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Childhood immunisation statistics - the good, the bad and the three Cs

On 18 September, NHS Digital published their annual ‘Childhood Vaccination Coverage Statistics’, detailing the uptake of routine vaccinations available through the NHS for children in England. While the UK remains at the forefront of vaccine discovery and development, and overall coverage remains high, these statistics indicate that uptake of many routine vaccinations has declined for the fourth consecutive year. On average across England, all vaccines failed to meet the World Health Organization’s (WHO) coverage target of 95% at the correct ages outlined by Public Health England, with uptake of all but two vaccines (DTaP-IPV-Hib and rotavirus) declining compared to the previous year. There was also a significant amount of regional variation.

Herd immunity

The WHO’s target of 95% coverage in a given population is essential to achieve herd immunity. When the majority (more than 95%) of a population is immune to a disease, the disease is prevented from spreading to those that are not able to be vaccinated, such as young babies or people with a deficient immune system. The North East consistently achieves the highest vaccination rates, and this year was no exception with County Durham and South Tyneside exceeding the WHO’s 95% coverage target for all vaccines and other North East local authorities showing high uptake across the board. However, vaccine coverage was highly variable across the country, and in some London local authorities, coverage for some vaccines was as low as 66.5%.1

Disease outbreaks

Failure to achieve adequate levels of vaccine uptake results in outbreaks of preventable diseases such as measles and meningitis. The MMR vaccine, which protects against measles, mumps and rubella, has failed to achieve more than 90% coverage across England since 19982 and, as a result, we’ve recently seen regular outbreaks of measles and mumps. In 1997 there were 171 cases of measles in England, whereas 2008 and 2012 saw 1,370 and 2,000 confirmed cases respectively.3,4 In 2017, a large-scale outbreak across Europe saw 23,927 measles cases reported on the continent, with over 41,000 people infected with measles and 37 associated deaths in the first half of this year in Europe.5 This has led to further outbreaks in the UK, with just over 500 cases recorded in England in the same time period.6,7

Cases of mumps have also seen regular spikes:  2005 saw an outbreak of over 43,000 cases in England, compared with 181 cases in 1997, and cases have generally hovered between 2,000 and 6,000 per year since then.3 It is therefore crucial that we strive to raise awareness of the importance of vaccines and improve their uptake in order to prevent recurring outbreaks of these and other serious diseases.

Downward trends

In addition to regional variation, average uptake of several routine vaccines has decreased slightly for the fourth consecutive year. We are especially seeing a reduction in the vaccines which require booster doses, which are needed to ensure that the immunity conferred is strong and long-lasting. Although uptake is higher than ten years ago, the past five or six years show a slow decline in booster uptake and this year, less than 95% of children in most areas across England received boosters for any vaccine that required them by age five.1 It is crucial that this is improved on, particularly as children at this age usually start school and mix with lots of other children, increasing the ability of diseases to spread and magnifying the importance of herd immunity.


Maps showing vaccination coverage by local authority for PCV booster (Streptococcus pneumoniae), DTaP-IPV booster
(diptheria, tetanus, pertussis and polio) and the full MMR (measles mumps rubella) across England 2017-2018.
Contains information from NHS Digital, licenced under the current version of the Open Government Licence.

Confidence, complacency and convenience

The lowest uptake of all vaccines is consistently seen in London; for example, just 85% of children have received the first dose of the MMR vaccine by their second birthday and less than 90% of children received boosters for any of the vaccines requiring them by their fifth birthday.1 The reasons parents don’t have their children immunised are complex and multi-factorial, comprising a number of considerations specific to the individual.

Confidence in the safety and effectiveness of vaccines is one of the drivers of the reduction of vaccine uptake.8 For example, in 1998 the now-discredited gastroenterologist Andrew Wakefield published a fraudulent paper claiming that there was a link between the MMR vaccine and autism. Following this, a minority of people lost confidence in the safety of the MMR and uptake fell, leading to outbreaks of mumps and measles throughout the 2000s, and we are still seeing the effects today.

Due to the success of vaccines, many once-common diseases such as diphtheria and polio are now rarely seen in the UK. Although this highlights the importance of vaccines in the fight against infectious diseases, this can also lead to complacency as people may simply be unaware of the devastating effects these diseases can have and therefore not see the importance of getting vaccinated against them.

Ensuring convenient access to vaccines is also important in improving their uptake. For some families, a lack of affordable transport can be a barrier to vaccination and so increasing the availability and accessibility of healthcare services could improve vaccine coverage. There has been an indication of successes with this in the past: improvements in vaccination rates seen between 2010 and 2015 coincided with an increase in health visitors who could vaccinate children in a domestic setting, improving accessibility.9,10  Additionally, due to the wide range of vaccinations available, the immunisation schedule can become confusing – especially when there is more than one child requiring vaccination. Parents may simply not know or lose track of which vaccines are required when. The NHS does provide an online vaccination ‘planner’, however increasing visibility of this service could improve uptake. 

The future

There needs to be a concerted effort to improve vaccine uptake amongst children. Local authorities and healthcare services need more support in improving education on vaccines as well as increasing access. The BSI is committed to supporting efforts to improve public understanding of vaccines. You can read our official response to this year’s immunisation statistics here.  We have recently piloted our Vaccine Ambassador Scheme where we support our members in engaging with new and expectant parents on vaccines and immunity. We have also produced a ‘Guide to Childhood Immunisations', which can be downloaded for free from our website.

Eleanor Sherwood

Policy and Public Engagement Officer


References

1. NHS Digital 2018 Childhood Vaccination Coverage Statistics – England 2017-2018

2. House of Commons 2009 Measles and MMR Statistics  

3. Public Health England 2014 Confirmed cases of Measles, Mumps and Rubella 1996-2013  

4. BBC News 2013 Measles outbreak in map and graphics

5. World Health Organization 2018 Measles cases hit record high in the European Region

6. Public Health England 2018 Laboratory-confirmed cases of measles, rubella and mumps, England: April to June 2018

7. Public Health England 2018 Laboratory confirmed cases of measles, mumps and rubella, England: January to March 2018

8. Hardt et al. 2013 Vaccines 1 204-224  

9. UK Government 2013 Health Visitor Numbers

10. World Health Organization 2014 Report of the Sage Working Group on Vaccine Hesitancy 

 

 

  

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