Bridging the final mile: Translating adult immunization knowledge into consistent clinical practice

Sir, We found the article “A study on knowledge, attitude and practices (KAP) towards adult immunizations among health care professionals” by Abdul Rahiman et al. to be very interesting.[1] The authors are to be commended for focusing on adult immunization, which is a relatively neglected but increasingly crucial aspect of preventive healthcare in India. The article points to important deficiencies that have immediate implications for primary healthcare. However, only 35.8% of healthcare personnel had received at least one adult vaccine in the previous 2 years, excluding the COVID-19 vaccine, despite the findings that 95.6% of them had a positive attitude towards recommending adult vaccines.[1] This large gap indicates that the problem is not in recognizing the problem but in implementing the knowledge into practice. Such a large gap between awareness and actual practice among healthcare workers has been observed in professional reviews of guidelines and in the Indian context; thus, confirming that it is a systemic issue and not a behavioral issue.[2,3] Institutional and policy-based interventions that promote adult vaccination as a professional requirement are needed to bridge the knowledge-practice gap. The integration of adult vaccination into the regular occupational health services is one feasible and immediate remedy. Healthcare institutions can provide free or reduced-cost vaccines in-house while requiring proof of adult immunization status during hiring, annual physical exams, and infection control checks. Compared to voluntary and self-driven vaccination, evidence from healthcare institutions has shown that institutionally facilitated efforts are highly effective in enhancing the vaccination rates of healthcare workers.[4] Competency-based training needs to supplant knowledge-based teaching as an important element of educational policy. The medical school curriculum includes adult vaccination, but it gives very little attention to counseling, arranging vaccinations, and adult vaccine hesitancy. Application can be improved by adding case discussions, simulated counseling exercises, and undergraduate and graduate-level testing of competencies in preventive care. It has been shown that continuing medical education courses focusing on communication and barriers to implementation improve clinicians’ confidence and adherence to vaccine recommendations.[5] Other opportunities for closing the practice gap are offered by digital health tools. When linked to the health records of staff members, automated reminder systems for healthcare providers can be used to ensure that vaccinations and boosters are administered on schedule. Healthcare providers can assist patients in obtaining preventive care in an organized fashion by adding adult immunization reminders to electronic prescriptions or appointment reminder systems. In healthcare settings, reminder and recall systems have been shown to significantly improve adult vaccination uptake.[6] At the policy level, the challenge of systematic implementation is still being faced because there is no comprehensive national framework for adult immunization. A functional platform for service delivery could be developed by integrating adult immunization with existing national programs such as Ayushman Bharat’s Health and Wellness Centers. National guidelines for adult immunization with specific criteria for priority groups, sources of funding, and indicators for tracking could help enhance accountability and reduce variability in practice 3. The importance of life-course immunization strategies that extend beyond childhood is again highlighted by the global policy agendas such as the Immunization Agenda 2030.[7] In conclusion, the results of the study conducted by Abdul Rahiman et al. have clearly indicated that despite the existence of positive attitudes towards adult immunization, they are not practiced. To overcome this gap, there is a need to implement immunization policies at the institutional level and through competency-based training and reminder systems. It is important to improve adult immunization practices among healthcare professionals not only for their own health, but also for the health of their patients in India. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.