Portugal must be doing something right: More than 95% of children have received the recommended vaccines, and measles vaccination coverage is among the highest in the world at 99%. Portugal’s COVID-19 vaccination drive was a source of national pride in 2021, and a report for the European Commission in 2022 showed that Portuguese citizens are the most in favor of vaccination in the EU.
Portugal’s vaccination rates are among the highest in Europe Influenza vaccination rates are approaching the 75% target and the COVID-19 rollout has been successful Awareness of the recommended shingles and pneumococcal vaccines is low Experts are concerned about misinformation, especially online New initiative +Longevidade aims to increase vaccination rates among people of all ages by focusing on healthy ageing
“Portuguese people really believe in the benefits of vaccination and have a positive approach to vaccination,” Dr. Diana Costa said. “We have a vaccination culture.”
Dr. Costa helped coordinate Portugal’s COVID-19 vaccination campaign and coordinated the National Vaccination Center for two years. She said the instinct among the public, health professionals and policymakers was to go beyond the target and achieve the highest possible vaccination coverage. “For example, with COVID-19 vaccination, we had a 99% first dose coverage rate for adults and 95% for people over 60 years old.”
Read more: COVID-19 vaccinations protect Portugal from wave of deaths
The sharp reductions in hospitalisations, intensive care admissions and deaths, combined with high public recognition of these achievements, have reinforced the view that vaccination is effective. This success has also been driven by close collaboration between institutions and individuals across the immunisation service, Dr Costa added.
“The Directorate General of Health was supported by the COVID-19 NITAG (National Immunization Technical Advisory Group), which ensured high quality and safety of the vaccine through its rapidly evolving evidence-based strategies and recommendations,” it explained. Other key elements include a national vaccination campaign, effective mass vaccination centers, a booking system, a centralized vaccine registry, and a management platform called Vacinas.
“However, in my opinion, the success of the COVID-19 vaccination campaign is the product of the legacy of a national vaccination program spanning several years,” Dr Costa said.
Shifting focus to maintaining health at all ages and stages of life
While most vaccines are widely accepted, some adult vaccines are less well known. Uptake of shingles and pneumococcal vaccines among older adults is generally lower than the excellent vaccination rates consistently seen in childhood programs. The public still considers vaccination to be part of early childhood health care.
Dr Costa said education and public health campaigns were key to changing this perception and highlighting “the need for lifelong vaccination to prevent disease and stay healthy throughout adulthood”.
“I think there are various challenges to vaccinating adults. Some older people may have misconceptions about vaccination and underestimate its importance, and some may have concerns about the safety, efficacy and side effects of the vaccine,” she explains.
“Older people, especially those with reduced mobility, such as those who use wheelchairs or have difficulty walking, face additional (practical) challenges. Some older people do not have their own cars or have difficulty using public transport. Many older people live in rural areas or in areas with limited access to health centres.”
Read more: Portuguese pharmacists on the frontline of flu prevention
During the 2023-2024 seasonal vaccination campaign, which ran from September to April, mobilizing pharmacists nationwide played a key role in addressing vaccination access issues. Portugal has a long history of early adoption of pharmacy vaccination, with 95% of the population supporting influenza and COVID-19 vaccination in their local pharmacies. Last winter, a record 2,491 pharmacies participated in the influenza/COVID vaccination campaign, administering 2.5 million doses of influenza vaccine over a six-month period.
Driving action through data
As the focus on preventive healthcare expands to include healthy ageing, Portugal aims to build on its high public trust, excellent vaccination infrastructure and learnings from recent campaigns.
Convenient access to the free vaccine and active engagement with the public are essential to ensure people of all ages get the recommended vaccine, said Dr. Filipe Flores, a consultant in respiratory and intensive care at Pulido Valente Hospital in Lisbon.
“Getting the flu vaccination is recommended – no appointment or prescription is needed, just a visit to a pharmacy,” he points out. “We are running a strong communication campaign to advise people on the benefits of the vaccine and answer any questions they may have.”
Vaccine-preventable diseases put huge strain on hospital systems
The example of the influenza vaccination campaign shows what can be achieved by engaging a range of healthcare organisations and advocates. Six scientific organisations, including experts in pulmonology, diabetology, cardiology, geriatrics, internal medicine and infectious diseases, produced a position paper on the impact of influenza prevention. This pioneering paper, of which Dr Froese is lead author, reviews the evidence on the impact of influenza, the safety and effectiveness of influenza vaccines and strongly recommends vaccination.
Achieving similar outcomes for pneumococcus, shingles and respiratory syncytial virus in adults will require time and the generation of robust evidence. Awareness of the impact and burden of the disease, and knowledge of some adult vaccines, is low. “For shingles, I believe there is sufficient evidence to include it in the national immunization program, but more data are needed to convince decision makers.”
Dr. Froese is coordinating a study on the burden of infectious diseases in Portugal, including a study on hospitalizations related to community-acquired pneumococcal infections. Preliminary findings show that hospitalization and mortality rates fell after the introduction of the pneumococcal vaccine for all children born after 2015. “This is very telling,” says Dr. Froese. “We will present this data to the authorities to highlight the importance of vaccinating children and to go further and increase vaccinations.”
In 2012, after examining the disease burden and the cost-effectiveness of the vaccine, Portugal’s Ministry of Health decided to make the vaccine free for everyone over 65. “Things don’t happen by chance. We are now benefiting from the work we started 10 years ago,” he says. “Vaccination rates have increased since then, but results are not immediate. You need planning and organization.”
Proactive communication is key to maintaining vaccination rates
Dr Froese, who advises the Ministry of Health and sits on the technical advisory group that shapes vaccination decisions, says health care workers should lead by example by having their own vaccine and sharing that information with their patients: “By getting vaccinated, we are protecting ourselves, setting an example for our patients and preventing them from transmitting the virus to our most vulnerable patients and family members.”
Live longer and healthier
A new multi-stakeholder initiative called +Longevidade has been launched to support healthy ageing, with vaccination playing a central role in living longer and staying healthier.
The project aims to generate local evidence on the burden of disease and the impact of vaccination among adults, raise awareness and health literacy, and support planning and policy development. A series of meetings were held in April and May before moving to the public campaign.
Dr. Flos, an ambassador for +Longevidade, says that in an ageing society, the transition from childhood vaccinations to lifelong immunization is crucial. “This is a problem in Portugal and other countries,” he points out. “We are working together to change this paradigm and raise awareness so that the value of prevention is better understood by the public and politicians.”
Meanwhile, Portugal remains vigilant against rising cases of measles and whooping cough in Europe. In January, authorities reported that a hospitalized infant in Lisbon had contracted imported measles — a timely warning that even a country with strong community defenses against most vaccine-preventable diseases should not let its guard down.
Disinformation: a public health threat
Public engagement remains a big challenge, he noted. “After COVID-19, we have to recognize that we face a new threat: disinformation. This is one of the great challenges of our time,” Dr. Froese said. “I’m not talking about inaccurate information or misinformation. Disinformation is false information with a hidden agenda. It’s lying for a hidden interest.”
He calls for four approaches to address this problem.
Public education about the dangers of disinformation and how to identify it; Proactive dissemination of accurate information; Working patiently and persistently to help people distinguish between truth and disinformation through critical thinking and source checking; Holding purveyors of disinformation accountable through legal and regulatory action, where necessary.
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