The importance of vaccination was widely understood and accepted by the Taiwanese public during Covid. In response to the threat of respiratory diseases in the fall and winter, Taiwan’s government in 2023 expanded national immunization programs for elderly people against the threats from seasonal flu, Covid, and invasive pneumococcal diseases. This expanded program reinforces protection for the elderly. To increase public awareness of vaccines and improve vaccination rates, Taiwan Centers for Disease Control also plans to optimize its website content to provide the public with more comprehensive vaccine information. 

“Taiwan’s new immunization  program  provides nine publicly-funded routine pediatric vaccines and 12 publicly-funded adult vaccines against influenza, pneumococcal infections and Covid-19 through our vaccine fund. These vaccines protect people against 16 different diseases,” Taiwan Centers for Disease Control Director General Chuang Jen-Hsiang explains. “The government has also expended the protection for the elderly against pneumococcal disease by lowering the age eligibility for vaccination from 71 to 65 years of age and providing one more brand of vaccine.” 

This adjustment was highly endorsed by Taiwan’s medical community. President of Infection Control Society of Taiwan and Chief of Division of Infectious Diseases at National Taiwan University Hospital Chen Yee-Chun appreciates the change in policy, adding that “Older people often exhibit a reduced response to vaccines, so it’s essential to ensure they receive vaccines that are specifically designed for their age group. In particular, the publicly funded pneumococcal vaccination for those 65 years and above as well as offering a new generation vaccine option at cost are positive steps in addressing the threat of pneumococcal disease among the elderly.” 

According to Ministry of Health and Welfare data, pneumonia was the fourth most common cause of death in 2022, and the third among people over 65. While efforts to vaccinate this group should take priority, other groups of people should also consider increasing the vaccine uptake.  Chen recommends that people with impaired immunity due to medical conditions or those taking immunosuppressive medication should be vaccinated, as well as smokers and those with comorbidities or underlying diseases like diabetes, heart disease and asthma. Similarly, healthcare personnel, caregivers, and individuals who live or work closely with the elderly or immunocompromised individuals should consider vaccination to prevent transmitting pneumococcal infections to those at higher risk.    

Winter is Coming 

To understand why vaccination in the fall and winter is particularly important, it is important to understand the mechanisms of virus transmission. Chen identifies several reasons why respiratory diseases peak during this period. “In colder weather, people spend more time indoors in close proximity to one another, and in spaces which might not be adequately ventilated, which facilitates the spread of respiratory viruses. Because the air is colder and drier, the mucous membranes in the respiratory tract dry out, making it easier for viruses to infect the airways.” 

Chen adds that contracting respiratory diseases, for example, can impact the individual in other ways. “Influenza, Covid-19 and other infections may trigger or exacerbate underlying chronic conditions like heart disease such as congestive heart failure, coronary artery diseases, and increases the risk of strokes.” Individuals with existing respiratory illness may also experience more severe symptoms and are particularly at risk when there is more than one respiratory virus circulating in the community simultaneously.  

Increasing Public Awareness 

Public awareness and education are therefore powerful tools we possess to protect ourselves against respiratory diseases this fall and winter. Chen says that a greater focus on public engagement and empowerment would help stress the importance of life course immunization – getting vaccinations at different stages of life – and strengthen public awareness of the benefits of vaccination. She believes that providing simple materials in a variety of languages has the potential to reach an even wider range of people, and that multimedia (television, social media, the Internet, radio, etc.) should be utilized as it is for common chronic diseases.  

She suggests establishing a one-stop website for vaccine information, including who should get what vaccines, available brands, known side effects and an FAQ section. Information should be transparent, jargon free and reviewed by experts. On the frontlines, healthcare personnel should be informed about regional and national vaccine rollouts and could incorporate that information into regular visits and checkups, where they can also answer questions or manage any misapprehension people may have.  

Chuang says that the Taiwan CDC has made public awareness and information sharing a key part of its national immunization program. At present, their official website not only provides key vaccination information for current vaccination programs in real-time, but it also includes a “Vaccine-Preventable Diseases Control” section including immunization schedules by type and by age for routine pediatric vaccination, and a section where recommended adult vaccinations are listed by age group and status, for example “over 65s” and “immunocompromised individuals.” He says the government values feedback from the public and medical professionals, and says his agency plans to optimize the online vaccination-related information in the future. 

Chen is confident that continuing conversations with the government are bearing fruit. She believes that by implementing these measures, the government can empower the public to make informed decisions about vaccines, foster open communication with medical staff, and ultimately increase vaccination rates while reducing vaccine hesitancy.  

Vaccination as a Cost-effective Measure 

From a healthcare perspective, increasing vaccine uptake among the more vulnerable can offer better protection to society at large, but there is also a financial payoff, particularly important when fiscal resources are already stretched. Chuang says that the direct medical cost caused by pneumonia is estimated at NT$3.4 billion a year. Research has shown that vaccination of those over 65 with the pneumococcal vaccine could save more than NT$1 billion in medical expenses annually.  To provide more comprehensive health protection for citizens, Chuang also promised that the government will continue to strive for more resources to invest in the national vaccine fund, which includes adjusting the ratio of tobacco surcharge to vaccine funds. In this way, it could ensure long-term and stable financial resources and introduce more novel vaccines in timely fashion. 

Vaccination is a critical tool in preventing the spread of respiratory diseases, particularly during the fall and winter seasons, and it is of utmost importance for the elderly and others with weakened immune systems. Chen adds that scientific data and clinical evidence continue to support the effectiveness of vaccination in safeguarding the health of vulnerable populations. It falls on all of us to ensure that vaccinations become a routine part of our lives.