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England misses targets for almost all preschool vaccines in 2018/19, new report finds

A new report by the National Audit Office has found that NHS England missed vaccination targets for nearly all preschool vaccines in 2018/19.

All but one of the vaccines that are recommended for children of preschool age had below 95% uptake in England, according to the investigation – missing the optimum coverage level recommended by the Department of Health and Social Care.

NHS England has said it plans to bring groups of GPs and healthcare professionals together to agree ‘collective action’ to reverse the falling vaccination rates. 

The NAO report found that uptake of both doses of the MMR vaccine by five years of age was 86.4%, down from 88.3% in 2013/14. It also found that:

  • Uptake of the 5-in-1 vaccine by two years of age was 94.2%, down from 96.1% in 2013/14.
  • Uptake of the pneumococcal vaccine by 12 months of age was 92.8%, down from 94.1% in 2013/14.

It suggested that the dismantling of primary care trusts in 2013 may have contributed to the drop in vaccination uptake, as vaccination appointment call/recall requirements for GP practices were not clearly laid out by NHS England, leading to inconsistencies in practice across the country. It also found that there is ‘limited evidence’ that ‘anti-vaxx’ messages contributed to the falling rates of uptake. 

The NAO report said that under-served communities, including Travellers, recent migrants and some religious groups, who struggle to access healthcare services in traditional ways and may struggle to access vaccination appointments, contributed to the falling rates.

Prime Minister Boris Johnson said earlier this year that the role of ‘local immunisation coordinators’ must be strengthened in order to encourage hard-to-reach groups to vaccinate, following news that the World Health Organization had rescinded the UK’s ‘measles-free’ status. 

NHS England said in response to the report that it hoped the introduction of PCNs would help with access, as they could offer more evening and weekend appointments for patients. NHS England also said that it would look at how payments to GPs, particularly for the MMR vaccine, could help boost uptake. 

Dr Richard Vautrey, BMA GP Committee chair, commented: ‘Practices are striving to reach everyone who can be vaccinated using every opportunity to encourage uptake of vaccinations. However, we need resources for improved information systems, particularly regional databases, so that records and vaccination figures are always accurate.

‘Re-organisation and cuts to services delivered outside of practices – including public health, health visitors and school nurses – mean there are fewer opportunities for both positive discussions around the importance of vaccines and to identify any children who may have missed out earlier.

‘It’s positive that the Government, NHS England and Public Health England are beginning to prioritise improving vaccine uptake, and crucially we need better research into why certain groups are still not having their children protected and how best to target them effectively.’

Measures that will be taken forward by NHS England to combat falling vaccine rates, according to the investigation, will include improving the consistency of call/recall systems, continuing to promote information on vaccine safety and tackle false messaging, and implementing a more consistent approach to working with under-served communities.

Professor Stephen Powis, NHS medical director said: ‘Looking at ways to expand access to appointments will make it even easier for parents to protect their children and with the NHS playing its part, it is vital that everyone takes up this life-saving opportunity and isn’t swayed by the dangerous marketing of false information by anti-vaxxers.’

The news comes as official figures released by NHS Digital in September showed that coverage of all 13 childhood vaccinations fell over the last year. 

Health Secretary Matt Hancock said earlier this month that there was a ‘strong argument’ for compulsory preschool vaccination.


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