Let's not reinvent the wheel

A new NICE guideline (NG218) on Vaccine Uptake in the General Population was published in May 2022. This replaces the 2009 guideline which focused on immunisation in the under 19s. This latest version emphasises the importance of vaccine programmes throughout the life course not just in childhood and adolescence. The evidence, on how to best ensure maximum uptake of vaccines, reinforces the need for: availability of high quality data on an individual’s vaccine history for use by local health care professionals and the individual and which links into local and national systems.   Such data are also a necessity for having effective systems to call people in when vaccines are due and to recall and remind them if they don’t respond; services which are designed and relevant for the local population, with a trained and knowledgeable workforce who are able to ensure patient safety and provide evidence based information which people trust. In essence this echoes and reinforces much of the advice published in 2009 and subsequent revisions.

Vaccines save lives. The World Health Organization (WHO) has indicated that globally vaccines save the lives of 3 – 3.5 million children every year. However, in 2019, the WHO warned that vaccine hesitancy was one of the top ten threats to global health (WHO 2019). This underlines the need to maintain a focus on vaccine programmes, once introduced they need constant attention to ensure continued success.  The recent detection of polio virus in North London sewage is a sharp reminder of how tenuous our control on infectious diseases is. 

Across the UK nationally, the overall uptake of childhood vaccines remains reasonably high. However, small declines in uptake each year for the past eight years (NHS Digital) are a cause for concern as are the marked disparities in uptake, with London consistently falling well behind most other parts of the country. The pandemic has also had an impact on uptake.  At the start of the first lockdown in March 2020 the communications focussed on advising people to stay at home, not burden the NHS, etc. Many interpreted this to include all routine services, including vaccination, and the public were only advised several months later about the importance of ensuring they got their vaccines (Bell et al 2020 and Skirrow et al 2022). 

The COVID-19 vaccine programme has provided yet more evidence of the value of vaccination with recent data suggesting that COVID-19 vaccines saved 20 million lives in the first year of their use (Watson et al 2022). In the UK, high demand for vaccination was evident with people literally queuing around the block at vaccination centres. Clinics were set up as pop-ups or in venues including religious buildings and sports grounds to make the vaccine as easily accessible to all groups in the community as possible. These initiatives all contributed to a highly successful programme prompting questions about what can be learnt from it to apply to improving uptake in other vaccine programmes. 

Some of these lessons include ensuring rapid access to reliable data and accessibility of tailored vaccination services for people in the places they are living and working to meet population needs. However, delivering a specific vaccine programme in response to a global pandemic is very different from delivering a highly complex, constantly evolving programme designed to protect the population against many different infections and diseases.

We must be cautious about trying to reinvent a service which has already proved successful. The reality is that sustained focus is required to make vaccine services work and remain relevant and accessible to the population. We can never be complacent and there is real danger in thinking it’s done…. you can never take your foot off the pedal. The newly published NICE guidance is a must read for all those involved in the provision of vaccine services. It highlights that although there are some remaining questions about how to improve vaccine uptake, we already have a solid evidence base to inform the strengthening of our services.

The guideline referred to in this blog was produced by the Guideline development Team for the National Institute for Health and Care Excellence (NICE). The views expressed in this blog are those of the authors and not necessarily those of NICE.