Held the Pharmaceutical Manufacturers Association of Japan (PMAJ) Media Forum. Life Course Immunization in the 100-year life era
Background of the Forum
Health is the foundation of security in the age of 100 years of life, and prevention and health promotion have multifaceted significance. Today, the importance of immunization for lifelong health maintenance is recognized worldwide, and the number of vaccines available for adults and the elderly is increasing. The Japan Pharmaceutical Manufacturers Association (JPMA) has planned this forum on September 13, 2024 as an opportunity to communicate the significance and value of lifelong immunization from infants to the elderly.
The event was attended by 21 media representatives from 14 companies at the venue and via webcast.
The following is a summary of the presentations.
Lecture Scene
Opening Remarks
Toru Tanzawa, Chairman, Vaccine Working Committee, Biopharmaceutical Committee of the Pharmaceutical Manufacturers Association of Japan (PMAJ)
In the Immunization Agenda 2030, the World Health Organization (WHO) sets three goals for a world in which all people everywhere and of all ages can fully benefit from vaccines to improve their health and well-being.
- To reduce mortality and morbidity from vaccine-preventable diseases over the life course
- To leave no one behind by expanding equitable access to and use of new and existing vaccines
- Ensure the health and well-being of all people by strengthening immunization in primary health care and contributing to universal health coverage and sustainable development
This year, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) reported that adult immunization programs provide benefits 19 times greater than the cost of immunizations. (Figure 1)
Figure 1: Socioeconomic value of immunization for adults
This report has drawn worldwide attention to the value of enhancing adult immunization programs in healthcare systems by adopting a prevention-first approach that includes adult immunization programs.
The Pharmaceutical Manufacturers Association of Japan (PMAJ) is promoting the research, development, and production of vaccines and creating an environment that facilitates the use of immunization programs by the public in order to realize "Life Course Immunization," a global standard in Japan.
Lecture
What is Immunization based on Life Course Approach?
Akihiko Saito, Professor, Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences
What is the life course approach?
Today, there are an increasing number of vaccines that adults should consider being vaccinated against. It is important to raise awareness of the need for vaccinations not only for children but also for adults.
There are various approaches to a healthy life course. For example, one of them is health checkups. We receive various health checkups at each stage of our life, such as antenatal checkups for pregnant women, infant checkups for infants, and physical examinations to prevent adult diseases. The immunization approach is based on the "life course approach," which is to add immunization to our approach to health maintenance throughout our lives, and to think about how to prevent vaccine-preventable diseases (VPD) from occurring, and even if they do occur, how to prevent them from becoming serious diseases throughout our lives. The life course approach to immunization is to consider the entire life of a person as a whole.
Immunization of society as a whole creates collective immunity. If many people in society are not immunized, pathogens will spread to those who are susceptible. However, in a society where many people are immunized, even if there are non-immune people in the society, such people can be protected from pathogens (Figure 2, collective immunity). The concept of immunizing society as a whole by immunizing not only children but also adults with vaccines is very important.
Figure 2.
What are vaccinations based on the life course approach?
Most vaccines must be considered based on the life course approach, and today I will introduce six diseases (Table 1).
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Whooping cough
These diseases have a high risk of severe illness and death in infants. Vaccinations are required for all generations to protect infants. We often encounter cases where the symptoms of what is thought to be a "lingering cold" are actually adult-onset whooping cough. The five-vaccine combination vaccine, which has been used as a routine vaccination since this spring, is mainly used to prevent whooping cough. The age distribution of pertussis patients in Japan shows that 63% of them are between 5 and 15 years old, and adults in their 30s and 40s also account for 16% because they are infected by children. The reality is that even if children are well immunized in their infancy, their immunity declines during their school years and adolescence. Thus, the current Japanese immunization schedule does not control the outbreak of pertussis, and we must consider additional vaccination with a pertussis-containing vaccine (triple vaccine) before entering elementary school or around the age of 10, as in other countries.
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Varicella and shingles
Chickenpox is often caused by viral infection in infancy, resulting in a rash over the entire body and fever. Shingles, on the other hand, occurs when the virus, which was dormant in the nerve roots in the body after contracting the chickenpox virus, awakens again when the immunity is lowered. It is characterized by the fact that the pain at that time is very strong. The number of chickenpox outbreaks in Japan has decreased significantly since the chickenpox live vaccine became a routine vaccination, and the number of elderly people who have lost immunity to the chickenpox virus due to the lack of chickenpox outbreaks is increasing. There are many reports overseas that the number of shingles outbreaks increased when the number of chickenpox outbreaks decreased due to the widespread use of live varicella vaccine, making prevention of shingles by live or inactivated shingles vaccine important for the elderly.
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Streptococcus pneumoniae
Streptococcus pneumoniae is an infectious disease that carries a high risk of serious illness and death in infants and the elderly. Two types of vaccines are available: a conjugate vaccine used primarily for infants and toddlers and a polysaccharide vaccine used for the elderly and at-risk patients. There are more than 90 serotypes of Streptococcus pneumoniae, some of which cause severe infections, especially in children. The vaccine covers these types. The number of children with severe pneumococcal infections has decreased to about 30% of that before routine childhood vaccination began, but the number of infections caused by those not covered by the vaccine has relatively increased. Currently, 13-valent and 15-valent conjugate vaccines are used in routine childhood vaccination, but it is known that increasing the number of serotypes in a single vaccine reduces the effectiveness (immunogenicity) of the vaccine against each serotype, so it is necessary to consider how far to expand coverage in a single vaccine. In October 2024, a 20-valent conjugate vaccine will be added to the routine childhood vaccination schedule, and it is expected that vaccination of not only children but also the elderly will increase in the future.
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Influenza
Influenza vaccination is necessary for all generations. Pregnant women should also be vaccinated to protect their infants with transferable antibodies from the mother. The influenza epidemic has changed dramatically with the outbreak of new coronary infections; the 2023-2024 season was a season of very high overall caseloads, with the epidemic beginning in the fall and not decreasing after the first of the year. It is important to increase immunization rates among children and adults in order to achieve mass immunity against influenza. This season, a new live intranasal vaccine has become available, increasing the number of options.
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RS virus
RS virus (RSV) is a virus that causes severe lower respiratory tract infections and a high risk of death in infants and the elderly. To protect early-born infants and high-risk children, monoclonal antibodies were administered once a month before the start of the RSV infection season, for a total of 6-8 doses, to prevent transmission to infants. Recently, sustained monoclonal antibodies have been developed, and from May of this year, high-risk patients can be vaccinated once during the RSV infection season to prevent infection. New vaccines for the elderly and pregnant women have also been developed; RSV infection has entered a new era this year, with more options for prevention.
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Rubella
The rubella virus, when transmitted in early pregnancy, causes a high rate of congenital rubella syndrome (CRS) in unborn children; the main symptoms of CRS include cataracts, retinopathy, sensorineural hearing loss, and heart malformations. CRS has become a disease of the past in developed countries. Unfortunately, Japan experienced a rubella outbreak in 2013, and about 45 cases of CRS have been reported since then. In order to protect pregnant women from rubella, free antibody testing and vaccination in the event of a negative test are available until the end of March 2025 for men born between 1962 and 1978 who have not had the opportunity to be immunized. It is very important for adult males to be vaccinated.
Table 1. Life course approach for six infectious diseases
Challenges to realize immunization based on the life course approach
As challenges in Japan to achieve immunization based on the life course approach, the Japan Health Policy Organization has identified five perspectives (Fig. 3).
The first is that "immunization and vaccine policies based on the life course approach should be promoted"; the second is that it is important to continuously disseminate information by establishing "dissemination and awareness activities and communication strategies" targeting healthcare professionals and the public. Currently, there is a lack of information on vaccination coverage in Japan. Dissemination of information through the media will be particularly important.The third point is that linkage of information systems on immunization and outbreaks of targeted diseases, and the creation of a system to analyze and share epidemiological effects, is important for policy making and evaluation. For example, there are no accurate data on the number of cases of RSV infection among the elderly, and there is a lack of data to assess disease burden and vaccine effectiveness. It is important to constantly conduct surveillance and accumulate and analyze data. Finally, the fifth point is that we should promote investment in immunization policies that take into account peacetime and contingency situations and future vaccine demand.
Figure 3. 5 perspectives of immunization and vaccine policy based on the life course approach
Finally, I will tell you about the "benefits and risks of vaccines" that lead to the decision on the need for vaccines. In fact, it is very difficult to evaluate them (Figure 4). The benefits of vaccines include the prevention of disease severity and complications and the eradication of disease, but these become invisible once the vaccine is effective, leaving only risks such as adverse reactions and adverse events. It is important to keep data on how many diseases have been eliminated and how many patients with serious complications have been reduced by vaccination, and to provide this information to the public. Japan has not invested enough in surveillance data and record-keeping of vaccination histories during normal times, and has not invested enough in immunization as a whole so far. In the future, we believe it will be important to ensure that epidemiological data and vaccine benefits, i.e., effects that may otherwise remain invisible, are also communicated to the public.
Figure 4. Benefits and risks of vaccines
The End
(Responsibility: Shuichiro Yano, Vaccine Working Committee, Biotechnology Committee of the Pharmaceutical Manufacturers Association of Japan)