RSU Professor Dace Zavadska: vaccinations are like a seatbelt for our health

 ‘If someone is afraid of vaccination – whether simply of needles, or because they have heard myths about vaccines – we invite them to a friendly conversation and consultation,’ says Professor Dace Zavadska of Rīga Stradiņš University (RSU), Head of the Family Vaccination Centre (Ģimenes Vakcinācijas Centrs) at the Children's Clinical University Hospital and a paediatric infectologist. As RSU supports science-based medicine, we are publishing an interview with the professor to provide a deeper understanding of vaccination.

Publicity photo of Prof. Zavadska

Latvia’s largest vaccination centre, the Family Vaccination Centre, celebrates its tenth anniversary this April. Over the past decade, the Centre has become a trusted hub where people not only receive vaccinations but also gain professional advice and clear answers to their questions about vaccines. Dace Zavadska, paediatric infectiologist and professor at RSU, stresses that vaccination is neither something extraordinary nor something to fear – it is a cornerstone of health protection for both children and adults. In the ten years since its establishment, the Centre has played a crucial role in public health, becoming a reliable partner to the wider medical community. It also serves as a resource for healthcare professionals across Latvia, having provided more than 25,000 consultations to date.

Why was the Family Vaccination Centre established?

Vaccinations have long been available at the Children’s Clinical University Hospital, but over time, the need for vaccination – and awareness of its importance – has grown significantly. This is particularly true for patients in high-risk groups, such as premature infants, who are especially vulnerable to vaccine-preventable diseases. Parents also increasingly sought advice and asked about vaccination opportunities for themselves, highlighting a need for a specialised centre.

The Centre therefore also plays a key role in educating the public. Over time, we have begun providing vaccinations for travellers as well. Our skills and competences have grown, and over the past ten years we have become a stronger, more capable institution. We continue to develop and are regularly consulted by experts from the Centre for Disease Prevention and Control and the Ministry of Health. International cooperation is expanding, and we are actively involved in scientific research on vaccines and immunisation practices. Our activities reflect the expectations placed on healthcare providers in developed countries: expertise, capacity, and accessibility.

We provide more than 2,000 outpatient consultations every year, along with approximately 500 inpatient consultations. In recent years, we have also begun offering remote consultations to healthcare professionals via e-mail. This allows patients to receive the necessary advice without having to be referred to the Children's Hospital in person. Medical professionals describe the case, and we provide detailed responses—not only outlining what should be done, which vaccine to administer, and at what intervals, but also explaining the rationale behind these recommendations. This helps improve the healthcare professional’s understanding of immunisation. Altogether, we have provided more than 25,000 consultations over the past ten years.

The objectives of the Family Vaccination Centre include the management of complex vaccination cases. Which cases are considered complex?

For example, if a child has a rare disease, there may be defects in their immune system. If a child has haemophilia or other bleeding disorders, the injection itself can be dangerous, and the correct vaccination technique must be used. The same applies to small, fragile, premature babies. It is now known that these children should be vaccinated according to the standard immunisation schedule, not their corrected age. The stereotype that one should wait for these babies to grow is outdated. There is also a persistent and unfounded myth that allergic children should not receive vaccines.

When it comes to children with various illnesses, the question is not which vaccines should be avoided, but rather which additional vaccines are needed to ensure better protection. It is very rare for a vaccine to be withheld; far more often, there is a need for extra vaccines that are not included in the publicly funded vaccination programme. We are advocating to the Ministry of Health and the National Health Service for these additional vaccines for children to be state-funded. For example, the most commonly recommended additional vaccine is against meningococcal infection.

Sometimes we hear people say: the child is still small, let’s wait until they’ve filled out a bit, and then start vaccinating. If premature babies should be vaccinated right away, does that mean there’s no situation in which we need to wait for them to ‘gain weight’ before starting vaccination?

The important thing is to understand and accept that a vaccine is nothing special – neither for the child’s immune system nor for their body. If a child is born prematurely, their immune system is much more immature, meaning they require protection more than a full-term baby. A vaccine provides this protection in a very gentle, supportive way. When a baby is born, they enter an environment full of microbes, many of which can pose potential threats to a premature baby. In some cases, such a baby may even need an additional dose to achieve the same results as a full-term baby, for example, for protection against pneumococcus.

We are accustomed to calculating medicine dosages for children based on their weight, but this is not the case with vaccines. Most vaccines are so gentle and effective that it makes no difference whether you vaccinate someone who weighs two, four, fifteen, or sixty kilograms. What really matters is age – very young children and the elderly are quite similar in terms of their immune systems. Worldwide statistics show that both children and the elderly are most at risk from infections. Therefore, these groups require a broader umbrella of immunity protection.

Expectant mothers, in particular, need to be protected. If a mother receives a vaccination during pregnancy, she not only protects herself but also her baby – this is crucial for parents to understand. That is why there are vaccines that are primarily designed to protect the mother herself, and others that are primarily intended to protect the newborn.

The first vaccine to be given to pregnant women decades ago was a combined vaccine against whooping cough, diphtheria, and tetanus. The aim of this vaccine is to transfer the antibodies developed during pregnancy to the baby, providing protection during the first few months of life – a time when whooping cough poses the highest risk of severe illness or even death. This vaccine serves as the first shield a mother can provide her baby until the child is vaccinated and develops their own immunity.

The next vaccine that has long been administered to pregnant women is the flu vaccine – both to protect the mother and to prevent serious illness, which could otherwise lead to premature birth. The third is the Covid-19 vaccine, which is primarily intended to protect the baby. Vaccination during pregnancy is now a standard, safe healthcare practice worldwide and is therefore publicly funded in Latvia.

If the vaccine is nothing out of the ordinary, why do certain groups in society perceive it as something exceptional?

Thirty years ago, there was a significant lack of knowledge about vaccination in Latvia. Even among medical professionals, training on the importance of immunisation was limited. When people know little about a topic, they are more likely to attribute a sense of mystique or unwarranted concern to it. At the time, there was also very little communication about the expected reactions to vaccines. For instance, we accept that a person undergoing chemotherapy may experience hair loss and nausea, because the treatment is seen as addressing a serious illness. In contrast, vaccines are administered to healthy individuals in order to keep them healthy—so when side effects occur, it may seem puzzling or even alarming.

Vaccination should be a subject taught in schools.

Yes. Just as we educate children about brushing their teeth—how often, how best, and why—we should also teach them about the protection that vaccination provides. Vaccination can be compared to wearing a seat belt: some people find a seat belt uncomfortable, just as they may dislike the jab of a vaccine. But that discomfort is minor compared to the serious consequences that both can help prevent.

Vaccination is also very important when travelling. Do you offer travel vaccinations?

Yes. When travel resumed after the Covid-19 pandemic, we began offering this service, and now we often see whole families coming in for travel vaccinations. Depending on the destination and the nature of the trip, we draw up an individual vaccination plan. If you're travelling within Europe, you're unlikely to need any additional vaccines—the Latvian childhood vaccination calendar is comprehensive and provides strong protection. However, if you're heading further south, even within Europe, vaccines against hepatitis A or yellow fever may be recommended. Latvia is a rabies-free country, so it's not a concern here. But if you're travelling to certain parts of Asia or Africa, rabies vaccination may be advisable. It involves two doses and provides lifelong protection, although a booster dose is required if exposure occurs. For destinations such as India, vaccines against cholera and typhoid may be useful. In some African countries, the risk of malaria must also be considered. In fact, a yellow fever vaccine is a mandatory requirement for entry into several countries.

When a person calls to book a travel vaccination, the call centre will always ask for the intended destination so that we can prepare a suitable vaccination plan in advance and, if necessary, order the required vaccines ahead of the visit. Unfortunately, travel vaccinations are not publicly funded. However, if you've saved up for a long journey, it's wise to budget for vaccinations as well. The Family Vaccination Centre offers all vaccines that are approved for use in the European Union.

How widely available are the services of the Family Vaccination Centre?

Anyone can book a consultation, and you can ask immediately whether there will be a fee. For instance, a referral from a doctor is required to have your child's vaccinations covered by the state. Pregnant women do not need a referral, as their maternity passport serves this purpose. Vaccines that fall outside the publicly funded calendar are subject to a fee, including advice for situations such as traveling. I also recommend using the educational materials produced by the Family Vaccination Centre, which are available for both parents and doctors on veselapasaule.lv under the Vaccination section. The explanatory content is based on reliable data and scientific evidence.