Test your Policies here Data based on Swedish policies

Policy Calculator Icon
Policy Calculator

Policy
Calculator

Data base on Swedish Policies

Choose your Policies

Feel free to choose any of the policies you would like to see implemented.
Please be mindful that when a policy is chosen to be tested, the result will correspond to its full implementation.

Health authority accountability & strengths of influenza programHealth authority accountability & strengths of the program

get more info about this pollicy

In pursuit of specific health objectives, countries, and in some cases, their regions, establish goals to guide their efforts. One commonly set objective is to achieve desired vaccination coverage rates (VCR). This is particularly relevant in the context of vaccines targeting prevalent diseases such as influenza, commonly known as the flu.
For instance, if out of a target population of 100 individuals, 65 have received the influenza vaccine, the vaccination coverage rate stands at 65%. These VCR targets serve as benchmarks to gauge the effectiveness of vaccination programs and to ensure adequate protection against infectious diseases within the population.

Bibliographical references:

  1. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States [Internet]. Stockholm; 2018.

  2. Blank PR, van Essen GA, Ortiz de Lejarazu R, Kyncl J, Nitsch-Osuch A, Kuchar EP, et al. Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later. Hum Vaccines Immunother. 2018;

  3. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

get more info about this pollicy

For individuals to access influenza vaccinations, there needs to be funding provided by either public or private entities. This policy specifically targets funding for flu vaccinations across various social groups for whom influenza vaccination holds particular significance.

Bibliographical references:

  1. Ting EEK, Sander B, Ungar WJ. Systematic review of the cost-effectiveness of influenza immunization programs. Vaccine [Internet]. 2017

  2. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States [Internet]. Stockholm; 2018.

  3. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

  4. WHO. Guidance on the economic evaluation of influenza vaccination. 2016.

get more info about this pollicy

This policy entails the nationwide regular monitoring of patient vaccination coverage rates (VCR) at vaccination sites and healthcare provider (HCP) levels by Health Authorities (HA). In essence, it involves the systematic oversight conducted by health authorities at the national level to track the vaccination coverage rates at individual vaccination sites and among healthcare providers.

Bibliographical references:

  1. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States [Internet]. Stockholm; 2018.

  2. Blank PR, van Essen GA, Ortiz de Lejarazu R, Kyncl J, Nitsch-Osuch A, Kuchar EP, et al. Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later. Hum Vaccines Immunother. 2018;

  3. Paul KT, Loer K. Contemporary vaccination policy in the European Union: tensions and dilemmas. J Public Health Policy [Internet]. 2019;40:166–79.

get more info about this pollicy

This policy involves incorporating healthcare provider (HCP) vaccination coverage rates (VCR) against the influenza virus as a component of hospitals' performance criteria. In essence, it means that hospitals evaluate the performance of their staff based on their adherence to influenza vaccination protocols, emphasizing the importance of healthcare professionals being vaccinated against the flu.

Bibliographical references:

  1. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  2. Lindley MC, Mu Y, Hoss A, Pepin D, Kalayil EJ, van Santen KL, et al. Association of State Laws With Influenza Vaccination of Hospital Personnel. Am J Prev Med [Internet]. 2019;56(6):e177–83.

  3. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Netw open. 2018;1(2).

  4. Kitt E, Burt S, Price SM, Satchell L, Offit PA, Sammons JS, et al. Implementation of a Mandatory Influenza Vaccine Program: A 10-year experience. Clin Infect Dis. 2020;

  5. Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Influenza vaccination of healthcare workers in Italy: Could mandatory vaccination be a solution to protect patients? Future Microbiol. 2019;14(9s):45–9.

get more info about this pollicy

This policy entails the establishment of a sustainable procurement system aimed at guaranteeing a consistent vaccine supply to prevent shortages and ensure that all individuals identified as vaccination targets have access to their required vaccine doses.

Bibliographical references:

  1. Grieco L, Panovska-Griffiths J, van Leeuwen E, Grove P, Utley M. Exploring the role of mass immunisation in influenza pandemic preparedness: A modelling study for the UK context. Vaccine [Internet]. 2020;38(33):5163–70.

  2. Farooq MU, Hussain A, Masood T, Habib MS. Supply chain operations management in pandemics: A State-of-the-Art Review Inspired by COVID-19. Sustainability. 2021;13.

  3. Wilsdon T, Lawlor R, Li L, Rafila A, García Rojas A. The impact of vaccine procurement methods on public health in selected European countries. Expert Rev Vaccines [Internet]. 2020;19(2):123–32.

Faccilitated access to vaccinationFaccilitated access to vaccination

get more info about this pollicy

This policy aims to facilitate access to multiple vaccination settings, enabling individuals to receive vaccinations conveniently at various locations.

Bibliographical references:

  1. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  2. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

  3. Gazmararian JA, Coleman M, Prill M, Hinman AR, Ribner BS, Washington ML, et al. Influenza vaccination of health care workers: Policies and practices of hospitals in a community setting. Am J Infect Control. 2007;35(7):441–7.

get more info about this pollicy

This policy involves coordinating call-to-action communications from multiple stakeholders related to influenza vaccination. The objective is to effectively inform and motivate individuals from diverse target groups to get vaccinated against influenza.

Bibliographical references:

  1. Influenza Diabetes Community, European Scientific Working group on Influenza. Commitment paper of the Influenza/Diabetes Community [Internet]. 2019.

  2. Tailoring Immunization Programmes for Seasonal Influenza (TIP FLU) [Internet]. 2017.

  3. ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. 2015.

get more info about this pollicy

This policy entails healthcare organizations sending pop-up notifications or SMS messages to eligible individuals, reminding them to receive the flu vaccine as recommended.

Bibliographical references:

  1. Loiacono MM, Mitsakakis N, Kwong JC, Gomez GB, Chit A, Grootendorst P. Development and Validation of a Clinical Prediction Tool for Seasonal Influenza Vaccination in England. JAMA Netw open. 2020;3(6):e207743.

  2. WHO. Tailoring Immunization Programmes for Seasonal Influenza (TIP FLU). 2017.

  3. ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. 2015.

Healthcare professional accountability and engagementHealthcare professional accountability and engagement

get more info about this pollicy

This policy ensures that healthcare professionals undergo regular education and training in influenza vaccination. By staying updated, they are equipped to provide accurate information and assistance to individuals seeking guidance on vaccination.

Bibliographical references:

  1. Goldstein AO, Kincade JE, Gamble G, Bearman RS. Policies and Practices for Improving Influenza Immunization Rates Among Healthcare Workers. Infect Control Hosp Epidemiol. 2004;25(11):908–11

  2. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  3. Maltezou H, Poland G. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare. 2016;4(3):47.

  4. Gazmararian JA, Coleman M, Prill M, Hinman AR, Ribner BS, Washington ML, et al. Influenza vaccination of health care workers: Policies and practices of hospitals in a community setting. Am J Infect Control. 2007;35(7):441–7.

get more info about this pollicy

This policy ensures fair and specific compensation for healthcare organizations and professionals for each vaccination administered.

Bibliographical references:

  1. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Netw open. 2018;1(2).

  2. Gazmararian JA, Coleman M, Prill M, Hinman AR, Ribner BS, Washington ML, et al. Influenza vaccination of health care workers: Policies and practices of hospitals in a community setting. Am J Infect Control. 2007;35(7):441–7.

  3. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

get more info about this pollicy

This policy mandates the vaccination of healthcare professionals, making it a requirement for them to receive the vaccine.

Bibliographical references:

  1. Short E, Zimmerman PA, van de Mortel T. Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review. J Infect Prev. 2020;21(6):212–20.

  2. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  3. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Netw open. 2018;1(2).

  4. Paul KT, Loer K. Contemporary vaccination policy in the European Union: tensions and dilemmas. J Public Health Policy [Internet]. 2019;40:166–79.

  5. Lindley MC, Mu Y, Hoss A, Pepin D, Kalayil EJ, van Santen KL, et al. Association of State Laws With Influenza Vaccination of Hospital Personnel. Am J Prev Med [Internet]. 2019;56(6):e177–83.

  6. Kitt E, Burt S, Price SM, Satchell L, Offit PA, Sammons JS, et al. Implementation of a Mandatory Influenza Vaccine Program: A 10-year experience. Clin Infect Dis. 2020;

  7. Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Influenza vaccination of healthcare workers in Italy: Could mandatory vaccination be a solution to protect patients? Future Microbiol. 2019;14(9s):45–9.

  8. Wang TL, Jing L, Bocchini JA. Mandatory influenza vaccination for all healthcare personnel: A review on justification, implementation and effectiveness. Curr Opin Pediatr. 2017;29(5):606–15.

  9. Maltezou H, Poland G. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare. 2016;4(3):47.

  10. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

Awareness of the burden and severity of the diseaseAwareness of the burden and severity of the disease

get more info about this pollicy

This policy involves a coordinated effort among various entities, both public and private, related to influenza vaccination, to create comprehensive awareness and communication campaigns. These campaigns aim to educate the public on the importance of influenza virus vaccination, including the involvement of patient advocacy groups (PAGs).

Bibliographical references:

  1. Influenza Diabetes Community, European Scientific Working group on Influenza. Commitment paper of the Influenza/Diabetes Community [Internet]. 2019.

  2. Maltezou H, Poland G. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare. 2016;4(3):47.

  3. Chevalier-Cottin EP, Ashbaugh H, Brooke N, Gavazzi G, Santillana M, Burlet N, et al. Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases. Infect Dis Ther. 2020;9:467–80.

  4. WHO Europe. Vaccination and trust [Internet]. Copenhagen; 2017.

Belief in influenza vaccination benefitsBelief in vaccination benefits

get more info about this pollicy

This policy advocates for positive media coverage of influenza vaccination, ensuring that the media adequately covers and promotes the importance of vaccination against influenza.

Bibliographical references:

  1. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

  2. Kumar S, Xu C, Ghildayal N, Chandra C, Yang M. Social media effectiveness as a humanitarian response to mitigate influenza epidemic and COVID-19 pandemic. Ann Oper Res [Internet]. 2021;

  3. Bonnevie E, Rosenberg SD, Kummeth C, Goldbarg J, Wartella E, Smyser J. Using social media influencers to increase knowledge and positive attitudes toward the flu vaccine. PLoS One [Internet].

Target Population

We acknowledge that some of the policies are already in partial implementation in the country, despite presenting room for improvement.

 
Clear Selection  

Complementary Bibliographical References

First Influenza records
and possible epidemics

The origin of the Influenza virus and its early epidemics/pandemics remains unclear.

China
China

The oldest record associated with the possibility of an influenza epidemic/pandemic dates from about 8000 years ago in China1. However, the temporal distance and the impossibility of having direct or indirect evidence of what happened leads us to consider this first record as strongly speculative.

greece
Greece

Later, Greek records from 412BC have been identified regarding epidemic outbreaks that could be due to influenza2. Since then, other registers have been found in the literature about possible influenza epidemics/pandemics (e.g., in the years 1580, 1729, 1830)2.

Spain
Spain

The 1918-1920 Spanish flu pandemic was one that caused the most significant damage, being estimated to have infected over half of the world population, with a mortality count between 40-50 million individuals2.

The influenza virus has only been isolated and identified in the early 1930’s by Shope3.

Further pandemics were registered2-4, such as the Asian flu (1957-1958), Hong Kong flu (1968-1970), and swine flu (2009-2010).

Characteristics
of the Influenza Virus

Image
chart-influenza

Total Molecular Weight5: ~3.9x106Dimensions6: 80-120 nanometers; Composition7: Single-stranded; RNA Family7: Orthomyxoviridae.

What is the
Influenza Virus

Four types of influenza virus are identified in the scientific literature8-11.

Influenza A and B are the types mainly associated with the disease ́s seasonal epidemics; Influenza C and D are also registered to cause illness but at lower scales.

influensa A

The classification of influenza A10 viruses encompasses different subtypes according to the composition of proteins in their surface, namely the hemagglutinin (H) and neuraminidase (N). So far, 18 types of hemagglutinin have been identified, along with 11 neuraminidase. The combination of these proteins could potentially form 198 different influenza A viruses, although only 131 have been identified up to the moment (e.g., H1N1, H3N2). These viruses may also be further classified according to “clades” and “sub-clades”, corresponding to “groups” and “subgroups” that identify each virus type according to different genetic compositions. Influenza A viruses are known to circulate both in humans and domestic animals.

influenza B

The classification of influenza B10 viruses encompasses two lineages: B/Yamagata and B/Victoria. These viruses can also be classified into different “clades” and “sub-clades”. Their circulation is known to occur only in humans, although some rare cases were registered in animals.

Influenza C

Influenza C10 viruses are identified to have six genetic lineages. Although these viruses are considered as not posing a risk for epidemics, they may still cause mild illness or asymptomatic infection. Around 90% of the population already presents seropositivity to influenza C by 7-10 years old12.

Influenza D

The Influenza D9, 10,13 viruses are known to mainly affect cattle, pigs, small ruminants, horses and other animals, with no events being found on human infection or illness.”

History of Influenza
epidemics/pandemics

Two main mechanisms are identified14-17 for the changes in the influenza viruses, allowing for the recombination of antigens according to different H and N proteins: Antigenic Drift and Antigenic Shift. These comprise the changes in influenza virus genetic compositions that allow for influenza re-infection.

Antigenic Drift

This mechanism occurs within virus replication, producing small changes in the virus that originate virus with similar antigenic combinations. The accumulation of changes due to the antigenic drift may lead to the appearance of viruses with different antigenic combinations.

Antigenic Shift

This mechanism assumes a more sudden change in the influenza viruses antigen combination, for example through zoonosis. This abrupt change composes a major threat for pandemic influenza outbreaks since the population’s immunologic response may be totally unprepared to deal with the new antigenic combination of the influenza virus.

Influenza
Signs and Symptoms

Influenza (flu) is only one of many types of respiratory diseases caused by virus infection18, such as the syncytial virus, rhinovirus, coronavirus, adenovirus, among others.

There are several signs and symptoms associated with influenza and other respiratory infections18-23, such as: fever, cough, headache, muscle and joint aches, fatigue, sore throat, runny nose.

The similarity of signs and symptoms between some respiratory diseases often present similarities, such as COVID-19, Influenza (Flu) and Common Cold.

Signs and Symptoms COVID-19 Influenza (Flu) Commom Cold
Fever Common Common Rare
Aches Common Common Sometimes
Chills Common Common Rare
Fatigue Common Common Sometimes
Sneezing - Sometimes Common
Cough Common Common -
Stuffy Nose Rare Sometimes -
Store Throat Sometimes Sometimes Rare
Headache Sometimes Common
Shortness of Breath Common Rare -
Diarrhea/Vomiting Sometimes Common -
Loss of taste/smell Common Rare Rare

Sources: ECDC21 & WHO23.

Influenza (Flu) is not an aggravated form of the common cold.

Although influenza is registered to cause mild to severe illness, it may also lead to death18, with high-risk groups being more vulnerable to aggravated forms of illness (e.g., elderly, pregnant women, young children, individuals with chronic and immunosuppressive health conditions.

Evolution of the
influenza vaccination

1940

The genesis of influenza vaccination
dates do the begining of the
1940´s 24-27, soon after the virus was
isolated, with the development of
a monovalent inactivated vaccine
for an influenza A subtype, with significant
contributions from Jonas Salk and Thomas Francis.

The lower effectiveness of the vaccin
 in the following years lead to the discovery of changes in the proteins of influenza´s surfacer, along with the identification of influenza B.

1942

In the face of the
new facts, a new
bivalent vaccine for
influenza A and B
strains was produced
in 1942 25-27.

2012

It took over 30 years for
the trivalent vaccine to
be developed, including
two influenza A and
one influenza B strains.

The quadrivalent vaccine was introduced in 2012 25,
adding on influenza B antigen to its predecessor.

Influenza
burden of disease

seasonal influenza

The WHO estimates that seasonal influenza is responsible for around
one billion infection cases worldwide,
from which is 3-5 million severe cases and
between 290-650 thousand respiratory death each year28-29.

Influenza is also identified
in the literature

to aggravate underlying health conditions and exert consequences in different
health domains 28 such as cardiovascular, neurological, renal, respiratory and diabetic complications.

24,3 quality-adjusted life years

It is estimated 28 that influenza losses of around
24,3 quality-adjusted life years
and 2.9 million absences

(average of 3.6 days at work and 2.4 days at school)
per influenza season.

economy burden

The economic burden of influenza in Europe is estimated between
6-14 billion euros per year.

Influenza prevention
through vaccination

The effectiveness of influenza vaccination is estimated between 40-60% to reduce the risk of developing flu illness in the general population30-32. However, it must be noted that these values are influenced by patient characteristics (e.g., age, health conditions, etc.), matching between circulating influenza viruses and administered seasonal influenza vaccination, among other aspects.

Demystification of resistances to influenza vaccination

Influenza vaccination
as the best prevention tool
for the disease

Vaccines were one of the great contributions to human health in controlling diseases, some that were managed to be eradicated. Currently, there are over 20 vaccine preventable diseases36-37, some of which being: smallpox, diphtheria, measles, mumps, rabies, tetanus, pertussis, yellow fever, meningococcal disease, human papillomavirus, polio, among others.

Vaccines work at two levels, reducing the likelihood of contracting the disease, and if one contracts the disease, offering higher protection against severe forms of the disease than without vaccination38. However, vaccination is not a guarantee of 100% protection since its effectiveness depends on different factors (e.g., age and health conditions).

Vaccines should not be seen as a panacea for all disease-related problems38-39 but always used in articulation with a set of preventive mechanisms, such as:

NPM

NPM

Personal hygiene, surface cleaning, use of masks in respiratory infections, reduction in the presence of environmental disease vectors (e.g., infections transmitted by mosquitoes), among others.

Education

Education

for health literacy.

Development

Development

of a cultural notion on health risk.

Development

Among others