Watch: ‘Keeping up vaccination rates is essential’ – Charmaine Gauci

Malta’s first national vaccine strategy is currently being drafted, with health authorities focusing on combating misinformation and encouraging people of all ages to keep up with childhood, adult and seasonal vaccinations, including COVID-19 and influenza.

“Vaccines save lives. High coverage is essential to prevent outbreaks and protect vulnerable populations,” said Superintendent of Public Health Charmaine Gauci.

She stressed that all vaccines, including COVID boosters and flu jabs, are safe and remain important to protect the vulnerable.

A recent study published in the Malta Medical Journal found that, among 121 doctors and nurses who responded to a survey, only 20.8 per cent had received the COVID-19 booster. Most chose not to take it due to concerns about side effects and vaccine safety. The authors said the findings highlight the need for policies to increase vaccination rates among healthcare professionals, given their significant influence on public perception.

Gauci acknowledged the study’s limitations – including its small sample size, the tool used and the timelines – but said it nevertheless reinforces the need for more information both for the public and for health professionals, who play a crucial role in countering misinformation.

Tackling misinformation

To tackle misinformation more broadly, the authorities have engaged two global experts in misinformation and behavioural science. Beginning next year, these experts will carry out a gap analysis to identify weaknesses in information flows and then develop tailored training for healthcare professionals.

Their work will focus on health misinformation in general, with particular attention to vaccines, including the COVID and MMR vaccines. The latter, which protects against measles, mumps and rubella, was wrongly linked to autism in the 1990s, in a paper published in the scientific journal The Lancet. The paper was then retracted.

Speaking about COVID boosters, Gauci noted that there is an international trend in declining vaccine uptake. During the pandemic, people took the vaccine and boosters because they witnessed the virus’s impact and devastation. 

Since the threat is less visible, interest has dropped and misinformation has contributed to this decline.

“Many are no longer seeing the devastating effects of COVID – that broke out in Malta in March 2020 – because, thankfully, the virus is now causing less harm than when it started, although we still have people being admitted and occasional deaths,” she said.

Vulnerable individuals remain susceptible to complications, and younger people who come into contact with vulnerable relatives should protect them

Last year, there were 42 deaths attributed to COVID (listed as the primary cause of death) and 27 due to the flu. COVID deaths stood at 191 in 2020, 209 in 2021, 202 in 2022, and 53 in 2023. Additional deaths not included in these statistics would have occurred due to an indirect cause.

Last year, there were 846 hospitalisations due to COVID as the main or secondary diagnosis and 555 hospitalisations for flu. There were 1,003 COVID hospitalisations in 2023, 1,927 in 2022, 1,573 in 2021 and 974 between April and December of 2020, 191 of which resulted in death.

Addressing concerns about how quickly COVID vaccines were developed, when compared to others that take years, she explained that the scientific groundwork had already begun before the pandemic and COVID-19 created a global emergency with unprecedented research focus.

Clinical trials also benefited from large numbers of willing participants, removing one of the typical constraints in vaccine development. She reiterated that both the initial vaccines and the boosters went through all necessary phases and were approved by the European Medicines Agency. Scientific literature shows that most vaccine side effects emerge shortly after administration, not many years later, and safety continues to be monitored through pharmacovigilance systems.

Gauci emphasised that vaccines remain necessary, especially for influenza and COVID. Vulnerable individuals remain susceptible to complications, and younger people who come into contact with vulnerable relatives should protect them.

Healthcare workers are particularly exposed and can pass infections to patients, whereas vaccination reduces both their risk of illness and their likelihood of transmitting the virus.

Childhood vaccines

Childhood vaccinations are another priority. Malta’s coverage is high but even small dips threaten herd immunity, particularly for measles.

Malta has maintained the recognised status of measles elimination since 2016 and recorded no cases in 2023 and 2024 despite large outbreaks in Europe, where over 35,000 cases were reported in 2024.

Mumps cases remain very low – typically two or three per year – and there have been no rubella cases since 1995. Pertussis, or whooping cough, cases increased in 2024, prompting an assessment of whether an additional adolescent booster may be necessary. Malta has had no polio cases since 1964, and wastewater monitoring, which is tested abroad, remains negative.

But this can’t be taken for granted – dips in vaccine uptake can shift the picture, especially as Malta is not isolated.

Malta’s population is increasingly diverse, with nearly 30% foreign residents in 2024. Immunisation status of foreign children is often unknown and their coverage rates may be lower than Maltese-born children.

Dips in vaccine uptake can shift the picture, especially as Malta is not isolated

“Keeping up vaccination rates is essential in keeping certain diseases at bay,” she said.

So, the past year has been devoted to preparing the new vaccine strategy. Vaccination policy was previously included within the communicable disease strategy but, given international trends and Malta’s interconnectedness, the authorities believe a proactive, standalone strategy is needed.

The draft will be submitted to cabinet before being launched for public consultation next year.

The strategy will focus on improving data collection to better reflect Malta’s dynamic population, establishing more targeted outreach, strengthening training for healthcare professionals and addressing misinformation.

It will also include emergency preparedness plans to ensure vaccination programmes remain functional during crises, and it will promote cancer prevention by scaling up HPV and Hepatitis B vaccination in line with the EU’s 2024 recommendations, including linking vaccination data with cancer registries to measure long-term impact.