Immune Response: Adult immunisation in the UK

Report urges greater role for pharmacy in adult immunisation; the introduction of adult vaccination record card; and a review of whether the approach to vaccination of social care workers is adequate.

Immune Response, published in November 2013, by the leading think tank on longevity and demographic change, the International Longevity Centre – UK (ILC-UK), sets out proposals for the UK to become a world leader in terms of the vaccination of older people.

Immune Response argued that whilst prevention is better than a cure, vaccination remains an underused public health strategy for adults in the UK and across Europe. According to the WHO, immunisation prevents between 2-3 million deaths a year across all age groups

ILC-UK argue that the growth of antibiotic resistance, the challenges of immunosenescence and the context of migration mean that we need to put greater focus on improving adult vaccination in the UK.

The report highlights new evidence, published by SAATI last week in Brussels, which found cost effectiveness evidence for vaccination of older people in relation to herpes zoster, influenza, Invasive pneumococcal disease and pneumonia. The SAATI report presented a framework to evaluate investments in health from a government perspective that revealed that every €1 invested in adult vaccination commencing at the age of 50 years would yield €4.02 of future economic revenue for government over the lifetime of the cohort (Netherlands case study).

The SAATI report also highlighted the ongoing impact of vaccine preventable diseases on health in the UK.

  • Seasonal influenza: The UK reported a 2010-11 winter period more severe in terms of pressure on hospitals than during the 2009-10 pandemic winter. In 2012-13, excess death rates were the highest since 2008-09, with peaks coinciding with influenza circulation (Public Health England).
  • Pneumonia: UK and Slovakia have the highest reported mortality rates in Europe (25 per 100 000 population cases in 2005 and 2009).
  • Invasive pneumococcal disease: In 2005, the UK, as well as Belgium, Ireland and Sweden, reported rates of confirmed cases which approach or are greater than 10 per 100 000.

Among the thirty plus recommendations set out in Immune Response, ILC-UK call for:

  • The piloting of a voucher scheme for those eligible for the seasonal flu vaccine. These vouchers could be used not just in GP surgeries but also in registered high street pharmacies.
  • Public Health England and the Department of Health should review whether the current approach to the vaccination of social care workforce in England is appropriate.
  • The QOF to include an annual check on the immunisation status of all GP registered patients.
  • Healthcare professionals undertaking health check-ups of older people to check whether their patients are up to date with their vaccines.

ILC-UK set out a number of proposals to support the creation of a better informed and engaged health consumer. They propose:

  • The introduction of an adult vaccination record card which could be carried throughout a lifetime.
  • A simplified adult vaccination checklist for the over 18s.
  • Encouraging people to incorporate a record of their immunisation history to be carried with their passport.
  • GPs to be permitted to privately prescribe approved vaccinations (in addition to travel vaccines) to adults on their books.

ILC-UK also call upon the Prime Minister’s Behavioural insight Unit (“Nudge Unit”) to explore the potential to use behavioural economics to improve take-up of vaccinations amongst adults. ILC-UK propose the team consider:

  • The use of ‘declination forms’ by health services and employers could encourage employees to think twice about turning down vaccination.
  • How to play on the strong sense of civic duty which might encourage vaccination to protect others, particularly if advised to do so by their physicians.
  • Creating a social norm of adult vaccination (beyond flu) through an investment in communications.
  • How to make vaccination an “easy” default choice?

Baroness Sally Greengross, Chief Executive of ILC-UK said:
Innovations in public health over the past two hundred years have transformed life expectancy in the UK and we are living longer than ever before. Over recent decades, policymakers have begun to use vaccination to support good health later in life.

So we start from a very positive place. But now is not the time to get complacent.  The growth of antibiotic resistance, the challenges of immunosenescence and the context of migration mean that we need to put greater focus on improving uptake of adult vaccinations in the UK.

David Sinclair, Assistant Director, Policy and Communications at ILC-UK added:
The UK takes a world leading approach to childhood immunisation. With an ageing society we must focus more on prevention of ill health and the vaccination of older people has to play an important role. We must improve the levels of vaccination amongst NHS staff whilst also ensuring that employees from the independent social care sector access the vaccinations they need. We must also make vaccination more accessible. An enhanced role for pharmacies could help achieve this. We need an informed consumer who knows what vaccinations they need across their life. An adult vaccination record card for all is vital.

Dr Peter Carter, Chief Executive & General Secretary of the RCN said:
Nurses are ideally placed to lead the move towards improved adult vaccination in the UK, and checking that patients are up to date with their vaccinations should be part of all routine health check ups.

Nursing staff are often the first or only point of contact people have with the health service, which means they have the opportunity to talk with patients about all aspects of their health, and encourage a healthier lifestyle. This should also include checking patients are up to date with routine immunisations, which is fundamental to public health.”

Professor David Taylor, Professor of Pharmaceutical and Public Health Policy, The UCL School of Pharmacy:
Extending access to vaccination amongst older people has a significant potential for improving public health in the UK and Europe more broadly. The International Longevity Centre’s new report highlights the fact that although the UK’s record is already relatively good we could do more to optimise immunisation rates throughout our life courses. Greater community pharmacy involvement in the delivery of seasonal influenza vaccination for older people could generate increased health gains. So could enhanced protection against shingles in older people and better use of vaccines to guard against the long term consequences of conditions such as hepatitis, meningitis and HPV infection in younger men and women.

The report is available on the ILC-UK website via this link: Immune Response