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Improving the childhood vaccination rate in the UK

The British Society for Immunology is here to represent our members and discipline of immunology as a whole. A key aim, highly valued by our members, is to provide a strong voice on behalf of our community to represent immunology to the highest levels. Part of this is ensuring that the public reaps the benefits from immunology research and clearly a crucial topic in this is vaccination.

Over the past 18 months, the BSI has significantly increased our external affairs work, in particular focusing on the childhood vaccination rate in the UK. Vaccine uptake in England has decreased over the last five years. England does not hit the World Health Organization target of 95% uptake at the correct time point for any of the routine childhood vaccinations.1  Although uptakes are, on average, 2–3% higher in the devolved nations, they too have seen recent decreases and do not achieve the 95% target in some vaccinations. We are now starting to witness the implications of these declines, with cases of measles and mumps at their highest for over 10 years. As the UK-wide organisation representing scientists and clinicians who study the immune system, we feel that the BSI is ideally placed to provide a loud voice to champion vaccines in the public arena and to advocate for what is needed to increase uptake rates. 

 

What’s causing the decline in childhood immunisations rates?

This is obviously a complex and multifactorial issue, but it helps if we break it down into the ‘3Cs’ – confidence, complacency and convenience.

Despite much publicity around social media’s effect on vaccine ‘confidence’, there is little evidence in the UK to back up claims that this is a leading cause of decreased uptake rates. Public Health England research shows that the public’s confidence in vaccination is actually high, with healthcare professionals the most trusted source of information while social media is the least.2 Rather than focusing on the zeitgeist of social media, the BSI advocates that instead we should put efforts into ensuring that healthcare professionals have the information and resources they need to engage with parents who have questions on vaccination.

Vaccines have been one of the most effective public health inventions, saving millions of lives around the world. In fact, they have been so effective that they can be seen as a victim of their own success. Many of the diseases targeted are now rare in our communities, meaning it’s easy to be complacent and forget just what a serious risk they pose to children’s health. The BSI view is that instead of alienating parents who miss their child’s vaccinations, we should engage with them to answer their questions and to provide evidenced-based information on just how important vaccinations are.

The last factor of convenience refers to the suitability and accessibility of our healthcare services for the communities they are designed to serve, and there’s evidence that this is a significant cause of the decreased vaccination rates. Over the past decade, there has been a reduction in overall capacity and specialist knowledge within our immunisation services. This is due to several factors including fragmentation of the service following the Health and Social Care Act 20123 and public health budget cuts. Despite the efforts of hardworking and dedicated immunisation teams, these changes have resulted in a service that is underfunded and less fit for function. However, there is action we can take. As well as increasing funding, improving the number of immunisation co-ordinator roles, standardising reminders for parents on when vaccinations are due, and ensuring clinics are open at appropriate times are all techniques that we know boost immunisation rates. Additionally, it’s important that services have the capacity to reach out into under-vaccinated communities to engage with people directly and gain their trust.

 

What is the BSI doing?

The BSI works on a number of fronts to increase the childhood vaccination rate and provide reliable, evidenced-based resources for parents on immunisation.

Parliamentary engagement

Our parliamentary engagement takes a number of different forms but has seen success on many fronts. We regularly contact MPs to suggest questions on vaccinations that they can put to Ministers in the Department for Health and Social Care. To date, we’ve had 20 questions asked for us by 6 MPs from 4 parties (Conservative, DUP, Labour and Liberal Democrat). As well as raising the profile of vaccination among MPs, this also allows us to get the Government to state on the record what actions they are planning and can identify areas requiring more scrutiny.

Earlier this year, we worked with Chris Green MP (Con, Bolton West) to hold a debate on childhood vaccination uptake in Westminster Hall.4 We provided Chris with a briefing on important issues to raise, and he was able to mention most of these in presenting the case to Seema Kennedy MP (Con, South Ribble), the then Parliamentary Under Secretary of State for Public Health and Primary Care, that more measures should be taken to reverse the decline in vaccination coverage seen during recent years. We were pleased that, in her response, she mentioned all of the key areas that the BSI been calling for more Government support on – more accessible services, more information and more training for healthcare workers. 

Responding to consultations around vaccination is also a key part of our work and certainly kept us busy over the summer. Having built up a relationship with the Chair of the All Party Parliamentary Group on Vaccinations for All, Dr Philippa Whitford MP (SNP, Central Ayrshire), we responded to their inquiry on vaccine uptake, the findings of which have yet to be published. We also responded to a NICE consultation to increase vaccine uptake.

Evidently, Government experienced many changes over the summer but the BSI was on hand to make sure that vaccination did not get lost in the mix. Within one week of Boris Johnson taking office as Prime Minister, we sent a letter to him from our President, Arne Akbar, suggesting that he take early action to tackle the issue of childhood vaccine uptake. Now, naturally the Prime Minister’s office receives lots of correspondence so we can’t claim sole credit here, but we were delighted that less than one month later a press release was sent out from Number 10 entitled ‘Prime Minister orders urgent action to improve vaccination uptake’,5 containing proposals that the Government intends to take on this, many of which were actions we’d been calling for. They also pledged to publish a comprehensive vaccine strategy. Although this is now on hold due to the General Election, we will be campaigning hard to the new Government to take this forward.

 

Partnership and consensus building

As well as carrying out our own work around vaccinations, we feel that it’s incredibly important for us to reach out to other organisations working in this sphere to understand their views, build consensus and look for fruitful partnerships. Over the last year, we have met with representatives from many organisations including Public Health England, Royal College of Nursing (RCN), Royal Society for Public Health and Royal College of Paediatrics and Child Health (RCPCH). We also met with Sally Davies, the then Chief Medical Officer, to discuss our plans around providing training for healthcare professionals on vaccination and were pleased to gain her support.

 

Media work

As a champion of immunisation, we feel that it’s vital that the BSI speaks out to the media and provides a strong evidence-based voice for vaccination. This year, vaccination has rarely been out of the spotlight, which has kept our media team, and our President and Chief Executive, extremely busy. Since the start of the year, we’ve received major national and international coverage on the issue of vaccinations in outlets including BBC News, The Times, The Guardian, Daily Telegraph, Daily Mail, The Sun, Daily Mirror, CNN and Sky News to name but a few. Particular highlights include contributing an opinion article to The Guardian on the reasons for the fall in vaccine uptake, which gave us an excellent platform to put forward our views.6 We also worked with the Science Media Centre and experts from the RCN and RCPCH to provide a briefing for journalists on the topic of mandatory vaccination. This was incredibly successful, leading to over 25 national news articles and allowed us to put across the evidence behind the decline in vaccine uptake. Finally, we worked with the Daily Mail on their recent campaign to increase uptake of MMR, which has seen significant success in raising the profile of this issue.

 

Healthcare professionals

Many of you will remember our vaccine ambassador scheme that we piloted a couple of years ago. While the results of this were positive, the logistics of setting up meetings with parent and baby groups proved too resource heavy for us to take forward. So, we took a step back and re-evaluated as we still felt there was value in the approach; we have now redefined it to ‘a train the trainer’ approach – essentially using a similar format to engage with healthcare professionals who give vaccinations. We are currently running focus groups with these frontline healthcare professionals who deliver vaccinations to find out what their learning needs are and what resources they would like to be able to deliver an optimal service. From these, we will develop a more fully formed plan on how to take this aspect of our work forward.

 

Public information

Our popular ‘Guide to Childhood Vaccinations’ and accompanying videos are available for free on our website and provide a reliable, easy to understand guide to how vaccines work and why they’re important.7 We have plans for both updating this guide and for producing more in the series – watch this space.

We also regularly provide opportunities for the public to engage with our members directly on this topic, both through our Communicating Immunology grant scheme and our own centrally organised public engagement activities. For example, in the summer we supported a Science Day run by the Dr Jenner’s House & Museum, where we provided two speakers on the topic of vaccination and ran an activity stand for kids.

 

Next steps

This has been a year where vaccination has been high up in the social consciousness, due to the decrease in vaccination rates and increase in measles cases. Although we’ve achieved notable successes this year, we have no intention of stopping there and will continue our programme of work into 2020. We’re particularly keen to start a programme of engagement with the devolved nations.

Vaccines, and immunological research which led to them, have revolutionised public health in this country and round the world. The BSI is proud to champion the importance of vaccinations on behalf of our community, and the life-saving benefits they confer.

Jennie Evans
Head of External Affairs, BSI
Email: j.evans@immunology.org


BSI’s stance on compulsory vaccination

The BSI does not support compulsory vaccination. Our view is that it is a blunt tool, with no current evidence that it would increase the UK’s immunisation rate, but rather concerns that it could increase current health inequities, and alienate parents with questions on vaccination. Rather than implement this costly policy, we advocate that the Government should instead increase funding our vaccination services to ensure they are adequately resourced to provide accessible services to parents.


References

1.  NHS Digital 2019 Childhood Vaccination Coverage Statistics – England 2018–19

2.  Public Health England 2019 PHE offers support to UK vaccine heroes

3.  Chantler et al. 2016 “It’s a complex mesh” – how large-scale health system reorganisation affected the delivery of the immunisation programme in England: a qualitative study BMC Health Services Research 16 489

4.  Chris Green MP 2019 We are losing sight of the unrivalled success of vaccinations PoliticsHome

5.  Gov.uk 2019 Prime Minister orders urgent action to improve vaccination uptake

6.  Doug Brown 2019 What’s the best remedy against antivaxxers? Reverse public health cuts The Guardian

7.  British Society for Immunology Guide to Childhood Immunisations