Professor Helen Bedford discusses how pressures on health visitors are impacting measles vaccinations rates in the UK
It is encouraging to hear that the Government takes the issue of vaccination rates seriously. Last week, following news that the UK has lost its measles free status, a series of measures to improve vaccine uptake rates with a particular focus on MMR vaccine, was announced. These include making vaccination more accessible, addressing parents’ concerns and sending reminders for vaccination. These are not new – indeed they form many of the recommendations made by NICE 10 years ago and were more recently underlined in Public Health England’s (PHE) measles rubella elimination strategy.
So, why are they needed? Uptake of vaccines in the UK is generally high with over 90% of 12-month olds fully immunised with the 6-in-1 vaccine and with the first dose of MMR vaccine by 24 months. However, pockets of lower uptake remain, for example in parts of London, a complicated city with considerable population mobility and social disadvantage, rates are considerably lower than elsewhere in the country, bringing down the average uptake in England. Some groups of children in particular are less likely to be vaccinated for a variety of reasons, mainly difficulties accessing services, including for example, children in care, children in large families, children with chronic health conditions or disabilities, and children in traveller and other highly mobile families.
Promotion of vaccination is one of the six high impact areas included in the health visitor-led Healthy Child Programme (HCP), the universal public health programme for children and families. Health visitors are an important source of advice for parents, and their contacts in the early weeks after a baby’s birth come at a critical time when parents are making vaccine decisions for their babies. Although it is regrettably uncommon for health visitors to actually administer vaccines, parents need information to support their decision making before they attend for vaccination. Indeed, if they are unsure about vaccination, without such advice they may never actually attend at all. This advice is valuable, with research by Public Health England among parents showing that a high proportion receive vaccination advice from health visitors, they trust it and it makes them more confident about vaccination.
The problem is current pressures in the system. Cuts to public health spending have resulted in a decline of 24% in health visitor numbers since 2015 with large number of parents not seeing a qualified health visitor after 6-8 weeks. In England, health visitors’ capacity to deliver all five of the HCP-mandated health and development reviews is reduced as they become increasingly focussed on supporting the most vulnerable children and families. This, together with pressure in general practice, with many practices closing due to difficulties with recruitment and retention of staff, make it more difficult for parents to get the specialised information they need or to get an appointment for vaccination. In a recent survey by the Royal Society for Public Health, timing of appointments, availability of appointments and childcare duties were identified as key barriers to vaccination.
Vaccination has been shown to be the most effective medical intervention available. It prevents serious illness and disability and saves lives. In the 50 years since vaccination against measles became available in the UK, it is estimated that it has prevented 20 million measles cases and 4,500 deaths. While the Government’s announcement of measures to improve uptake of vaccination to ensure this continued success is welcome, achieving this will require more than just words.
Increasing and maintaining high vaccine uptake will quite simply require more money for staff and resources. As the ultimate goal of any just society is to provide children, our future, with the best start in life, surely this would be money well spent?
Professor Helen Bedford is a professor of children’s health at the University College London Great Ormond Street Institute of Child Health. She has a background in nursing and health visiting and her research focusses on the determinants of childhood vaccine uptake.