10 | Nursing in Practice | Summer 2023
ANALYSIS
Nurses key to reversing
the decline in childhood immunisation uptake
WHO child immunisation targets are now regularly missed , with the pandemic and inequality of access taking the blame . Wiliam Hunter investigates initiatives to tackle the problem and looks at the importance of nursing expertise in any potential solutions
The outbreak of the Covid-19 pandemic saw the topic of vaccination gain huge importance in the lives of patients and clinicians . However , a glance at the statistics for routine childhood and adolescent vaccination tells another story .
While the rollout of the Covid-19 vaccination has been praised as a success in public health policy , uptake of other vaccinations has been in near-freefall , with the UK health security agency ( UKHSA ) recently warning that young people are now at risk of disease due to declining immunisation rates .
Data released by UKHSA show that , during the 2021 / 22 academic year , uptake of Td / IPV and MenACWY vaccines for children in Year 9 ( age 13-14 ) was 69 %, around 7 % lower than the previous year and well below prepandemic levels . 1 The two vaccinations protect children from tetanus , diphtheria , polio and four types of meningococcal disease .
Now , with uptake well below the 95 % target set by the World Health Organization , Professor Helen Bedford , professor of children ’ s health at UCL Great Ormond Street Institute of Child Health , says ‘ there is a real risk of having big outbreaks ’ of these diseases .
She cites recent incidents to illustrate her point . ‘ We ’ ve had diphtheria in asylum seekers , and polio in sewage water . These are really striking demonstrations that if we don ’ t keep vaccinations up , these diseases can get a hold .’
Why is uptake continuing to fall ? Based on the changes in uptake since 2019 , one common response has been to ascribe falling rates to missed appointments during the national lockdowns .
A study published by researchers at the University of Oxford found pandemic-related disruption had led to a global drop in uptake . 2
However , as Professor Bedford and many others have pointed out , the decline in uptake started well before the arrival of Covid-19 .
‘ The decline has been going on for 10 years now ,’ Professor Bedford tells Nursing in Practice . She attributes the beginning of the decline in England to the NHS reforms in 2013 , which changed the way immunisation services were commissioned . This included the introduction of CCGs and the transfer of responsibility for the health service from the Department of Health and Social Care to NHS England .
Crucially , the 2013 reorganisation also removed the role of immunisation coordinator in England . This position carried responsibility for ensuring nurses were trained to national minimum standards for immunisation , as well as for supporting surgeries that had lower uptake .
RCN professional lead for primary care Heather Randle explains the importance of the role and why it has been missed : ‘ They would run the programmes and then go out to do the assessing . That built their relationship with the nurses so that when nurses had problems , they could go to them .
‘ They would also support practices where rates had dropped to get their immunisation rates back up , and I feel that there is a really big gap now .’
Vaccine hesitancy There are also growing concerns that Covid-19 might have had a long-term impact on uptake rates by damaging trust in healthcare services and increasing rates of hesitancy .
Sharon White , chief executive of the School and Public Health Nurses Association ( SAPHNA ), tells Nursing in Practice school nurses are being asked more questions by parents , teachers and pupils around ‘ anti-vax propaganda information ’.
Ms White believes ‘ mixed and sometimes contradictory ’ messaging around vaccinations during the pandemic has ‘ dented confidence significantly ’.
Likewise , Professor Bedford says parents now have more concerns and questions in relation to vaccinating their children than a decade ago , because of the rise in ‘ misinformation or even disinformation ’ around the subject of vaccinations .
Similarly , GP partner Dr Priya Kumar , who is NHS health inequalities lead for Slough , says a lack of clear communication over the Covid vaccines may have harmed public confidence .
She says some patients who had a Covid-19 vaccine but still contracted the virus may not now see the value of routine immunisation , perhaps due to a lack of understanding of the different function of those immunisations .
‘ We ’ ve had families who think that because of the vaccine their loved ones have died , and people who think “ I ’ ve had Covid , I didn ’ t die . So , what are all these other vaccines , and do we really need them ?’’’
Mixed messaging around vaccines during the pandemic has dented confidence significantly Sharon White