As Taiwan works to ensure lifelong immunization, the critical need for adult vaccinations is becoming increasingly evident.
At age 13, I was one of the first groups of girls in my country to be vaccinated against the Human Papillomavirus (HPV).
Most HPV strains are harmless, but some genotypes can cause genital warts or several types of cancer. According to the World Health Organization (WHO), more than 95% of cervical cancer cases are caused by HPV. Knowing this, I was excited to be offered the chance of getting a “cancer vaccine” – a brand-new concept at the time – and felt protected after receiving my third and final shot.
I didn’t think about HPV much after that until a pap smear appointment last year, when my gynecologist asked me whether I wanted to receive another round of shots.
“Isn’t that just for teenagers?” I asked. She informed me that yes, around 15 years ago only children and young adults were recommended to vaccinate against the virus. The HPV vaccine I received back then protected against four strands and was only guaranteed to last for about a decade.
New vaccines, on the other hand, protect against up to nine strands and can be taken by anyone from adolescence to the age of 45.
In short, I needed a new round of shots. Since the HPV vaccine is covered by Taiwan’s National Health Insurance (NHI) only for junior high school students, adults must pay out of pocket. This financial barrier is a major reason why vaccination rates are lower among adults. But while the NT$18,000 fee for three HPV shots is substantial, it pales in comparison to the potential cost of treating cancer.
It turns out I’m not the only one needing a reminder about the importance of vaccination. Many adults, like a friend of mine who missed his shingles vaccine or my husband who delayed his flu shot and ended up bedridden for a week, find themselves playing catch-up with recommended immunizations.
In Taiwan, most adult vaccinations, including those for the flu, shingles, pertussis, HPV, and hepatitis A and B, are not government-funded and thus require self-payment. This gap in coverage contributes to lower vaccination rates and creates the need for enhanced public health campaigns.
Because self-paid vaccinations are not registered in the National Immunization Information System (NIIS), Taiwan’s vaccination rate for these conditions is not readily known. The voluntary nature of adult vaccines also means that funding for promotion and education is lacking.
“Millions of adults face risk from preventable infectious diseases and related complications,” says a spokesperson for British multinational pharmaceutical GSK. “Meanwhile, severe respiratory disease seasons may bring extra burdens to our health system. These situations can lead to increased hospitalizations and further medical issues. But it doesn’t have to be this way.”
An overlooked demographic
In emailed notes to Taiwan Business TOPICS, Taiwan’s Centers for Disease Control (CDC) lists several factors for vaccine hesitancy among adults, including concerns about safety and efficacy, fear of side effects, perceived low infection risk, and distrust toward vaccine protection.
“Continuous efforts are needed to promote accurate information about vaccine effectiveness and safety through various resources,” the CDC notes. “Misinformation and rumors should be promptly clarified to avoid hindering vaccination policies.”
The agency adds that before vaccination, individuals may wish to consult healthcare professionals to understand the safety, efficacy, benefits, and potential side effects of vaccines. They can also attend community health lectures to hear expert explanations and others’ vaccination experiences.
“Adult immunization and adult vaccination should be considered as a routine health intervention in the same way child vaccinations are, especially considering the fact that Taiwan is becoming super-aged by 2025,” says the GSK spokesperson.
With Taiwan on the brink of becoming a super-aged society, in which more than 20% of the population is aged 65 or above, adult immunization becomes even more critical. High vaccination rates among adults not only protect individuals but also contribute to herd immunity, safeguarding vulnerable populations.
Reasonably, the limited budget for vaccine promotion is focused on the most vulnerable groups. Still, there are low-cost measures that could encourage immunization. In AmCham Taiwan’s 2024 White Paper, the Chamber’s Public Health Committee emphasized the need to learn from the best practices of the CDC’s effective Covid-19 vaccination communication efforts to promote influenza and pneumococcal immunization.
Initiatives during the pandemic included providing detailed information about each vaccine and the manufacturers involved – an approach that fosters shared decision-making between patients and physicians.
Currently, the industry at large is also recommending that the CDC establish a dedicated webpage for vaccine information, providing easy access to accurate and up-to-date reference about vaccines. In addition, the value of adult vaccination is enhanced through partnerships across sectors with strong government support. International best practices demonstrate the importance of governments endorsing adult immunization, effectively communicating vaccine-related information with the public, and proactively addressing misinformation.
GSK reiterates this view, noting that the company wants to “work with patients, policymakers, and our peers to stop disease in its tracks, creating the right conditions to champion prevention and enable timely, proactive access to preventative interventions.”
Meanwhile, efforts to increase the convenience of vaccination could also increase adult immunization rates. Innovative approaches, such as combination vaccines for adults, are currently in late trial stages. One of the companies leading this effort is Moderna, which specializes in mRNA technology.
“For pediatric vaccination, it’s very common to administer combination vaccines,” says Joyce Lee, general manager for Taiwan and Hong Kong at Moderna. “Now we’re looking to do the same for adult vaccination. We’ve started to combine different respiratory vaccines together. For flu plus Covid, we’re in phase 3 clinical trials, and it’s looking promising.”
The demand issue
While these efforts have yet to be implemented, pharmaceutical companies like Sanofi, a French multinational, are investing in their own educational initiatives to increase vaccination awareness.
“For the flu vaccine, we run a year-round program – it’s not only limited to the flu season,” notes Shelley Chan, general manager of Sanofi Hong Kong & Taiwan Vaccines. “We work with promotional materials and through traditional and social media to educate the public.”
Part of Sanofi’s efforts includes working with healthcare providers to embed flu vaccination information into health checks for conditions such as hypertension and diabetes, Chan says. “We want to ensure that we help provide protection beyond flu.”
People with pre-existing conditions such as diabetes and asthma are at higher risk of developing flu-related complications. According to the U.S. CDC, influenza vaccination is also associated with reduced rates of certain cardiac events among individuals with heart disease, particularly those who have experienced a cardiac event within the past year.
In addition to public efforts, employers can play a crucial role in ensuring that their employees are protected from preventable diseases. Quite naturally, pharmaceutical companies are leading by example in this area. MSD offers free HPV and pneumococcal vaccinations to its employees, while Sanofi Taiwan’s internal flu shot program boasts a 65% vaccination rate.
For its part, GSK has set up a Partnership for Prevention (P4P) program, which provides a comprehensive range of free vaccines for employees and their families, highlighting the importance of corporate responsibility in public health.
“The biggest challenge is the difficulty in gauging and predicting the willingness to vaccinate among different age groups,” the CDC told TOPICS in emailed notes. “Additionally, the high cost of certain vaccines may exceed some individuals’ financial capacity, leading to health inequality.”
Vaccines differ from medicines in several significant ways. Besides the challenge of predicting demand, vaccines produced for seasonal viruses place companies in a continuous race against time. “The flu season only lasts three to four months,” says Sanofi’s Chan. “After we gather the WHO’s recommendations, we have very limited time for manufacturing.”
And companies are not the only ones in competition. Governments are also vying for priority delivery of this life-saving product with limited manufacturing capacity. When companies negotiate with governments, they review delivery commitments for the next three years to ensure a reliable supply. Countries with high demand will be prioritized if other market conditions, including a policy environment that offers predictability and ease of doing business, are favorable.
It is therefore imperative for governments to strike the right balance between promoting domestic industry and providing optimal public health protection for its citizens.
“Many markets, including Taiwan, aim to support local manufacturers,” says Chan. For instance, the government may help local companies by creating favorable criteria such as incentives for suppliers with local production. While she says this approach is understandable, “we have to find a way to balance supporting local manufacturers with enabling foreign multinational companies to ensure supply during times of urgent need.”
