The innovation fund creates vaccination knowledge

While the first two events of the MVF specialist congress series “Vaccination Status” in 2021 and 2022 focused more on the medical perspective, this year the thematic cycle was expanded to include that of the scientific community and pharmacists. The first experiences from two innovation fund projects on the subject of vaccination were highlighted and a project was presented that was carried out in cooperation between a private health insurance company and a pharmacists' association.

>> “According to the RKI vaccination surveillance, a vaccination rate of 47% was achieved nationwide for influenza in people aged 60 and over. Is that good or bad?” MVF editor Prof. Dr. opened with this question. Reinhold Roski hosted the 3rd MVF specialist congress from the “Vaccination Status” series, this time with the subtitle “Vaccination in times of pandemic and endemic”. His rhetorical answer: “We are 28 percentage points below the target in Germany.” His demand: “Vaccination rates must be increased until the respective goals for the respective diseases are achieved. Our health system cannot remain passive here. Missed or postponed routine vaccinations and booster doses must be made up for.”
Special attention must be paid to the vulnerable target groups that the established vaccination procedure among general practitioners and youth doctors simply does not reach.
Drugs: social situation as a vaccination factor
Gregor Drogies from DAK Gesundheit, Hamburg, responded to Roski's introduction with two counter questions: “How have the vaccinations of children and young people developed during the pandemic?” And: “What influence does the socio-economic situation of the parental home have on vaccination behavior during the pandemic?" He gave the answers with a deep look into the DAK's current DAK children and youth report, which uses the fund's own routine data to record 3.3 million doctor's visits per year from 782,000 DAK-insured children and young people between the ages of 0 and 17 was able to analyze 2021. Here Drogies pointed out two system
peculiarities of cash register data. Firstly, this data could only ever offer retrospective analysis options, and secondly, it could only provide information about vaccination quantities that would result from the vaccination rates billed to the respective statutory health insurance company - but this would then be very precise and with the possibility of establishing links, for example between a performance
usage and other anonymized, personal characteristics. Based on the figures available to him, it can be seen that there was no lasting change in general vaccination uptake during the corona pandemic - with the exception of the lockdown phases.
This is because, through the U-screening series, there is a closely monitored and fundamentally anchored process for children and young people when it comes to vaccination and its control as well as the approach during contact with a doctor, which is stable even during crises. According to Drogies, a similar picture emerges with the initial pneumococcal vaccination, where, given the available
According to the available data, there were “no real differences between boys and girls” and a constant pneumococcal vaccination rate was recorded during the pandemic.
Things are a little different with initial HPV vaccinations, which are a voluntary vaccination and therefore not firmly anchored in the U-screening series. Based on the data room, it can be seen that when reimbursement for the HPV vaccination for boys began in January 2019, the boys caught up with the vaccination rates for girls fairly quickly. However, there was a major slump during the first and a smaller one during the second pandemic period, and there was another significant decline in initial HPV vaccinations from the third quarter of 2021. In addition - and Drogies emphasized this - the decline in HPV vaccinations was greater among boys than among girls, which means nothing other than that “the perpetrators are no longer reached as well as we should be”. That's exactly why his health insurance company deals with such information very aggressively and has also brought this data into a working group.
Here too, Drogies pointed out a difference between checkout and RKI data rooms. In its evaluation system, the Robert Koch Institute only considers an HPV vaccination to be complete when the second vaccination takes place and actual vaccination coverage has been achieved. Drogies: “If we see a drop in voluntary first vaccinations in our data, that is a very central and important point.” Because the health insurance data shows the first vaccinations administered, “we notice very early on that something is going on changed in order to be able to react.”
Because we won't see whether the vaccination series has really been completed until the end of next year or even later after the first vaccination. The vaccination dent detected by the DAK should basically appear in the RKI evaluations at some point. In addition, it is unclear whether catch-up effects would be evident, particularly in 2022; This remains to be seen due to the delayed availability of data.
According to Drogies, it is also important to analyze the social situation of the parental home in such evaluations. However, since health insurance data would not have these parameters, the German Index of Socioeconomic Deprivation (GISD) was used to describe the social situation of the parental home. When both data streams are matched, it becomes clear that “things happened during the Corona period that caused the social situation to increase as a factor.” The example of obesity makes it particularly clear that the social situation during the pandemic has become a significant factor for boys aged 15 to 17 in determining an incident obesity diagnosis.
A decline in initial HPV vaccinations could also be observed, regardless of the social situation of the parents' home. This, according to Drogies, with an astonishing additional finding: Contrary to the assumption that children in higher social classes would consistently have a better vaccination rate, this was not the case - these were those in the middle social classes. It is also surprising that boys from lower social classes were even vaccinated more often than those from higher ones. Drogies: “Unfortunately we don’t really have a clear explanation for this, we’re still looking for an explanation.”
Schneider: Vaccinations in GKV
Routine data difficult to represent
Dr. also looked at possible explanatory patterns. Udo Schneider from TK. The innovation fund project VIPER, in which the technicians act as a consortium partner, deals - hence the acronym - with a comparison of vaccination strategies to prevent illness caused by respiratory syncytial viruses (RSV) and their effects on the burden of disease and costs. In addition to the TK, participants in this project, which started in March 2019, are the RKI as consortium leader and the London School of Hygiene and Tropical Medicine, an institute with - according to Schneider - very extensive experience in modeling vaccination strategies. The results report has been being prepared since the funding ended in February 2023 and will be handed over to the G-BA in August.
What is special about this project is the fact that there is currently no vaccination for RSV; This was the case at the time the project started and is still the case today, although this could soon change due to a current EMA recommendation. “With this project, we wanted to show that it is possible to model vaccination strategies on the basis of GKV routine data,” explained Schneider. This is linked to the hope of being able to contribute to a vaccination decision. To this end, the epidemiological and health economic effects of various strategies against the virus should be examined and the most effective and favorable strategy should be proposed.
A major challenge in this project has already been
being, from the insured collective to one
an RSV-specific
group, on the other hand a subpopulation that is likely to be infected with RSV
to describe the function. We
"We already knew at the beginning of the project that there was a large number of unreported cases because many of these infections were not correctly coded as such," said Schneider and immediately provided the answer: "Because they are hidden under a whole range of possible respiratory diseases." It became clear that the ratio of insured people with a specific diagnosis to insured people with a probable diagnosis is quite different, so for every insured person with a specific diagnosis there would be around 100 with a probable or potentially possible diagnosis.
According to Schneider, a first general finding of this project is that vaccinations are difficult to fully cover in GKV routine data.
are formed. In children and young people
As Drogies has already shown, this is still quite possible because there are much stricter vaccination schemes. However, the health services research carried out by the Techniker Krankenkasse has learned that the vaccination process in the adult population is difficult or almost impossible to map comprehensively.
This is due, among other things, to the fact that there are relatively long gaps between the basic immunization and the booster, which often go far beyond the health insurance-specific data storage, which is heavily regulated by data protection. However, the health insurance data are quite suitable for generating questions for possible vaccination recommendations, especially if there is no vaccination yet. In the expert's opinion, what is particularly crucial here is the answer to the question of which subpopulation could benefit greatly from a vaccination that has yet to be developed.
Grüter: sufficient vaccination protection for MAC patients?

VACcination of MS/Arthritis/Colitis patients, or VAC-MAC for short, is the name of an innovation fund project to increase the vaccination rate in patients with autoimmune diseases by developing recommendations for action based on evaluations of primary and secondary data from BARMER.
Similar to VIPER, attempts have been made here for around a year under the direction of Prof. Kerstin Hellwig (Catholic Hospital Bochum - Ruhr University Bochum) to find out why vaccinations are particularly important for the approximately five million patients with immune-mediated diseases in German-speaking countries are. The reason for this was explained by project employee Dr. Thomas Grüter, who is responsible for medical project management, told the online audience of the vaccination congress “Vaccination Status 2023” with reference to the vulnerability of MAC patients. For example, patients with rheumatoid arthritis (RA) have the highest prevalence, although RA can in turn increase both the incidence of influenza and its complication rate - such as strokes and heart attacks. According to Grüter, the following applies: “The underlying disease and the therapy we use lead to a risk of infections and also severe cases.” Since it is known that infectious diseases can increase the risk of disease progression, these people have sufficient vaccination protection particularly important. It is therefore necessary to consider special vaccination strategies for these patient groups, such as additional vaccinations, sequential vaccination, additional controls or different age limits (example: herpes zoster).
In all of this, it remains unclear whether there is sufficient vaccination protection in these patient groups because the study situation on vaccination rates among MAC patients is still very limited, and according to Grüter, influencing and promoting factors as well as potential barriers are not yet known. This is exactly what the VAC-MAC project, which runs until March 31, 2025, aims to change. Grüter: “We want to analyze the uptake of vaccinations, their effectiveness and the occurrence of vaccination reactions after vaccination.”
The project scope is supplemented by a health economic evaluation of avoidable follow-up costs. For this purpose, an analysis of GKV routine data will be carried out with a comparison of the uptake of vaccinations between MAC and non-MAC patients, including the
• Investigation of vaccination effectiveness with regard to vaccine-preventable infections
• Examination of vaccination reactions within the first 6 weeks after vaccination.
Arnold: Pharmacists definitely want to vaccinate more
Mathias Arnold, Vice President of the Federal Association of German Pharmacists Associations, brought a completely different perspective. V.,
a. He spoke about the status and experiences of vaccination in pharmacies from the perspective of his association, which represents all 17 state pharmacists' associations and all 17 state pharmacists' associations. According to Arnold, vaccination in the pharmacy is a global goal and has long been a global reality. Germany is actually a bit behind and one of the positive effects of Corona is that
now also vaccinating pharmacists in this country
should. And this has even been part of the standard supply since the Gas Price Brake Act came into force on April 8, 2023. However, this is something that has been going on since
In 2016, it was possible in at least 20 countries around the world, with a further 36 countries having been added since 2020 because, during the peak phase of the coronavirus, many countries were looking for additional opportunities where vaccinations could be offered; here, pharmacies were welcome partners for many health systems. There is also a wide range of vaccines that can be administered in pharmacies worldwide, from hepatitis A and B to diphtheria, measles, mumps, pertussis, pneumococci, rubella and influenza; Only the latter vaccine (in addition to Corona) is also administered in German pharmacies.
This is also necessary, said Arnold. Although, according to the European Union, 75% of older people should be vaccinated, in Germany it would only be 47% aged 60 and over. However, there are high regional differences, from 44% in western federal states to 62% in eastern federal states.
According to ABDA figures presented by Arnold, there are currently around 13,200 vaccination-trained pharmacists and around 1,174 pharmacies that offer flu vaccinations and 1,572 pharmacies that offer Covid-19 vaccinations and meet the necessary requirements, including the necessary training. The patients' experiences, as the flu vaccination model project has shown, are positive:
• Easy access to the pharmacy
• convenient opening hours
• no waiting times
• Trust in the competence of the pharmacist
• very high satisfaction with information and vaccinations in pharmacies
In the current 2022/2023 season alone, Arnold continued, 58,000 flu vaccinations were carried out in pharmacies. It should be noted that for 20% this vaccination was the first flu vaccination ever, 13% did not take up a vaccination without an offer in the pharmacy and over 90% the willingness to have another flu vaccination in the pharmacy as well as over 90% the willingness to receive other vaccinations the pharmacy. No wonder, said Arnold, because: "A pharmacy is basically one meter from the curb, doesn't actually have a waiting room and waiting times are hardly to be expected."
“Is this a substitution of a medical service or a supplement?” Arnold answered this rhetorical question by looking at the survey values mentioned, which clearly show that vaccinations in pharmacies are in many cases obviously a supplement and not a substitution
be. Arnold: “If this was the first flu vaccination ever for 20% of these people who were vaccinated in pharmacies, they probably had no contact with a family doctor in that sense and also no doctor’s office that they would regularly visit for vaccination.” And if 13% of those surveyed would say that they would not have gotten a vaccination without the pharmacy's offer because they were simply not prepared to go to a doctor's office or make an appointment for it or whatever the inhibition threshold was, it should be clear that this vaccination offer from be welcomed by a certain clientele. Some of these are particularly vulnerable groups who are certainly not part of the classic clientele who stop by the doctor's office every four weeks. But that also means that a vaccination campaign in pharmacies is definitely able to reach certain vulnerable population groups, which in turn is certainly very desirable from a health policy perspective.
According to Arnold, a quick online survey conducted by the ABDA in February/March of this year looked at the outlook for the coming flu season. 2,736 participants, including 1,994 pharmacy managers, from all over Germany took part and were asked about their status and planning status for Covid and flu vaccinations. Accordingly, both a Covid and a flu vaccination have already been and are being offered at 27% and 28%. And another 7% (Covid) and 13% (Influenza) are planning to do so.
According to the survey, reasons for vaccinations in pharmacies are:
• Easier access to vaccinations from a patient perspective (e.g. opening times): 76%
• active prevention contribution: 61%
• Sharpening the healthcare professional profile of the pharmacists: 55%
• Meeting consumer expectations: 35%
• Additional revenue for pharmacies: 26%

The survey also asked for reasons against vaccinations in pharmacies. Those were:
• additional personnel costs in the pharmacy: 71%
• additional space requirements in the pharmacy: 69%
• The relationship with neighboring doctors could suffer: 62%
• Vaccinations are a medical task, not a pharmacist's: 28%

What is also important is how the medical profession in the neighborhood views the vaccination in pharmacies; this was also collected from 1,142 pharmacy employees, explained Arnold. 22% stated that doctors in the neighborhood reacted mostly in agreement and positive, 14% reacted neutrally and another 29% mixed - some welcomed it, others rejected it. But only 18% were predominantly negative and another 17% had no reaction at all
been perceived. Therefore, it is certainly no surprise that pharmacists surveyed want to vaccinate more than just influenza. 32% was correct for vaccinations for selected indications and 19% even for vaccinations for all possible indications. 15%, on the other hand, do not consider any other vaccinations in pharmacies apart from influenza and Covid-19 to be useful, while 29% do not consider vaccinations in pharmacies to be useful at all. According to Arnold, the last value corresponds approximately to the percentage (28%) that sees vaccinations as a medical task and not a pharmacist's task.
Tscholl: from the vaccine contingent to the vaccination campaign
Someone who really enjoys vaccinating and would like to vaccinate even more is Martin Beutling, owner of the Glocken-Apotheke in Ober-
hausen. Together with the Linda umbrella brand association of stationary owner-operated
led pharmacies, which now includes around 600 pharmacies, a project in 2021
carried out to specifically provide privately insured people with access to vaccination.
should be simpler, as vaccination is a little more complicated for this clientele than for those with statutory health insurance.
The goal, according to Linda Head of Marketing & Communications, was
Vanessa Tscholl, the Quo
to increase the number of privately insured people in the area of flu vaccination.
For this purpose, customer
The letter from the insurer, Axa, specifically informs its insured persons. Customers then had the opportunity to order a flu vaccination or reserve a vaccination appointment either directly via the Linda app or via Linda pharmacies near their home. However, there was also the option of simply calling or stopping by and filling in the prescription at the pharmacy.
or to take the vaccine with you to the respective family doctor's practice or have it delivered. To this end, a cooperation partner from the pharmaceutical industry ensured in advance that an appropriate vaccine contingent was available in order to ensure that the pharmacies had enough vaccine available.
In addition, Linda put together a communication package. This ranged from an information presentation, internal mailings and newsletters to order forms and a podcast that explained exactly how customers can be activated and what exactly should be paid attention to. Tscholl: “We provided the pharmacies with appropriate documents to ensure that everything was properly documented according to the pharmacy operating rules and that a flawless process could be guaranteed.”
And with success. Over 3,000 active searches were documented in the Linda pharmacy finder, plus 84% promotional views in the Axa customer portal, which resulted in a total of 4,55% customers using the service. “We were very surprised that it got off to such a good start the first time and then repeated it again in 2022,” explained Tscholl.
Among other things, in Martin Beutling's Oberhausen pharmacy. However, he started getting the flu vaccination in 2020 as part of the model project “Flu vaccination in the pharmacy” between AOK Rheinland and the North Rhine Chamber of Pharmacists.
For this purpose, training was carried out by the AK-Nord-rhein in the summer of the model launch year 2020, so that Beutling was only able to carry out 14 vaccinations in the first flu season - slowed down by Corona; the following year there were already 24 and in 2022 there were already 312. According to Beutling, those wanting to be vaccinated praised both the low-threshold accessibility, especially when it came to the longer opening times compared to the doctor's office and the pharmacy, as well as the quick appointment allocation, with some even having an on-line system. the-go vaccination was possible. This makes sense especially for people who don't actually have a family doctor and therefore "wouldn't even be tempted" to get vaccinated there. Beutling: “I think that vaccinations will continue to take place in pharmacies, simply because the patients were consistently enthusiastic about them.” <<
from:
MVF editor-in-chief Peter Stegmaier