Childhood and School-Age Immunisation Programmes in Brent
The report summarises the work in providing immunisation programmes to children in the London Borough of Brent in 2017/18.
Dr Catherine Heffernan (Principal Advisor for Commissioning Immunisations and Vaccination Services, Public Health England) and Lucy Rumbellow (Immunisation Commissioning Manager for North West London, Public Health England) introduced the report which provided an overview of Section 7a childhood and school age immunisation programmes in the London Borough of Brent for 2017/18. There were 18 publicly funded immunisation programmes under Section 7a which covered the life-course. However, Dr Heffernan said that the focus of the paper was on immunisation programmes provided for 0-5 years under the national Routine Childhood Immunisation Schedule and those programmes provided for children aged 4-18. She spoke about the routine childhood immunisation programme outlined in section 4.1 of the report (page 16 of the Agenda pack) and said that London had been a complicated area to examine and it had performed worse than other parts of the country. Some of the reasons for this could be related to the vast diversity of the population living in the city, the high mobility rates and the high turnover of people. For example, by the age of one, one-third of children would have changed address at least once which this made it difficult to collect and track data.
The Committee heard that in line with other London Boroughs, Brent had not achieved the World Health Organisation recommended 95% uptake coverage for the primaries and Measles, Mumps and Rubella (MMR). Although the Borough’s rates were one of the highest in North West London, there was a concern that a cluster could be created in an area where people had not been vaccinated. Therefore, it was important for residents to visit their General Practitioners (GPs) and get their vaccinations done. Dr Heffernan pointed out that Public Health England was working to increase the number of vaccinations available as well as the number of vaccination nurses.
Ms Rumbellow provided an update of specific vaccinations such the ones against MMR and flu. She said that drop prior to the second intake of the MMR vaccine was in line with national trends and that although there had been an increase in the update of flu vaccines (current rate 34%), there were dips in years 2, 3 and 4 which had been addressed with the Local Authority. In relation to risks, Ms Rumbellow noted that there had been a national Measles incident, with young adults who had not had their MMR vaccination being a group of concern. An action plan to respond to an outbreak of Measles had been created and Public Health England was working towards raising awareness of the importance of having the MMR vaccine. Members heard that if a cluster or an outbreak was declared, the initial response would be to vaccinate people in the nearby area.
As far as challenges related to uptake were concerned, it was noted that although Brent had some specific barriers, these were not dissimilar from the ones in other areas of London. As Brent had a very diverse community, it was difficult to ensure that immunisation records were correct – vaccines could have been given without being properly recorded and vice versa. Public Health England had been working with the National Health Service (NHS) Digital to simplify its childcare information centre which was expected to contribute to the removal of double counting. Moreover, in some cases, such as flu vaccines, parents did not see the value of having of one or had declined their child to be immunised due to cultural reasons. Dr Heffernan explained that it was difficult to point out groups that were more or less likely to take vaccines as uptake varied by practice. Nevertheless, she supported the Committee’s view that community engagement was essential for increasing uptake. Work had been undertaken with the British Society for Immunology to establish the best way to communicate information about vaccines to various communities. Dr Heffernan acknowledged that Central and North West London NHS Trust, the provider of the vaccination service, could do more to engage with schools and raise awareness about vaccinations among teachers. A newsletter publication would be issued prior to the flu season as part of the process of improving the relationship between schools and the Trust. In addition, Public Health England, the commissioner of the service, held regular meetings with the Trust to allow issues to be escalated in a timely manner, e.g. letters about future vaccinations not being delivered to parents, and workshops with providers had been organised to take place every six months.
Dr Heffernan spoke of the need for an innovative approach to engaging schools to achieve better results. For example, the lack of return of consent forms had been a major issue as in some areas up to 55% of the forms were missing, hence, an e-consent form had been trialled. In response to a question about the reasons for lack of engagement, she said that refusals were mainly in primary schools which created a paradox because despite the school refusing to let vaccination nurses in, the child had the right to be offered the vaccine. Nevertheless, Dr Heffernan reassured Members that the number of schools refusing vaccinations, which had been religious or independent schools, was small and was declining.
Councillor Hirani (Lead Member for Public Health, Culture and Leisure) noted that there had been difficulties in engaging schools in other projects which were not related to immunisation and suggested that it might be helpful to present issues at the Headteachers Forum which would allow head teachers to discuss the benefits of various initiatives and share experiences.
A Member of the Committee asked a question that related to the monitoring of immunisation uptake and taking measures to ensure that people were informed about the vaccinations they had to have prior to arriving in the United Kingdom. Dr Heffernan said that immunisation records were part of GP records. When registering a new patient, GPs would ask patients what immunisations they had had and would follow guidance issued by Public Health England, which in most cases advised them to give a vaccine if they were not sure whether a patient had had it.
A Co-opted Member referred to figure 16 on page 31 of the Agenda pack and asked for an explanation why the figures for Human papillomavirus (HPV) vaccinations in Brent were declining. Dr Heffernan explained that the course of the vaccine had been changed, with the number of courses being reduced from three to two so in order to compare results accurately, it was necessary to look at the number of completed doses in Year 9. Moreover, as Brent had a considerably bigger eligible cohort, once vaccinations in Year 9 had been completed, the percentage of the population that had been vaccinated would increase. Responding to a question about the factors used to determine eligibility for the HPV vaccine, Dr Heffernan said that although there was no medical risk to offer the vaccination to girls who had had a sexual contact, it was preferable to give it prior to that. Furthermore, being sexually active was not a reason not to offer the vaccine.
The Committee discussed the role of parents in ensuring that their children had been vaccinated. It was noted that parents were the guardians of children’s health and it was their decision whether to vaccinate them. However, parents had the right to information and had to be empowered to make rational decisions. Public Health England had drafted the Serving the Underserved Strategy as part of which immunisation champions had been recruited to promote the benefits of vaccines and engage residents, including those whose first language was not English.
The Chair invited Julie Pal (Chief Executive, Healthwatch Brent) to comment on the report. Ms Pal said that she shared the concerns raised by the Committee around the uptake of flu vaccinations. She suggested that Healthwatch could work with Public Health England to encourage uptake and engage with schools to promote the benefits of the HPV vaccine and de-stigmatise some of the areas covered by it.
(i) The contents of the Childhood and School-Age Immunisation Programmes in Brent report, be noted;
(ii) Public Health England takes up the opportunity to work with the British Society for Immunology to promote understanding of vaccination and engage the community in Brent, including the recruitment of lay immunisation champions and reaching out to community and religious groups;
(iii)Public Health England works in partnership with Healthwatch Brent to promote the benefits of immunisation;
(iv)The provider Trust, the Council’s Public Health service and Public Health England collaborate with education professionals to determine what could be done to support Public Health England’s access to schools;
(v) The Council’s Public Health service and Public Health England work together to identify available resources and create a structured outreach programme, including training of non-clinical staff to have a basic understanding of childhood immunisation and the benefits of it.
- 06_Childhood Immunisation Cover Report, item 6. PDF 80 KB
- 06a_CWSC Brent Immunisation Report 2018, item 6. PDF 350 KB