The UK is a world leader in vaccine research and provision and an early adopter of many new vaccines. This has had a profoundly positive effect on the nation’s health, affording protection to our children and decreasing rates of infectious disease. Unfortunately, immunisation has been prominent in the headlines recently for all the wrong reasons.
Immunisation rates have now decreased to the point where, in England, we no longer achieve the World Health Organization’s required level of 95% coverage in any of the routine childhood vaccinations at the correct time point. This is a travesty not only for the children who miss out on vaccination and are susceptible to catching the disease, but also for people who can’t have vaccinations – babies, people undergoing cancer treatment – who gain indirect protection from high immunisation rates preventing disease spread.
Measles is of particular concern because it is so contagious – in an unvaccinated community, each person with measles would on average pass the disease on to 12 others. That’s why ensuring a high vaccination rate is critical to stopping the spread of this disease, and why this week’s news that the UK has lost its “measles-free” status is so concerning.
But why have vaccination rates dropped? As always, the answer is complex and multifaceted, but it helps if we bear in mind the “3Cs” – confidence, complacency and convenience. Despite anti-vaccine rhetoric on social media being regularly cited in the media as leading to a drop in vaccine “confidence”, there is little evidence to bear this out for UK parents – Public Health England research shows that healthcare professionals remain the most trusted source of vaccine information for parents, with social media the least trusted. Rather than focusing our debate on the ills of social media, putting resources behind empowering healthcare professionals with information and the means to engage with parents who have questions around immunisation seems a sensible way to progress.
Vaccinations are somewhat a victim of their own success – we don’t often see people affected by these diseases in our communities any more and we can all be prone to complacency, forgetting just what a serious risk they can pose to children’s health. Rather than alienating parents who miss their child’s vaccination, we need a programme of engagement to ensure they have access to accurate information on the risk of the diseases and the importance of vaccination in protecting their children.
Where policy and government can make a significant impact is through convenience – the suitability and accessibility of our healthcare services for the communities they are designed to serve.
In recent years our vaccination system has been hit by a multitude of factors which, no doubt, have contributed to the drop in immunisation rates. Studies have shown that the complex and wide-reaching reforms introduced by the Health and Social Care Act 2012 are linked with declining vaccination coverage in England. The legislation had a number of unintended consequences, including fragmenting England’s immunisation programmes through the loss of key staff, such as immunisation coordinators. This, combined with the shift of public health budgets from the NHS to local authorities and the subsequent cuts to these budgets, have created the perfect storm whereby pressure on our vaccination services is now being reflected in lower vaccine uptake.
Despite the efforts of dedicated and hardworking immunisation teams around the country, overall loss of capacity in the system coupled with loss of specialist knowledge has resulted in a service that is less agile and fit for function. To increase uptake in under-vaccinated communities, local knowledge and engagement are vital to build trust and relationships. Strategies such as sending parents reminders, having appointments available at appropriate times and widening services to go out into communities are all initiatives we know work to increase vaccine uptake, but which also require appropriate resources.
The ambition of the NHS’s long-term plan and No 10’s recent announcement on plans to improve vaccine uptake are to be commended, and are a welcome move in the right direction. However, these interventions require adequate funding levels and a reversal of the public health funding cuts enacted over the past decade. We know vaccination saves the health service money – the 2012-13 measles outbreak in Merseyside cost more than 20 times more to treat than the vaccinations that could have prevented it. Investment in preventive vaccination services is the only way to tackle long-term spiralling healthcare costs and ensure the children’s future health.
• Dr Doug Brown is chief executive of the British Society for Immunology. The society publishes a free Guide to Childhood Vaccinations which provides evidence-based information for parents
