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Vaccines: prevention is better than cure

The NHS is fighting for its life in terms of cashflow as the £30 billion black hole in funds is well documented. The first argument put forward by NHS England's Five Year Forward View states that sustainability of the NHS rests on a "radical upgrade of prevention and public health". Savings can no longer be found from the obvious places, so it's time to get creative and vaccine programmes are one way. After all, prevention is better than cure.

The Meningistis B (Men B) vaccine is the latest to be approved to be part of the NHS's immunisation programme. The vaccine, named Bexsero, has been available privately in the UK, priced at £75, since 2013 and will be available to children from September this year.

Secretary of state for health Jeremy Hunt made the announcement in March 2015 following the agreement between the government and GlaxoSmithKline (GSK), the vaccine manufacture, saying it will “save generations of children from death and disability” the disease causes.

Men B is a form of meningitis and septicaemia, it mostly affects babies and children and causes a number of permanent disabilities including epilepsy, limb loss and brain damage. The NHS choices online states that “around 1,200 people… get meningitis caused by meningococcal group B bacteria each year in the UK”.

 The Oxford Vaccine group statistics show one-in-20 cases of MenB disease result in death and one-in-five survivors suffer from permanent effects including, amputation, brain damage and skin scars. Hunt says: “MenB can be severely disabling or fatal, especially in babies and young children. Losing a child is every parent's worst nightmare so I am delighted that we have reached an agreement with GSK to supply the vaccine.”

Shona Robison cabinet secretary for health, wellbeing and sport in Scotland also supports the new vaccine saying: “The Scottish Government has been consistent in its support for the introduction of the Men B vaccine, Bexsero. We will now work to roll out the vaccination programme as quickly as possible.

“By offering this vaccine as part of the routine programme we will be able prevent this and save lives. This disease can be devastating for children and their families and I'm very pleased we can now take the necessary steps to tackle its effects.”

Vaccines such as this are considered to be the most powerful weapon in the fight against disease and second only to clean water, according to the World Health Organization (WHO). So there is little wonder the NHS has introduced a number of new vaccinations into immunisation programmes in the last few years.

The WHO states that “immunisation is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between two and three million deaths each year. It is one of the most cost-effective health investments”.

Another vaccine that gained approval for NHS funding is the Gardasil human papilloma virus (HPV) vaccine, which protects against genital warts as well as cervical cancer. According to the Department of Health (DH) “the HPV vaccine protects against the two types [of HPV] that cause most cases (over 70%) of cervical cancer”.

Cancer Researh UK points out that as “it takes between 10 and 20 years for a cancer to develop after HPV infection, benefits in reducing cervical cancer won't be seen for quite a long time”. It says that the number of cases of pre cancerous changes in the cervix (CIN) will fall quite rapidly and as protection last for 20 years it is expected that the vaccines should last for life but more research is needed.

More recently, in July 2012, a vaccine to prevent rotavirus became a part of the NHS offering. The DH states: “The rotavirus immunisation programme in the UK is expected to prevent a significant number of young infants from developing this infection. A published study estimated that vaccinating a birth cohort of infants in England and Wales may prevent around 90,000 infections and about 10,000 hospitalisations.” Also made available in 2012 was the whooping cough (pertussis) vaccine. The NHS states: “Research from the UK vaccination programme shows that vaccinating pregnant women against whooping cough has been highly effective in protecting young babies until they can have their first vaccination when they are two months old.”

The five-in-one for children vaccine is another recent introduction to the NHS. The Health and Social Care Information Center (HSCIC) has highlighted the success in uptake of this vaccine, stating: “In 2012-13, it was reported that 94.7% of children reaching their first birthday had completed primary immunisation courses against diphtheria, tetanus, pertussis, polio and haemophilus influenzae type B (DTaP/IPV/Hib).”

However, not everyone is convinced about the benefits of vaccination as the 2013 measles outbreak demonstrated. The Guardian reported on the £20 million catch-up campaign to immunise children who had not received [measles, mumps and rubella] MMR jab following an outbreak in Swansea, Wales. The director of immunisation at the Department of Health, David Salisbury, supported the campaign and said at the time: “What is happening in Swansea could happen anywhere in England.”

That particular vaccination had been at the centre of a controversy whereby Dr Andrew Wakefield linked the vaccination to autisim. He was later struck off the register and his research discredited.

The HSCIC said at the time [2013] a catch-up campaign was necessary because, “outbreaks of measles in England have been increasing in the last two years with an annual total of 1,920 confirmed cases in 2012, the highest annual figure since 1994”.

Public Health England's most recent report on measles in the UK states “only four measles infections were laboratory confirmed in England with onset dates in October to December” in 2014.

Additionally, the number of people eligible for the influenza vaccine has increased.

But despite the NHS and leading doctors emphasising the “flu vaccine is the best protection we have against an unpredictable virus” the DH did acknowledge that “the seasonal influenza vaccine has provided low protection this winter [2014/15]” following research into the vaccine by Public Health England (PHE). 

The DH explained: “The research, based on the results from 1,314 patients presenting in primary care across the UK, found that vaccine effectiveness in preventing laboratory confirmed influenza was estimated to be 3% overall.”

The deputy chief medical officer Professor John Watson commented on the report stating: “The latest data show that levels of flu are generally decreasing in the UK. We do see 'drift' in the flu virus from time to time, but even so, I want to reassure people that it is still the best overall way to protect yourself and your family from flu.”

Though in the long run these various vaccine programmes are hoped to save money as well as protect the population, implementation comes at a price.

When the Men B vaccine becomes accessible from September 2015, it will affect the work of medical professionals.

Once in place nurses and GPs will give babies from between the age of two and five three separate doses, ensuring the intervals between are not less than one month. If a child is unvaccinated from the age of six months to 10 years of age they will be given a total of two doses of the vaccine with no less than two months between intervals. However, there has been discussion on the effect this will have on the workload of nurses and doctors distributing the vaccine. Nigel Higson, a retired general practitioner, expressed his concern in response to an article on the British Medical Journal that discussed the new MenB vaccine. “We must all be thankful for the development and success of a vaccine against meningitis B. However, I believe the time has come for the workload and impact that vaccination programmes create on primary care in the UK to be evaluated.”

The HSCIC has shown evidence that prevention through vaccination is positively received by patients: “Reported figures show increases in coverage across all or most childhood vaccinations for most regions.”

Further vaccination programmes are likely. Pharmaceutical company GSK is in the early stages of development with medication and vaccines for HIV, hepatitis C, Alzheimer's and diabetes. Although these are at early phases of the work.

Dr Mary Ramsay, head of immunisation at Public Health England says: “It's been acknowledged that after clean water, vaccination is the most effective public health intervention in the world for saving lives and promoting good health.

“In the UK, immunisation programmes are introduced following independent advice from the Joint Committee of Vaccination and Immunisation (JCVI), who give due consideration of the evidence on cost effectiveness of each programme.”