Abstract
Introduction: In January 2023, Flanders crisis management approach for COVID-19 vaccination transitioned to regular operation, being fully integrated into primary healthcare. General practitioners, pharmacists, nurses, occupational health physicians and residential care centers became responsible for administering vaccinations.
During the pandemic (December 2020-May 2022), a centralized campaign was employed, involving Flemish Government-initiated invitations and pop-up vaccination centers. The 2023 COVID-19-vaccination strategy, which commenced in September, shifted towards a decentralized approach, emphasizing ownership and shared leadership. Objective was achieving optimal vaccination coverage within target populations, recommended by the Belgian Superior Health Council (HGR). Collaboration among stakeholders within primary healthcare was essential.
While implementing, stakeholders faced challenges like vaccine hesitancy, complex logistic chains and short vaccination timeframe. The initiative for vaccination lay with the vaccinator and target group, which emphasized the need for clear communication to citizens regarding vaccination locations.
Target group: The COVID-19 vaccination strategy targeted a priority risk group of 1.967.000 citizens, based on recommendations by the HGR, for an additional mRNA COVID-19 booster dose. In addition, voluntary vaccination was possible.
Collaborators: Coordination, medical- and pharmaceutical expertise and nursing commitment were essential. This led to continuous co-creation, collaboration, coordination and feedback mechanisms among professional organizations, primary care networks (PCNs), local authorities, Flemish Institute for Primary Care (VIVEL) and the Flemish Logo’s (local health consultation), supported by the Flemish government.
Project activities: A workflow, regarding process of orders, transport and vaccination was developed. PCNs coordinated, facilitated and operationalized the campaign, with VIVEL’s support. Professional groups contributed to informing, operationally deploying, supporting and facilitating within their sectors. The professional groups Flemish Pharmacists Network and Domus Medica developed pop-ups in their Electronic Patient Records, facilitating target group identification and sensibilization.
The Flemish government designed the communication campaign, in partnership with the Logo’s. The Logo’s raised awareness among citizens and healthcare professionals, acting as decentralized epidemiological points of contact for PCNs, local actors and intermediaries to reach vulnerable individuals.
In practical implementation, coordinators, medical- and pharmaceutical contacts, nurses and local authorities were mobilized. Alignments among vaccinators within PCNs, addressing aspects such as ordering and distribution logistics, were essential.
Preparation and registration of vaccines was mandatory in the central vaccination database. Flanders developed a Dashboard for real-time monitoring. A collaborative agreement between Flanders, general practitioners and pharmacists was established for data collection.
Results: Since September 4, 2023, in Flanders, nearly 2 million vaccines were ordered, with approximately 1.450.000 of them registered. At the end of November, over 60% of individuals age 65+ and over 90% of nursing home residents were vaccinated.
International implications: This vaccination strategy highlights the role primary healthcare can play in prevention, detection and sensibilization. Co-creation and role definition at both regional and local levels were effective in enabling vaccination.
Efficient coordination in PCNs ensures local collaboration among key actors. Possession of data empowers actors to initiate targeted and proactive interventions.
Next steps: An evaluation report, along with recommendations, will be issued in May 2024. Flanders will revise its vaccination health objectives and stakeholders will collaborate in evaluating the performance with field vaccinators.