Welcome to NHS Hot Topics! Every two weeks we dissect national and global health news that affects the NHS. This week’s topic is vaccinations.
Vaccinations are an important public health issue. There are currently 13 routine childhood vaccines administered in the UK which protect against many diseases that were once prevalent in the population.
Not only do vaccinations provide immunity for the individual, but if a high enough proportion of the population is vaccinated, it prevents the disease from spreading through the population. This concept is called herd immunity, and the World Health Organisation (WHO) target is 95% in order to achieve this.
Despite these vaccinations being readily available and free on the NHS in the UK, uptake of all 13 routine childhood vaccines fell in England between 2018 and 2019.
The fall in the rate of the MMR vaccinations specifically, between 1998 and 2004 is having an effect now. Those who were children in that time period largely comprise the university population now, and there are high levels of measles and mumps being reported.
In 2019, there were 890 cases of measles, following almost 1000 cases the previous year. The same year there were over 5500 cases of mumps. The dip in vaccination rates can be clearly seen to correlate with this huge increase in cases now.
In August 2019, the UK lost its measles free status (this status meaning there is a high enough level of immunity so that there is no endemic transmission).
Uptake of the first dose of the MMR vaccine has fallen for the fifth year in a row, with uptake of 90.3% as of 2019. Childhood vaccination rates first fell in the UK in 1998 until 2003/4 when they reached a low of 79.9% coverage.
This came as a now-discredited paper (published in The Lancet) linked autism to the MMR vaccine. The claims have now been retracted (partially in 2004, fully in 2010). Rates had increased before beginning to decrease again around 2014.
The reasons for this current fall are likely many and complex. False information still circulates in the media and on social media, which is likely to influence some people.
A study by the Royal Society of Public Health showed that 2 in 5 parents have been exposed to negative messages about vaccines online. Another suggestion is that it has been generations since these diseases such as mumps and measles were endemic in the UK.
A professor at Nottingham University suggests that people have forgotten how serious these infections are, so place less importance on vaccinations for their children.
A professor for child health suggests that the reduction in the number of health visitors has a role to play. The combination of these has resulted in lower vaccine uptake, which in turn causes more cases of very preventable illnesses.
How does this impact the NHS?
Analysis has shown that 1 in 7 children at age 5 have not had both doses of the MMR. The NHS is trying to improve the percentage of vaccinated children to reach that 95% target set by the WHO.
Measures include looking into payments for GPs to provide an incentive to vaccinate as many children as possible with the MMR. Other ways to be discussed in order to improve uptake are consistent ways of reminding people to attend appointments for vaccinations.
This means ensuring IT systems can alert staff to who needs vaccinations, broadening access to training for healthcare professionals and the continuation of promoting information on vaccine safety and efficacy to address concerns stemming from misinformation.
One reason contributing to the falling rates of vaccinations is the lack of appointments available for parents to take their children to the GP. Especially for working parents, time slots during the day are unfeasible.
The NHS has said that GP practices joining together to form new primary care networks allow for a bigger range in appointment times including weekends and evenings which would allow more convenient times for parents.
Public health concerns such as outbreaks of these highly contagious but preventable diseases are the concern of the NHS. Although the majority of patients with measles or mumps do not require hospital treatment, the complications can be severe.
In order to have a healthier population, it is vital that vaccination rates improve to reach that 95% target. The health of the population determines the strain placed on the NHS.
Question to think about: What do you think is the most important reason for the reduction in vaccine uptake and what ways can this be addressed?
Words by: Safiya Zaloum
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