Childhood vaccination rates, a casualty of the pandemic: a new report helping to change the tide

By Helen Donovan, Michelle Falconer, Catherine Heffernan, Satvinder Lall, Mike Lane, Pauline MacDonald, Caroline O’Brien – The Vacceptance Project Steering Group.

Recent data from the United Kingdom Health Security Agency (UKHSA) has revealed that, despite the eyes of the world being on vaccinations for the past two years, routine immunisations which protect our families and communities have been declining.

Falling childhood vaccination rates

In February 2022, the UKHSA reported that rates of the first measles, mumps and rubella (MMR) vaccine dose in 2-year-olds had fallen below 90%, and coverage of two MMR doses in 5-year-olds had dropped to 85.5%. This falls far short of the 95% World Health Organization (WHO) target needed to achieve and sustain measles elimination.¹

Sharing expertise to boost acceptance

In light of this situation, a report discussing barriers to vaccine uptake in the UK and offering actionable strategies to increase routine vaccination rates is very timely.

The Vacceptance (vaccine acceptance) project, set up in 2020, was led by a steering group (SG) that brought together members from across UK healthcare delivery to explore how interactions between parents, patients and healthcare professionals (HCPs) may impact vaccination uptake across England.

The SG’s report is based around five key insights, which are summarised below:

1. Misuse of the term ‘vaccine hesitancy’

The SG notes that the term “vaccine hesitancy” is increasingly used by some HCPs when describing anyone with queries about immunisation, even though “asking questions does not signify vaccine hesitancy”.

Unfortunately, misattributing people as “vaccine hesitant” can be detrimental to uptake rates as it could be presumed that they are resistant to vaccination and will respond poorly to further discussion. In fact, those described as “vaccine hesitant” can hold a broad range of attitudes, and it is important for HCPs to understand the rationale behind patient questions.

2. ‘Pre-vaccination interactions can positively impact uptake’

Five standards have been introduced to the GP contract as part of the process of making vaccination and immunisation provision an essential service.² Importantly, many of these additions support positive pre-vaccination interactions, which have the potential to considerably impact vaccine uptake, especially in communities with lower vaccination rates. However, at present these standards are not always clearly defined, leaving the risk that they may not be implemented effectively and consistently.

The SG noted that, although the standard for “initial call and recall” was clearly defined, there was significantly less detailed guidance for the “named practice lead”. Until requirements for each standard are widely and clearly communicated, the report warns that compliance may be lower than expected.

3. ‘Regional Vaccine Champions”

Passionate and motivated individuals can have a significant impact on vaccine uptake within individual communities. In line with this observation, the report recommends creating a clearly defined role of “vaccine champion” potentially operating at integrated care system (ICS) level to drive local vaccine uptake and address inequalities.

The vaccine champion would work as an educator, facilitator and networker, implementing regional strategies and supporting all stakeholders by identifying and sharing best practice related to vaccination and immunisation across the ICS.

4. ‘Training everyone to engage confidently’

Across the primary care network, there can be discrepancies in HCP training and confidence levels regarding patient engagement around immunisation. It is therefore important to ensure that all primary care team members – from receptionists answering the phone to nurses administering jabs – are empowered to develop the skills to listen to patient concerns and engage in positive vaccine dialogue.

Training hubs and peer mentoring can provide valuable educational support in achieving this goal. Alongside this, vaccination and immunisation must be adequately covered in the standard syllabus for all relevant HCP training to ensure consistency.

5. ‘A consistent positive mindset’

The SG highlights that the pandemic has reignited the commitment of many HCPs who have rediscovered a positive engagement with vaccination and have stepped up to deliver the recent immunisation programme. As a result of this and the wider public sentiment, there is currently a golden opportunity to leverage the momentum of COVID-19 and forge a collective, forward-looking mindset rooted in an understanding and acceptance of the value of all routine vaccination programmes.

How can you help?

The Vacceptance SG calls on UK stakeholders and decision-makers to address the issues raised in the report by providing investment and leadership to support its initiatives. Learn more about the positive additions and changes to the GP contract by reading the NHS England GP contract arrangements for 2022-23.

Through further education, clearer definition of standards and roles, and promotion of a positive mindset, we can maximise each HCP-patient interaction. This will help to drive Vacceptance and ultimately protect individuals and communities from vaccine-preventable diseases and their complications.

Read the full Vacceptance report to learn more here.

The Vacceptance Steering Group: Helen Donovan, Michelle Falconer, Catherine Heffernan, Satvinder Lall, Mike Lane, Pauline MacDonald, Caroline O’Brien.

The Vacceptance Project was initiated and funded by Pfizer Ltd.

References

1) UK Health Security Agency. (2022) Around 1 in 10 children starting school at risk of measles. Available from: https://www.gov.uk/government/news/around-1-in-10-children-starting-school-at-risk-of-measles.  [Accessed June 2022]

2) BMA, NHS England. (2020) Update to the GP contract agreement 2020/21-2023/24. Available from: https://www.england.nhs.uk/publication/investment-and-evolution-update-to-the-gp-contract-agreement-20-21-23-24/. [Accessed June 2022]