Project Immuno – Slovenia (SloMSIC)

Name of the activity: Project Immuno

Country/NMO: Slovenia (SloMSIC)

Program: Communicable Diseases

Contact information: [email protected]

Type of the activity: Campaign

Focus area:

Work to increase rate of Vaccination

Problem statement:

With the Immuno Project we have set out to educate the population about the importance of vaccination.
In Slovenia, we are facing a considerable problem with a decreasing number of vaccinated children. Parents have grown distrustful of scientific data, and are refusing to vaccinate their children, even though vaccination is as of yet obligatory by law. As a result, Slovenian population is dealing with a number of infectious diseases that should be rare on account of inoculation. For example, last year there was a boy with a case of tetanus. He was not vaccinated and this was the first case of a child having contracted tetanus in 23 years in our country. This year we are facing with first new cases of measles since 2014 and new cases of whooping cough even though all of these diseases are included in obligatory vaccination schedule, but people are not respecting it, because there is very low supervision of the lawbreakers.
The numbers are alarming, the coverage of MMR vaccination (mumps, measles and rubella) fell under the 95 percent and in our capital city even decreased under 90 %. Vaccination coverage for the hepatitis B vaccines are even lower, about 88 percent.
Optional vaccination coverage is catastrophic. Immunization rate for TBE (Tick-borne encephalitis) is around 12 percent and Slovenia is one of the endemic places of this disease. For example, our neighbouring country Austria has 87% coverage and the vaccination is optional as in Slovenia. The data is showing that something is going wrong and vaccination is really the public health issue in our country.
Indeed, there is a lack of education about infectious diseases and vaccination, which leads to people placing too much trust in false information on the internet and certain forums. However, there are also there are some non-profit organizations which strive against mandatory vaccination.
Our Project is trying to inform the people, especially young parents, about the importance of the vaccination.

Target groups and beneficiaries:

Slovenian population, mostly the people who are unsure of the use of vaccines in order to give them the right information to eliminate their doubt.
We seek to make an impact on different target groups.
First are the soon to be parents, who will be shortly dealing with questions about vaccination. They will have concerns about this topic and will need additional information.
Second target group are medical students. They need to be educated about the importance of vaccination and be ready to discuss this topic with their patients.
We would also like to have an impact on high school students by familiarizing them with this topic. An important part of the system are teachers in nurseries who have more contact with parents as well.
Thirdly, a very important target group are health workers. They play an especially important role in emphasizing the importance of vaccination and encouraging their patients to get a flu shot.
Next are teachers and workers in preschool and primary education, who are in contact with young parents and are exposed to the vaccination dilemma amongst them.
We should not forget about the elderly who should also get vaccinated against influenza.
Of big importance are also the politicians who we try to influence with our advocacy and collaboration with their working groups.

Objectives and indicators of success:

Inform at least 200 future parents with organized lessons and at least 1000 students from other disciplines and high school students about the importance of vaccination by the end of June.
Increase the percentage of medical students vaccinated against influenza for at least 40% by the end of 2020 and of health workers for 5% by the end of 2019.
Increase the immunization coverage of children in Slovenia for 10% by the end of 2020.
Encourage others to set up similar projects.

Indicators are the numbers of parents and students on our lessons. We are also noticing an increase in the number of vaccinated students (against influenza) and health workers. A big indicator will be the increased vaccination coverage of children. An important factor is also the rising support for our project by national institutions and the media.

Methodology:

We divided our activities into several phases.
1. educating future and young parents (from February 2016)
2. educating high school students (from October 2016)
3. Informing the medical students about the importance of flu vaccination (October and November 2016, October and November 2017)
4. collaboration with the Medical Faculty of Maribor (from November 2016)
5. cooperation with Municipality of Ljubljana (from December 2016)
6. educating future teachers – students of Faculty of Education in Ljubljana (from December 2016)
7. Workshops for Secondary school for healthcare (from January 2017)
8. Workshops for students in First and Second Year (from March 2017)
9. Major congress for medicine students (in April 2017 and in March 2018)
10. Participating with Ministry of Health on new Communicable Diseases law (since October 2017)

In February 2016 we started educating future parents and parents of young children and are planning to proceed with this. We carry out 60 minutes long lectures about infectious diseases and importance of vaccination. Lessons are finished with discussion when parents can ask everything connected with this topic and we help them to resolve their concerns. The organization and performance of the activity is in our hands. We made an agreement with the Health Centre in Ljubljana and we have arranged dates for workshops for one year in advance.

In October 2016 we expanded our activities to high schools, where we are organizing workshops on vaccines. It is important for young adults as future parents to be aware of vaccination issues that we are dealing with on everyday basis. We got in touch with teachers or principals of high schools and offered to conduct workshops in biology classes. Our project is cooperating with five high schools Ljubljana and we will expand to secondary schools as well. Workshops are 90 or 45 minutes long, depending on the available time during the school schedule.

We also started with awareness raising campaign about the importance of flu vaccination. With the help of our Faculty, Clinic of Infectious Diseases in Ljubljana and National Institute of Public Health of Slovenia, we organize free flu vaccinations for two years in a row, for all students of the Medical Faculty of the University of Ljubljana every year. We succeeded in vaccinating over 60% of the students, compared to 50% in the years before and 14% of all healthcare workers. We plan to continue with this activity in the upcoming years, hoping to raise the coverage by 10% each year.
Methods we used are advertising the organized student vaccination on our Faculty via social media (Facebook), sending e-mails to students and hanging posters in the places where students hang around most often. We will continue with it this year and are planning to do the same with tick-borne encephalitis vaccine (TBE).

Another aspect of our work is cooperation with the other Medical Faculty in our country, one in Maribor. Recently we managed to encourage and help with the establishment of a similar project there. We have informed them about the problem of declining immunization coverage and are planning to do a introductory lecture on their faculty in February 2017 about the concepts and steps of fighting this phenomenon. Further collaboration took place in April when we organized a congress on our faculty. We invited different scientists, physicians, and infectious disease specialist to lecture the participants. We also shared the knowledge we gained during the project activities. We filled the lecture hall in less than 2 hours after opening the registration and the congress was attended by over 300 people, some of whom also came from other faculties. After the success of the event we decided to do something similar this spring, we will organize a congress on challenges and improvements of vaccination in March 2018.

Our arrangement with the Municipality of Ljubljana started in December of 2016 when we agreed on workshops and lessons for the general public in the municipal units. We adapt lessons according to the audience. We are trying to carry through at least one workshop or lesson a week.

We are highly aware that teachers in preschool education and in primary schools are the first who communicate with parents about their concerns about their children. It is important to educate them about the topic we are dealing with and show them where to find correct information about vaccines. So we offered the Faculty of Education in our capital, Ljubljana 45 minutes long lessons. With their help, we established our workshops as mandatory in biology class.

One of our goals is a proper education for future nurses at the Secondary School for Health Care in Ljubljana. We are in touch with their Dean’s office and the head of students to organise workshops guided by our members at their school.

Last year we also organized the workshops for younger students about the vaccinations and importance of good communication with people about this issue. Workshops were performed by our immunology professors and discussion took place afterwards. After evaluation we discovered the students were really satisfied with the lectures.

By bringing attention to the fact that vaccination coverage is indeed falling and to the very tangible threat this poses to public health, we are able to contribute to implementation of change to our legislature. Our advocacy efforts bore fruit: In 2017 we petitioned the Ministry of Health on new guidelines for cancer prevention. They decided to include our suggestions related to vaccine preventable cancers into the new guidelines, guaranteeing financial resources and promotion of accessible vaccination against HPV and hepatitis. After this success, we have been drafted by the Ministry of Health to serve as external consultants in developing new legislature dealing with infectious disease and vaccination.

We can say for sure, that in few years other methods will be used and our target groups will broaden (e.g. older people in elderly homes).

Plans for evaluation:

• Surveys after the activities for participants and project’s members
• External evaluation from SloMSIC
• Members meetings monthly evaluation

The results of the surveys are important.The average score of the workshop or lecture is 4/5 points. The average score of trust in vaccination before the workshop is 3/5 score points and after 4/5.
Our project coordinator regularly attends the meetings of SloMSIC Ljubljana, where in collaboration with other SloMSIC members our project’s progress is assessed and plans for the future are made. Every three months a report on our activity is written and presented to the dean of the Faculty of Medicine in Ljubljana.
We monitor out project with monthly meetings, where the members report on their work and ideas for the future.
We also keep track of the number of people we reach on social media (Facebook), which is important for rising awareness.