Stockholm, 9/10/2023: As autumn moves to winter, the WHO Regional Office for Europe, the European Commission and the European Centre for Disease Control and Prevention (ECDC) are issuing a clear, urgent message: people who remain unprotected against both COVID-19 and seasonal influenza – especially the most vulnerable and at-risk – should take up any offer for vaccination to prevent or mitigate the impact of these co-circulating respiratory infections.
Last year’s autumn and winter seasons were unpredictable. Last winter, the cumulative impacts of influenza, COVID-19, and respiratory syncytial virus or RSV hit the very young and the very old the hardest. Paediatric and intensive care wards felt the strain, and excess mortality was observed. While the picture may seem quiet now, this autumn we must work together to prevent excess mortality by protecting the most at-risk in our communities: those with co-morbidities, the immunocompromised, the elderly and pregnant women.
Vulnerable groups are the focus
As part of its autumn and winter immunization campaign against respiratory infections, WHO/Europe recommends that countries make both COVID-19 and influenza vaccination easily accessible to population groups that are at higher risk of severe disease.
Over 90% of reported deaths from COVID-19 are in those aged 65 years or above. Yet data WHO/Europe has received from its 53 Member States show that less than two-thirds (63%) of this group have received a first COVID-19 booster vaccine dose, and worryingly, only 29% have received their second. But more important than how many COVID-19 vaccine doses individuals have had in total, the focus now needs to be on when vulnerable individuals and groups received their last dose, information that will better help countries measure and track vaccine coverage and effectiveness. WHO recommends that priority groups including the elderly, immuno-compromised and pregnant women should be offered an additional dose 6-12 months after their last, depending on their level of risk.
“COVID-19 and influenza remain serious diseases, particularly for the most vulnerable, including those who haven’t completed their vaccination courses,” said Dr Hans Henri P Kluge, WHO Regional Director for Europe. “I have three main points to make. First, we have effective WHO-listed and nationally authorized vaccines and, for those infected with COVID-19, effective treatment to manage symptoms. Countries shouldn’t delay in providing COVID-19 booster doses in anticipation of having access to new or updated vaccines which could take some time to become widely available. Second, surveillance for COVID-19, including wastewater surveillance for SARS-CoV-2, remains key; if we can’t track the virus, we’re basically operating in the dark. And finally, we also need to focus on indoor air quality and ventilation as we head into the colder months; effective measures in this regard can go a long way in preventing infection and saving lives.”
The call to get vaccinated also applies to health care professionals who are more exposed to the risk of infection, and who need to protect their patients. Health workers should complete their primary COVID-19 vaccination series if they have not already done so, and if eligible, receive an additional dose before the winter.
“Vaccination remains our strongest tool against both influenza and COVID-19. It is crucial that targeted vaccination campaigns are rolled-out to reach people at risk ahead of the Winter season, including with the possibility to combine vaccination with COVID-19 boosters,” explained Stella Kyriakides, European Commissioner for Health and Food Safety.
“In the past years, we have seen how important it is to ensure easy access to vaccination services, engage communities and to keep citizens updated through clear communication campaigns. Now is again the time of the year to join forces to promote the benefits of vaccination and protect the most vulnerable as well as our health systems. Clinicians should also be encouraged to consider the early use of available antiviral treatments for COVID-19, RSV and influenza to prevent severe disease. The Commission, following the recommendation of the European Medicines Agency, has recently authorised two adapted COVID-19 vaccines as well as two new vaccines and a medicine to protect the very young and the elderly against RSV.”
There are simple steps all of us as individuals can take to keep ourselves and others safe from respiratory infections this autumn and winter, including by ensuring good respiratory hygiene by wearing a mask if unwell, coughing into our elbows or a tissue, staying at home if sick, and proper ventilation in closed spaces. Alongside vaccination, these steps can help keep infections down and reduce the burden on the health system this autumn and winter.
Strengthened surveillance and reporting goes hand-in-hand with vaccination
Protecting populations also requires a good understanding of which viruses are circulating and where. As the European Region moves out of the acute phase of the pandemic, surveillance has been significantly reduced. WHO/Europe and partners are urging countries in Europe and Central Asia to strengthen winter respiratory virus surveillance systems, not scale them down, across the community, primary health care and hospital levels.
“Surveillance and reporting play a crucial role in our ongoing battle against COVID-19, particularly during the winter season when other respiratory viruses circulate at the same time. Having fit-for-purpose and well-performing surveillance systems in all countries in Europe is essential, as it ensures a robust data set that is vital for us to enhance our effectiveness in planning and implementing public health campaigns and measures,” emphasised Dr Andrea Ammon, Director of the European Centre for Disease Control and Prevention.
While the numbers of COVID-19 deaths and people admitted to intensive care units have fallen considerably since the height of the pandemic, hospital admissions are beginning to creep up again in some WHO/Europe Member States, particularly where vaccine uptake remains low.
Cases among individuals at higher risk of severe disease need to be detected early and provided with treatment if available. Clinicians should also be given the tools to consider the early use of available antiviral treatments for COVID-19, RSV, and influenza to prevent progression to severe disease. Hospitals should be planning how they will cope and maintain services when they face a surge.
In the coming months, the risk of COVID-19, influenza and other respiratory infections will increase in the European Region. Already strained health services and an exhausted health workforce will come under increased pressure. Protecting the most vulnerable in society, while also protecting health systems from being overburdened, is the wisest approach.
Background
- There are over 220 million people aged 60 and above spread across the WHO European Region – equivalent to the entire populations of France, Germany, Sweden, and the United Kingdom combined. These individuals, many with underlying medical conditions, are at higher risk of severe outcomes from COVID-19, influenza and other respiratory viruses.
- A new joint study in Albania by the Albanian Institute of Public Health (Instituti i Shëndetit Publik), WHO/Europe and the United States Centers for Disease Control and Prevention (US CDC), has found that health workers who received a COVID-19 booster shot during the Omicron wave were 88% less likely to get severely ill than those who were unvaccinated.
- One way to strengthen SARS-CoV-2 surveillance is to boost testing and sequencing from sentinel surveillance systems and sustain complementary wastewater surveillance systems set up over the past years. Another way is for countries to better monitor all-cause excess mortality in near-real time, on a weekly basis, to gauge the severity and impact of the respiratory virus season. This will help detect new emerging virus variants quickly and share this information globally; monitor transmission, spread and severity to better prepare for any anticipated surge; and strengthen public health interventions, including risk communication, to reduce illness and possible deaths.