Copenhagen, 9 October 2023
As autumn turns to winter, the WHO Regional Office for Europe, the European Commission, and the European Centre for Disease Prevention and Control are issuing a clear, urgent message: people who remain unprotected against both COVID-19 and seasonal influenza – especially those most vulnerable and at risk – should take up any offer for vaccination to prevent or mitigate the impact of these co-circulating respiratory infections.
Last year’s autumn and winter seasons were unpredictable. Last winter, the cumulative impacts of influenza, COVID-19 and respiratory syncytial virus (RSV) hit the very young and the very old the hardest. Paediatric and intensive care wards felt the strain, and excess mortality was observed. While things may seem quiet now, this autumn we must work together to prevent excess mortality by protecting those most at risk in our communities: people with comorbidities, people who are immunocompromised, older people and pregnant women.
Vulnerable groups are the focus
As part of its autumn and winter immunization campaign against respiratory infections, WHO/Europe recommends that countries make both COVID-19 and influenza vaccination easily accessible to population groups that are at higher risk of severe disease.
Over 90% of reported deaths from COVID-19 are in people aged 65 years or above. Yet data received by WHO/Europe from its 53 Member States show that less than two thirds (63%) of this group have received a first COVID-19 booster vaccine dose and, worryingly, only 29% have received their second. But beyond the total number of COVID-19 vaccine doses people have had, the focus now needs to be on when vulnerable people and groups received their last dose – information that will help countries to better measure and track vaccine coverage and effectiveness. WHO recommends that priority groups, including older people, people who are immunocompromised and pregnant women, should be offered an additional dose 6–12 months after their last, depending on their level of risk.
“COVID-19 and influenza remain serious diseases, particularly for the most vulnerable, including those who haven’t completed their vaccination courses,” said Dr Hans Henri P Kluge, WHO Regional Director for Europe. “I have 3 main points to make. First, we have effective WHO-listed and nationally authorized vaccines and, for those infected with COVID-19, effective treatment to manage symptoms. Countries shouldn’t delay providing COVID-19 booster doses in anticipation of having access to new or updated vaccines, which could take some time to become widely available. Second, surveillance for COVID-19, including wastewater surveillance for SARS-CoV-2, remains key; if we can’t track the virus, we’re basically operating in the dark. And finally, we also need to focus on indoor air quality and ventilation as we head into the colder months. Effective measures in this regard can go a long way in preventing infection and saving lives.”
The call to get vaccinated also applies to health-care professionals, who are more exposed to the risk of infection and who need to protect their patients. Health workers should complete their primary COVID-19 vaccination series if they have not already done so, and if eligible, receive an additional dose before the winter.
“Vaccination remains our strongest tool against both influenza and COVID-19. It is crucial that targeted vaccination campaigns are rolled out to reach people at risk ahead of the winter season, including with the option to combine vaccination with COVID-19 boosters,” explained Stella Kyriakides, European Commissioner for Health and Food Safety.
“In the past years, we have seen how important it is to ensure easy access to vaccination services, engage communities and to keep citizens updated through clear communication campaigns. Now is again the time of year to join forces to promote the benefits of vaccination and protect the most vulnerable as well as our health systems. Clinicians should also be encouraged to consider early use of available antiviral treatments for COVID-19, RSV and influenza to prevent severe disease. The Commission, following the recommendation of the European Medicines Agency, has recently authorized 2 adapted COVID-19 vaccines, as well as 2 new vaccines and a medicine to protect the very young and the elderly against RSV.”
There are simple steps we can all take to keep ourselves and others safe from respiratory infections this autumn and winter, such as ensuring good respiratory hygiene by wearing a mask if unwell, coughing into our elbows or a tissue, staying at home if sick, and maintaining proper ventilation in closed spaces. Alongside vaccination, these steps can help to keep infections down and reduce the burden on the health system this autumn and winter.
Strengthened surveillance and reporting go hand in hand with vaccination
Protecting populations also requires a good understanding of which viruses are circulating and where. As the European Region moves out of the acute phase of the pandemic, surveillance has been significantly reduced. WHO/Europe and partners are urging countries in Europe and central Asia to strengthen winter respiratory virus surveillance systems, not scale them down, across the community, primary health-care and hospital levels.
“Surveillance and reporting play a crucial role in our ongoing battle against COVID-19, particularly during the winter season, when other respiratory viruses circulate at the same time. Having fit-for-purpose and well-performing surveillance systems in all countries in Europe is essential, as it ensures a robust data set that is vital for us to enhance our effectiveness in planning and implementing public health campaigns and measures,” emphasized Dr Andrea Ammon, Director of the European Centre for Disease Prevention and Control.
While the numbers of COVID-19 deaths and people admitted to intensive care units have fallen considerably since the height of the pandemic, hospital admissions are beginning to creep up again in some European Region Member States, particularly where vaccine uptake remains low.
Cases among people at higher risk of severe disease need to be detected early and provided with treatment if available. Clinicians should also be given the tools to consider early use of available antiviral treatments for COVID-19, RSV, and influenza to prevent progression to severe disease. Hospitals should be planning how they will cope and maintain services when faced with a surge.
In the coming months, the risk of COVID-19, influenza and other respiratory infections will increase in the European Region. Already strained health services and an exhausted health workforce will come under increased pressure. Protecting the most vulnerable in society, while also protecting health systems from being overburdened, is the wisest approach.