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55 years of the national immunization program – revisiting its birth, success, evolution and challenges | Opinion

On October 4, 1965, the 1st National Vaccination Program (PNV) started with the objective of reducing infant mortality in Portugal, which is extremely high compared to other European countries and is mainly due to infectious diseases, namely those preventable by vaccines then available.

The PNV has helped reduce the infant mortality rate, currently one of the lowest in the EU, due to the characteristics of the program, its governance model and its ability to achieve its objectives.

PNV is a universal, wide-reaching and fair program, completely free to the user. It includes vaccines considered as 1st line, which translate into the greatest health gains. Another characteristic of the PNV is proximity, the vaccination network being essentially based on primary health care.

The PNV governance model defines management at the central level, under the coordination of the DGS, but with decentralized competences at the regional and local level, which guarantees the unity of the Program, namely the same vaccines throughout the country and same price.

The PNV is dynamic, with the gradual introduction of more vaccines and the updating of vaccination schedules according to epidemiological factors, technological developments (with the availability of more and more vaccines and their combinations) or new scientific evidence. The 1st PNV included vaccines against 6 diseases; PNV 2020 protects against 13 diseases, with vaccines recommended for certain risk groups.

The PNV is a program subject to national and international evaluation (ECDC and WHO). Among others, the following indicators stand out:

1. Annual immunization coverage has always shown values ​​that help control target diseases and ensure group immunity, although vaccines are currently recommended and not mandatory.

As an example: the vaccine coverage against the human papillomavirus (HPV) in girls is among the highest in the world and in Europe, and the fight against cervical carcinoma in Portugal is expected in the more or less future. close. .

2. The impact on the target diseases demonstrates the health gains resulting from the NIP. For example: we have consolidated the eradication of smallpox; we have eliminated polio, measles, rubella and neonatal tetanus; we controlled tetanus, invasive meningococcal C disease, invasive Haemophilus influenza b disease, epidemic parotitis and pertussis.

The measles case illustrates the success of PNV. Measles persists in Europe because vaccination coverage is insufficient, does not generate group immunity or does not prevent epidemics. Major European outbreaks have occurred in countries where the goal of 95% vaccination coverage was not reached for the first and much less for the second dose, as is the case in France or Italy.

Portugal is considered by the WHO as a country where measles has been eliminated since 2012, and is an example at European level: vaccination coverage is very high for the two recommended doses and serological surveys demonstrate the immunity of the disease. population. However, there is a risk of importing cases and epidemics, so it is very important to keep the vaccination coverage rates for the 1st and 2nd doses very high (≥95%).

3. National serological surveys carried out to date confirm that the population has a high level of protection against most of the diseases preventable by the vaccines included in the PNV.

Regarding the future of the PNV, the challenges are at 4 levels: vaccines, vaccination, acceptance, but also the challenges generated by the SARS-CoV-2 pandemic

1. Vaccines are a limited asset. We can only vaccinate if we have vaccines and their continued supply is guaranteed. The need for and the acquisition of vaccines around the world is growing, so it is desirable to align with global goals, including WHO guidelines.

2. In terms of immunization, the PNV is the oldest and most cost-effective program of all the national programs, solidly implemented in the field, based on the continuous commitment of professionals and the confidence of the population. However, it is increasingly complex, due to scientific and technological development, changes in the epidemiological pattern of diseases and external social and political pressures. It is necessary to ensure that the technical proposal is based primarily on scientific, epidemiological and cost-benefit assumptions.

It is necessary to ensure the proper functioning of the PNV within the framework of the reforms of the health sector. Professionals are the ambassadors of vaccination, even if they are more and more those who, because of their age and the success of the PNV, have never lived the tragedy of preventable diseases by vaccination.

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3. Regarding acceptance, there is currently a crisis of confidence in vaccines. The reduction and control of vaccine-preventable diseases has led to a reversal of risk perception, with people fearful of vaccines more than the diseases they prevent. It is important to assess social dynamics for an adequate and timely response to the reluctance to vaccinate. In the report on confidence in vaccination, prepared by the European Commission in 2018, Portugal was found to be the country that trusts the most in vaccination. However, high immunization coverage is not a direct indicator of confidence in immunization, as even parents who immunize have doubts and fears.

4. With regard to the pandemic, it is essential to guarantee the sustainability of the PNV in this period of crisis; outbreaks of diseases for which vaccines exist can be catastrophic for communities already facing the impacts of COVID-19.

And finally, a thank you to all those who, over the years, have been able to maintain and improve the PNV! And to future generations responsible for the future of the PNV, believe that the most important thing is “Vaccinate, vaccinate, vaccinate”, as Professor Arnaldo Sampaio, the great leader of the 1st PNV, said!

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