Intended for healthcare professionals

Letters Trust in family doctors

Primary healthcare for a long term and sustainable vaccination strategy

BMJ 2021; 372 doi: (Published 08 March 2021) Cite this as: BMJ 2021;372:n650
  1. Arnaud Chiolero, epidemiologist and professor of public health1,
  2. Stéphane Cullati, senior lecturer in epidemiology1,
  3. Valérie Santschi, professor of health services research2
  1. 1Population Health Laboratory, University of Fribourg, 1700 Fribourg, Switzerland
  2. 2La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
  1. achiolero{at}

Organising the covid-19 vaccination programme puts enormous pressure on healthcare systems. Two major challenges must be tackled for a long term, sustainable strategy.

Firstly, we need to account for vaccination hesitancy. In 2019 it was listed by the World Health Organization among the top 10 threats to global health1 and hesitancy towards covid-19 vaccines is common in some countries.2

Secondly, the strategy must be tailored to the capacity of healthcare systems. In many countries public health authorities organise mass vaccinations in improvised centres, and this is necessary—in the short term—for rapid deployment. In countries with a dense network of primary healthcare providers, however, this could be counterproductive in the long term.

In a recent issue of The BMJ, Salisbury reminds us that the public rate physicians highly for trustworthiness.3 This is also true for pharmacists and nurses,4 and is why we should place primary healthcare providers at the heart of the vaccination strategy. Hesitancy is built on mistrust,5 and being vaccinated in places you know, such as a GP surgery or local pharmacy, by healthcare providers you know can foster trust. Primary healthcare providers can also identify frail patients to be prioritised and manage anxious ones in need of reassurance.4

Vaccination is a medical activity, with a biopharmaceutical product, and requires patient centred care. Patients not only need information, they need a healthcare professional with whom to talk and who will be accountable for efficiency, safety, and post-vaccination surveillance.

Given that covid-19 may remain endemic, a vaccination strategy based on the optimal use of existing healthcare resources should be favoured to achieve sustainable population health benefits. Within a social responsibility framework,6 public-private partnership between primary healthcare providers and public health authorities should be fostered to coordinate regional resources to maximise vaccine delivery.


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