Raising Taiwan’s Adult Immunization Rate

A number of actions could be taken to educate the public on the importance of adult vac-cinations for infectious diseases in Taiwan, including working with doctors on how to talk to patients about the benefits, improving government health resources, incorporating self-paid vaccination data in the NIIS, and loosening the restrictions on the advertisement of vaccine products.

Insufficient coverage is the product of several factors, among which is a lack of public awareness about the value of adult vaccines. However, industry leaders and public health experts say that just a few changes could lead to significant progress.

In Taiwan, vaccinations against pneumonia for adults aged 75 and above are free; the government foots the bill. Nevertheless, only 40% of Taiwan’s adults in that age group took the government up on its offer to get that vaccination. 

The government also covers the cost of influenza vaccinations for adults aged 50 and above. The most recent data, however, shows that only 19.2% of adults aged 50-64, and 52.6% of adults aged 65 and over, had received flu shots.  

Taiwan’s coverage rate for these two adult vaccines is not insignificant, but it is also not very impressive. As a point of reference, in the U.S., influenza coverage rates for the age groups mentioned above were 54% and 75%, respectively. Nearly 70% of Americans over the age of 65 are inoculated against pneumonia. 

Treatments for vaccine-preventable diseases such as pneumonia and influenza are readily available but costly when compared to prevention. Adults who contract these diseases may have to go to the hospital for treatment or take time off work. These measures not only affect patients and their families, but also result in high economic and social costs. The Taiwan Immunization Vision and Strategy (TIVS), an advocacy group formed by medical experts, reported that from 2010 to 2011, the cost of lost productivity from pneumonia and influenza was NT$30 billion (US$1.08 billion), while the procurement cost of influenza vaccines was only NT$120 million (US$4.33 million).  

Taiwan’s demographic trends make the issue of adult vaccination coverage more urgent. By 2026, Taiwan will become a “super-aged society,” meaning that 20% of its population will be 65 or older. The age-related decline in immunity heightens the risk of contracting vaccine-preventable diseases.  

The issue of Taiwan’s under-vaccinated adult population likely applies to infectious diseases other than pneumonia and influenza, such as shingles, pertussis, and hepatitis A and B. Due to a limited government budget, vaccines for these diseases require patients to pay out of pocket. Because the government collects data only for publicly funded vaccinations, coverage among Taiwan’s adults for these diseases is not known. It is reasonable to assume that like the immunization rates for pneumonia and influenza, they are similarly unimpressive.  

Although Taiwan is a global leader when it comes to childhood vaccination coverage, the same cannot be said for the vaccination of adults. Raising Taiwan’s coverage for adult vaccines across the board is a longstanding goal of the public health community.  

Increasing awareness 

Experts believe that a key problem is that there is not enough awareness among the public about the value of adult vaccines. AmCham’s Public Health Committee stated in the 2021 Taiwan White Paper that there is “insufficient public education regarding vaccine characteristics and the diseases they help prevent.” In a 2020 interview with AmCham, GlaxoSmithKline (GSK) Taiwan General Manager Mick Stanley stated: “With adults, there isn’t the same sense of urgency to vaccinate compared to infants, but the reality is that there are 9 million people here above the age of 50.” The issue of public awareness was also raised in a GSK policy position paper on Taiwan’s adult vaccinations this year.  

“Perceived severity is a major problem,” says Yang Chin-hui, director of the Division of Acute Infectious Diseases at the Taiwan Centers for Disease Control (CDC). “In Taiwan, for most adult vaccines, adults do not get vaccinated because they do not view the disease as severe enough, or they don’t think they will be so unfortunate as to get the disease.”  

Yang cites the example of COVID-19 vaccines – due to the perceived threat of the virus, Taiwan has reached over 70% coverage with the first dose. “For other adult vaccinations, like pneumonia or influenza, it’s very hard to get higher than 40-50% for adults because they don’t think that they are personally in danger.” 

However, most say that progress in raising awareness of the importance of vaccination is well within reach. The best way to do so, according to Director Yang, is to communicate with medical professionals about how to educate patients on the benefits. She says that a doctor’s suggestion holds the greatest sway regarding the willingness of adults to get vaccinated for infectious diseases, and she urges doctors and other medical professionals be more active in recommending such vaccinations to their adult patients. The government and industry can also encourage doctors to recommend vaccinations with a variety of incentives, including results and studies on the value of vaccines and financial benefits such as coverage for patient management fees. 

Government online resources are another means by which to educate the public. The government operates several platforms, such as the Ministry of Health and Welfare’s My Health Bank app, the CDC website, and the CDC chatbot Disease Control Butler. But finding information about adult vaccinations on these platforms is not easy. Representatives from the pharmaceutical industry say that a clear adult vaccination schedule, as well as notices to adults about when to get vaccinated, would be helpful. Director Yang agrees that the CDC’s platforms could be livelier and more straightforward.  

The government uses a variety of platforms to communicate health-related information to adults, but Taiwan’s 40% vaccination rate for pneumonia might indicate that such methods could be improved. Photo: Ministry of Health and Welfare

Industry leaders also advocate the creation of a digital vaccine passport. The Public Health Committee argued in this year’s White Paper that such documents would “provide Taiwanese citizens with easy access to their vaccination history and help them comply with government recommendations.” 

In addition, a more accurate understanding of Taiwan’s disease prevention status is needed. Most adult vaccinations are not covered by the government and therefore require self-pay. These vaccinations are for diseases such as shingles, pertussis, and hepatitis A and B. Because self-paid vaccinations are not registered in the National Immunization Information System (NIIS), Taiwan’s coverage rate for these vaccines is not readily known.  

The lack of information, TIVS’ 2020 policy paper notes, makes it difficult for the public to understand the weaknesses in Taiwan’s disease prevention status, and for public health experts to encourage the use of certain vaccines or warn about possible trends or outbreaks. Public health experts express hope that self-paid vaccinations will be registered within the NIIS like publicly funded vaccinations.  

Advertisements for self-paid vaccines may also help. Pharmaceutical companies are wary of such promotion, however, out of a fear of being fined for violating a strict law in Taiwan that limits the advertisement of drugs and vaccines. This year’s Public Health White Paper urged “the government to loosen restrictions on the advertisement of vaccine products.” The committee argued that “if more citizens are willing to pay out-of-pocket to get vaccinated, the corresponding decrease in preventable diseases would relieve some financial pressure on the government.”  

Public education is just one part of the effort to lift the rate of adult vaccinations in Taiwan. Nevertheless, it is one that can help bring rapid change. COVID-19 has shown how quickly public awareness regarding the need for vaccination can rise.  

“After the COVID-19 pandemic, maybe more and more adults will recognize the importance of adult vaccinations,” says the CDC’s Yang. “If public awareness is raised, the government will be willing to budget more for this target. If adults are more willing to receive vaccines, the government will offer more support for adult vaccinations.”