Leaving no one behind: The current measles outbreak demonstrates the importance of the NHS vaccination strategy

Vaccination is the best line of defence against disease outbreaks. The NHS vaccination strategy will make it easier for people to be protected in the future, says ABPI Medical Director Dr Amit Aggarwal.

Vaccination has saved more lives and prevented more serious diseases than any advance in medical history, resulting in dramatic declines of once common diseases.

Worryingly, the high levels of vaccination once achieved in the UK are in decline. This has increased the likelihood of once rare disease outbreaks, as is currently the case with measles which is the most infectious of all diseases transmitted through the respiratory route. It can also be severe, particularly in immunosuppressed individuals and young infants. [1]

Uptake of the first dose of the MMR vaccine – which protects against measles, mumps and rubella – in children aged two years in England is 89 per cent, and uptake of the two MMR doses required to ensure lifelong immunity in children aged five years is now 85 per cent. This is well below the 95 per cent target set by the World Health Organization (WHO) as the level needed to prevent outbreaks and protect the population including very young infants and vulnerable groups. Troublingly, last year no childhood vaccination programme in England achieved the WHO target of 95 per cent coverage. [2]

Beneath the headline national figures on vaccination there are significant inequalities across the country and between communities. Too often, people at the highest risk of vaccine-preventable diseases also have the lowest uptake of vaccines and the worst health outcomes as a result.

A catchup campaign for the MMR vaccine is already underway in key areas, but more broadly, NHS England’s vaccination strategy and comparable approaches in the devolved nations will be crucial to raising levels of vaccination for all diseases, and preventing outbreaks in the first place.

In England, for the first time, the vaccination strategy gives each area the responsibility and flexibility to design vaccination services according to the needs of its population. Integrated Care Systems will combine a ‘core offer’ that should be consistent across England with a new, separate requirement for targeted outreach to under-served populations. Services will be delivered by integrated multidisciplinary neighbourhood teams which can offer vaccination alongside other preventative and public health measures. There are already some great examples of roving outreach teams delivering vaccination alongside ‘health MOTs’ and advice on stopping smoking.

The reasons people don’t take up the offer of vaccination are varied and complex. They include inconvenient clinic times or locations; language barriers; uncertainty about whether vaccines are needed, safe or effective; lack of time in consultations to discuss concerns; religious or cultural barriers; and individual barriers such as sensory impairment. The strategy recognises that collaboration between NHS providers, local authorities and partners such as trusted community groups and patient organisations will be instrumental to addressing these challenges and meeting the needs of communities and individuals most at risk.

Vaccines researchers are supporting efforts to reduce vaccine inequity by improving the diversity of participants in clinical trials. Diversity includes age, sex, ethnicity, health and socio-economic status and is vital to understanding how the full range of people who might be offered a vaccine will respond to it.

During the pandemic it became clear that a simple, convenient and efficient ‘front door’ is crucial to encouraging people to take up the vaccines they are offered. The COVID-19 vaccination programme brought innovations such as easy personal access to vaccination records through the NHS App, a national booking facility, new data management system, and workforce flexibilities which enabled clinically supervised unregistered staff to vaccinate. The strategy includes exploring how these innovations could be extended to other immunisation programmes.

It will be important to carefully monitor the impact of the strategy over time to ensure it is delivering the outcomes we need to see.

Every additional vaccination is an opportunity to prevent illness or save a life. Putting this Strategy into action will make it easier for people to be protected against vaccine-preventable diseases in the future and help ensure no one is left behind.

[1] UK Health Security Agency, National measles guidelines, January 2024, p4, available at https://assets.publishing.service.gov.uk/media/65a7a806867cd800135ae9bb/national-measles-guidelines-january-2024.pdf

[2] NHS Digital, Childhood Vaccination Coverage Statistics, England, 2022-23, available at https://digital.nhs.uk/data-and-information/publications/statistical/nhs-immunisation-statistics/england-2022-23