By: Patrick Swain

A year ago today, Prime Minister Boris Johnson delivered a speech which marked the beginning of the UK’s first national lockdown. Millions of people were ordered to stay at home to suppress the spread of COVID-19, in order to save lives and stop the NHS from becoming overwhelmed. Life ever since has become unrecognisable.

Yet one year on, and thanks to the marvels of medical science, over half of UK adults have received at least one dose of a COVID-19 vaccine. These were developed, tested and manufactured in record time and now offer us a glimmer of hope. There is finally light at the end of a very long and arduous tunnel.

And while washing hands, wearing masks and social distancing were made key priorities to limit the spread of the virus, it was always clear from the start that a vaccine would be the only way out of this pandemic. COVID-19, for all the lives lost and misery caused, has acted as a stark reminder about the importance of immunisation.

The COVID-19 vaccine offers society the best form of protection against the virus. Once immunised, our bodies are better able to fight the disease if we come into contact with it.

This is even more critical for the millions of adults in the UK living with an underlying health condition. Since the beginning of the pandemic, the government has advised those who are clinically extremely vulnerable (CEV) to shield at home. Now, they have been prioritised to receive the COVID-19 vaccine first. As it stands, 90% of CEV individuals have had at least one dose(1).

Despite this high uptake, vaccination rates for other preventable diseases remain low. Pre-pandemic, for example, the influenza vaccine had a 44% take-up rate among adults with an underlying health condition(2). The pneumonia vaccine (PPV) was even lower, at just 17% (3). But given that flu, pneumonia and COVID-19 are all preventable respiratory illnesses and can become life-threatening to CEV individuals, why is take-up low?

Obviously, the current prevalence of COVID-19 in the community means that vaccine uptake will be considerably higher than for other diseases. Given that COVID-19 is far more infectious and can be transmitted asymptomatically, there is a much greater need to immunise the wider population to reduce the strain on the NHS and ensure that we can return to normality sooner. The swift and successful rollout of the vaccine has also been met with a positive response, with high take-up levels thanks to people’s willingness to roll up their sleeves and receive a jab upon invitation.

Yet given that the mortality rate for diseases such as influenza is 10 times higher across at-risk groups, why does it have a much lower vaccine uptake? The World Health Organization’s (WHO) influenza vaccination target for older people and those with underlying conditions is 75%; while the UK reached this goal for over-65s last winter (80%)(4), it remains woefully off target for the latter cohort. Despite an increase from pre-pandemic levels, flu vaccine take-up across at-risk groups was still only 52% last year(5).

Understanding this disparity is important in order to find ways to increase uptake and prevent excess morbidity and mortality for those most medically at-risk. ILC is currently exploring a programme of work – initiated and commissioned by MSD – to look at how to improve immunisation across adults in the UK with underlying health conditions.

Our preliminary discussions with health charities and at-risk individuals has highlighted that getting vaccinated can be complex. While vaccination comes down to an individual choice, a large number of external factors can impact a person’s decision. Socioeconomic, cultural and religious factors, as well as historical reasons and structural barriers means that uptake across certain patient groups is much lower. Online misinformation has also resulted in growing scepticism and people deciding not to take vaccines.

Therefore, finding solutions to combat these barriers is key. In particular, measures which help to increase accessibility and improve awareness and understanding is crucial. Having better means to receive vaccinations, as well as the knowledge and confidence about vaccines, could really improve uptake among at-risk groups.

Practical solutions such as administering vaccines in clinical settings could be more beneficial for patients receiving specialist care. For example, individuals with chronic kidney disease (CKD) could be offered seasonal vaccines during dialysis appointments. Given that flu vaccine uptake is 51%(6) for adult CKD patients, and just 7% for pneumonia (7) expanding access may be one solution to improve these immunisation rates. Seeming as there is a large gap between uptake for these two vaccines in general, offering all patients both at the same could also help to improve pneumonia vaccination figures.

Ensuring that GPs and clinicians provide patients the right information is also critical. Clear and practical guidance about vaccine efficacy, safety and compatibility with medication is key to making sure that at-risk groups are aware of the vaccines they can and should be taking. Ensuring that primary care staff are up-to-date with this information is important in order to make patients feel more comfortable about their vaccine choices.

Furthermore, targeted communication which resonates with patients as well as more reluctant communities is important. As highlighted in ILC’s 2019 paper Contained or Contagious?, unified messaging across all parts of society is vital (8). Making vaccines more transparent and recognisable to patients and marginalised groups can help to build confidence in the process. The recent collaboration between the NHS and patient group charities is a perfect example of this; the joint communication campaign aims to encourage people with underlying health conditions to get their COVID-19 vaccine. This approach could also be adopted for other seasonal vaccines in the future.

Thanks to the vaccine, we are edging closer to the end of this pandemic just a year after the first lockdown. This phenomenal achievement highlights how critical immunisation is in order to protect society from disease outbreaks. But moving beyond COVID-19, we must not forget this. The conversation about the benefits of vaccines and how they safeguard people must continue. In particular, improving uptake so that we reach the WHO’s 75% target should become a priority for the government and patient group charities. Current levels show how susceptible some at-risk groups are to vaccine-preventable diseases.

Moving forward, we must find ways to improve accessibility, information and communication on vaccinations. Ensuring that adults with underlying health conditions have better access to vaccines and a greater understanding of their benefits will result in improved confidence in the immunisation process and thus a greater uptake. More importantly, though, it will mean greater protection against diseases which we now know can have devastating consequences and long-lasting impacts on society.

References

NHS England (2021) COVID-19 weekly announced vaccinations 11 March 2021

PHE England (2021) Seasonal influenza vaccine uptake in GP patients: winter season 2019 to 2020

PHE England (2020) Pneumococcal Polysaccharide Vaccine (PPV) coverage report, England, April 2019 to March 2020

PHE England (2021) Seasonal flu vaccine uptake in GP patients: monthly data, 2020 to 2021

PHE England (2021) Seasonal flu vaccine uptake in GP patients: monthly data, 2020 to 2021

PHE England (2021) Seasonal influenza vaccine uptake in GP patients: winter season 2019 to 2020

PHE England (2020) Pneumococcal Polysaccharide Vaccine (PPV) coverage report, England, April 2019 to March 2020

ILC UK (2019) Contained or contagious?