subgroup on competency-based education is co-chaired by Dr Priscilla Robinson, Co-Chair of the PET Working Group.

Young WFPHA will contribute by identifying and supporting existing and emerging links between the Roadmap and its young audience in order to bolster the remarkable work accomplished so far.

The Roadmap stems from the 2021 Declaration of the G-20 Health Ministers, under the Italian G-20 presidency, which recognized the “importance of investing in and protecting an adequate and well-trained health workforce and community-based health services, addressing a global shortage, increasing productive capacities to meet needs in the face of health risks and emergencies, as well as insufficient human resource capacity at national and local levels.”