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BSI Vaccine Ambassador Scheme: herd immunity for your community

In September, NHS Digital published an annual report detailing coverage of routine immunisations available through the NHS in England.1 Overall, immunisation coverage remains high. However, worryingly, uptake levels across childhood immunisations have decreased for the fourth consecutive year. Moreover, significant regional variations mean that while some local authorities are achieving nearly universal coverage, in others, barely half of eligible children are receiving routine immunisations.

Regional variations

Comprehensive vaccination is especially important in achieving herd immunity. In order to prevent transmission of vaccine-preventable diseases and to achieve herd immunity, the World Health Organization (WHO) recommends 95% vaccination uptake against any particular disease in a given population. Failure to achieve herd protection has historically resulted in outbreaks and childhood deaths, examples of which we have seen here in the UK in the last decade.

The North East performs consistently strongly across all routine immunisations, in stark contrast to London boroughs with some local authorities barely achieving 50% coverage for key vaccinations. The MMR vaccine – which was the centre of the Wakefield scandal almost two decades ago – is still cause for concern, with only 88% of children in the country fully protected by age 5 and only 7 out of 149 local authorities hitting the 95% target.

Last year, when we reported on the 2015/2016 immunisation statistics, which painted a very similar picture to this year, we asked how disparities in uptake between different regions could be mitigated and reasons for such variations.

Vaccine hesitancy

Vaccines are undoubtedly one of the greatest medical interventions of the modern world. Yet, despite their historic success in reducing the burden of severe childhood diseases, vaccines have, since their conception, remained a contentious topic. Episodes of public concern about vaccines have occurred around the world and in this country, spreading quickly and sometimes seriously eroding public confidence in immunisation and ultimately leading to vaccine refusals and disease outbreaks.

Vaccine hesitancy is defined by the WHO as ‘a delay in the acceptance or refusal of vaccines despite availability of services’. The Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine monitors public confidence in immunisation programmes in several countries.2 In their 2015 report, they identified three main factors contributing to hesitancy as confidence, complacency and convenience. In the UK, a group of self-defined vaccine-hesitant parents gave 73 reasons for their hesitancy, including not believing vaccines are effective, safe or needed. Clearly, vaccine hesitancy is a multifactorial complex issue and requires several different approaches, tailored to specific populations.

BSI Vaccine Ambassador Scheme

One such approach to address vaccine hesitancy is through direct communication with vaccine-hesitant individuals. We have learnt that new and expectant parents would value the opportunity to have an informed discussion with experts about immunisations.

The BSI, in partnership with the British Science Association, has developed a Vaccine Ambassador Scheme3 which involves engaging directly with those most needing information on immunisations. BSI vaccine ambassadors attend local nurseries, antenatal and postnatal groups to facilitate discussions with new and expectant parents on immunisations. This provides parents with the opportunity to discuss the topic in an untimed environment surrounded by their peers.

“The vaccine ambassador training provided me with the all the facts and also confidence to engage with parents about the benefits of vaccination. The parents I interacted with in Hackney were very grateful for the ability to speak to an ‘expert’ on immunology and vaccinations. They understandably had lots of questions about how vaccinations work and they did not feel that they had enough time with their GP or health practitioner to get the answers to their questions, so were grateful to speak to a scientist. I found taking part in the vaccine ambassador programme a very rewarding experience and would encourage everyone to take part.”

Emma Chambers, BSI Vaccine Ambassador

Engaging with the public in Hackney

Following the recruitment of five BSI members for a pilot, we developed a unique half-day training programme tailored to the project. The training equipped the vaccine ambassadors with the confidence to discuss emotive subjects and vaccines with a wide range of audiences and prepared them to cope with a number of possible scenarios. Overall, parent group leaders were very happy to be involved in the pilot, many citing that they are frequently asked about contentious health topics, such as vaccines, and regularly feel unable to provide information.

We recently completed the pilot in Hackney in London. Hackney is diverse, not only in vaccine uptake, but also in socio-economic, ethnic and religious backgrounds, making it an ideal setting for a pilot. Through eight different parent sessions, we engaged with several people from an array of different backgrounds and with various views on vaccines. While most parents we encountered were positive about vaccines, perhaps unsurprisingly many lacked basic understanding of how vaccines work or where to access reliable information on immunisations. This led us to develop our own ‘BSI Guide to Childhood Immunisations’, which has been a helpful supplement in our sessions, but also a great tool for educating those through online networks and remotely.

Lessons from the pilot scheme

Having recently completed the pilot, now is time to evaluate and reflect. Firstly, we think about the transition from our traditional public engagement approach. This project encompasses a unique and novel form of public engagement using a strict and unique issue-driven targeted approach. Our recently completed evaluation report of the pilot will be considered by the BSI’s trustees for future development of the project. The BSI Vaccine Ambassador Scheme has potential to fill knowledge and confidence gaps that we are currently seeing in the national health landscape. Our membership is the lifeblood of the organisation and is instrumental in carrying out this and other engagement projects. We are very grateful to those who have taken part in our pilot and are looking forward to working with those who have expressed interest in taking the project forward. If you are interested in getting involved, please contact me for more information.

In summary

Addressing vaccine hesitancy and increasing public confidence and uptake rates across the country is not a straightforward task and will involve the efforts of many. Local authorities have a responsibility to oversee immunisation in their population and there is a need for more joint up working between local authority public health responsibilities with service delivery provided by the NHS. Addressing issues with service delivery and convenience may be beyond our remit, but providing access to experts and expert information is something that we are seeing has tremendous effect. At the BSI, we are striving to help people feel more confident in their ability to make informed decisions around immunisations.

Shannon Lacombe

BSI Policy and Public Affairs Manager

Email: s.lacombe@immunology.org


Further information

Find out more about our Vaccine Ambassador scheme on our website. 

Are you coming to BSI Congress 2017?

On Monday 4 December at 17:00 at the Congress, we will host a workshop on ‘Public perceptions of vaccination’. Here we will hear from a panel of experts, including Heidi Larson (LSHTM) and BSI vaccine ambassadors, on current public perceptions of immunisations and what is effective in addressing hesitancy. You can also hear more about this new BSI initiative and sign up to be a BSI vaccine ambassador. Please do join us there.


References

1.  NHS Digital 2017 Childhood Vaccination Coverage Statistics, England 2016–2017 

2.  The Vaccine Confidence Project. 2015 The State of Vaccine Confidence: 2015 

3. BSI Vaccine Guide 2017