24 November 2014
Article by Dr Shane Doheny, National Assembly for Wales Research Service
On 11 June 2013, the Minister for Health and Social Services, Mark Drakeford AM, announced changes to the National Immunisation Programme 2013-14. While each of the four UK countries can determine their own immunisations strategies, these are usually based on the advice of the Joint Committee on Vaccination and Immunisation (JCVI), as a way of ensuring UK wide coverage against specified diseases. In June 2013 the Welsh Government announced that it had:
- made changes to the timing and delivery of the MenC vaccine;
- introduced a Rotavirus vaccination programme for babies at two and three months of age;
- introduced a Shingles Vaccine for people over 70 years of age;
- provided for two and three year olds, and for children in school Year 7, to receive the seasonal influenza vaccine; and
- introduced a second flu vaccine for children up to nine years old who are considered at risk of developing complications.
The Welsh Government has set a Tier 1 target for children’s immunisation; for 95% of all resident children under four years of age to be up to date with all of their immunisations. The Welsh Government has been making advances in this area and the Chief Medical Officer (CMO) noted in her annual report that ‘the proportion of children fully up to date with routine vaccinations increased from 83 per cent to 88 per cent, with further increases anticipated’.
Poverty and deprivation continues to impact vaccination rates. According to Public Health Wales Observatory, in 2012, children from the most deprived areas in Wales were 9% less likely to be up to date with their immunisations than those in the least deprived wards.
Measles mumps rubella (MMR)
Although the Welsh Government is now achieving its target of 95% of young people receiving the MMR, concerns remain about the MMR booster. Recognising that ‘one in ten 16-year-olds in 2013 was still not fully Immunised’ the CMO advises that ‘sporadic cases of measles virus imported in to Wales with limited localised spread’ are likely in the coming years.
In the Assembly on 4 November 2014, the Minister noted how geography has impacted take up of a first MMR vaccination among 10-16 year olds ‘who missed out during the period of controversy about the MMR’ observing ‘that it is one of those areas that people respond to when they think the risk is really on their doorstep. […] So, it is not an easy area to make as much progress in as we would like.’
Human papillomavirus (HPV)
In September 2008, a HPV vaccine was added to the UK Childhood Immunisation schedule. There are many different types of HPV, and these are primarily passed on through sexual contact. The HPV vaccine is designed to protect against the types of HPV that most commonly lead to cervical cancer later in life, and is given to 12-13 year old girls, in three doses over a period of six months.
According to the CMO’s report, this vaccination programme was achieving 85.4% coverage for the full three dose course. The CMO also noted the increased prevalence of HPV related oral or throat cancers in men. Given this, the JCVI’s HPV sub-committee has been examining plans to extend the HPV vaccination programme to target men who have sex with men, and a universal vaccination program that includes adolescent boys.
The CMO states that ‘Meningococcal group B (MenB) now accounts for over 80 per cent of cases following the MenC vaccine campaign’. At the Assembly on 4 November, the Minister referred to the work of the JCVI which:
has recommended the introduction of meningitis B vaccination, provided that it can be supplied by the manufacturer at a cost-effective price. It is the Department of Health in London that is leading on behalf of all four nations in the negotiations with the manufacturer, and they are not, as yet, concluded.
In 2013, the seasonal influenza programme was extended to and all children aged two and three years of age, delivered using a nasal spray vaccine, and children in Year 7, vaccinated through the school nursing service. According to the CMO:
Uptake of influenza vaccine was 68 per cent for school year children and 38 per cent for infant age group. This is the first year of a programme planned eventually to offer all children aged two to 16 years vaccination against influenza every autumn.
Uptake of the influenza vaccine among health care workers was discussed in the Assembly on 4 November 2014. The Welsh Government’s target is that 50% of healthcare workers take this vaccine, and uptake has increased from 11.6% in 2009-10 to 40.6% in 2013-14. The Minister discussed changing the target but argued ‘that it would be demotivating, in this year, to move the goalposts further forward just as we look as though we are about to reach them’. Nevertheless, the Minister was ‘clear that this is the last year in which we will rely entirely on persuasion and making it easier for staff to take up the flu vaccination’.