6. Statement by the Minister for Health and Social Services: National Immunisation Programme for Wales

– in the Senedd at 4:31 pm on 27 June 2023.

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Photo of David Rees David Rees Labour 4:31, 27 June 2023


Item 6 this afternoon is a statement by the Minister for Health and Social Services, a national immunisation programme for Wales. I call on the Minister, Eluned Morgan, to make the statement. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr, Dirprwy Lywydd. I'm really pleased today to update Members on the development of the national immunisation framework and the incredible work that has been going on in recent months to create a vaccination system for Wales that is fit for the future. According to the World Health Organization, vaccination is one of the best health investments money can buy and it helps to prevent up to 3 million deaths a year worldwide.

We all remember the joy and the relief that came with the COVID-19 vaccine. It's impossible to overstate the impact that vaccination programme has had on all our lives. But it's not over. Today, I'm delighted to report that the COVID-19 spring booster programme will end this week. It has delivered well over 0.25 million vaccinations. The spring programme came hot on the heels of the winter respiratory vaccination programme, which ran from last September until 31 March. So, what that means is that for 10 consecutive months we've been offering the protection of COVID-19 vaccination to the most vulnerable in our communities, and this was the third consecutive year our NHS delivered a COVID programme as well as the flu programme, at pace and under pressure. Over 12 million doses of COVID-19 and flu vaccination have been administered to the people of Wales since 2020, in a population of just over 3 million people. This is something we could never have envisaged before the pandemic, and I’d like to express my sincere thanks to everyone involved.

Critical to the success of the programme has been the engagement of the public in coming forward for their vaccines. I’m so grateful to people for that, but we cannot and we must not take that engagement for granted.

It was the huge success of the COVID-19 vaccination programme that set us on the journey of reform that is described in the national immunisation framework. I want Wales to have a world-leading approach to vaccinations that ensures that, at every stage of life, our citizens are protected from diseases that could lead to serious illness or death. But I must be clear: a one-size-fits-all approach will never be suitable for vaccinations. That said, our ambition is to create a system where a national approach is adopted when and where appropriate. This will be a system that has a relentless focus on removing inequities to ensure that every citizen enjoys the health protection benefits provided by our vaccination programmes.

To develop the system I describe, I've provided the NHS Executive with funding to establish a team to oversee the operational delivery of all vaccination programmes. The new system has partnership working at its heart. The speed with which we established our mpox vaccination programme in response to last year’s outbreak is an example of how our transformed system can deliver quickly for the people of Wales.

A core aim of the national immunisation framework is to develop the digital infrastructure needed to deliver an effective and efficient vaccination system that works seamlessly for practitioners and for patients alike. This work will be crucial to the successful delivery of the framework, and, I must be frank with you, we have a long way to go. But I'm pleased to say that discovery work is well under way, and I expect to see plans for how this work can be progressed very soon. 

Using the learning from the pandemic, and acknowledging the level of risk currently held by general practice for the current model of flu vaccine procurement, I have made a commitment to introduce a centralised procurement model. Again, this is going to be a complex piece of work, which will be developed and delivered in partnership, but I'm hopeful it will be possible to introduce the new model in time for the 2025 flu season.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:36, 27 June 2023


Ensuring equitable access to vaccination is a key priority that underpins every aspect of the national immunisation framework. All health boards are developing plans to deliver the ambition of reducing and eventually eliminating the inequalities that currently exist, ensuring that everyone has equal access and opportunity to receive their vaccinations.

The pandemic caused disruption to our vaccination programmes, particularly those delivered in schools. I'm really pleased to see catch-up programmes in place and significant progress being made to ensure that children and young people who missed crucial vaccinations while we were living with restrictions can get them now.

While I'm sure that Members will agree there is much to celebrate, I'm keenly aware that the pandemic also saw an exponential rise in vaccine misinformation and disinformation. We will continue to work with NHS organisations to ensure that clear, accurate and trustworthy information about our vaccination programmes is easily accessible to all.

But I'd like to take this opportunity now to share with you changes that will be introduced to some of our vaccination programmes later this year. Recently, I have accepted advice from the Joint Committee on Vaccination and Immunisation that recommends that the vaccination schedule for human papillomavirus changes from two doses to one; that's the HPV virus. The committee saw compelling evidence that showed that a single dose of HPV vaccine provides good and long-lasting protection when offered in early adolescence. The HPV vaccine protects against head and neck cancers as well as cervical cancer. Studies have shown an almost 90 per cent reduction in cervical cancer cases among vaccinated groups. The change to the schedule will be implemented in the coming academic year.

We are also gearing up for a significant change to the shingles vaccination programme. Who knows what 'yr eryr' is? [Interruption.] Oh, 10 out of 10. Yes, it's shingles. There is a new vaccine available, and there will be a wider age range eligible for the vaccine. Shingles, or yr eryr, can cause severe illness, particularly in older people. One in every 1,000 cases can be fatal. By vaccinating people to prevent them from contracting the virus we are protecting individuals and protecting the health service.

For the first time ever, the structures put in place by the national immunisation framework will enable these changes to be introduced seamlessly, while other routine programmes continue and the winter respiratory vaccination programme for 2023 is delivered.

Once again, I would like to thank everyone involved in planning and delivering our vaccination programmes. The work that our vaccination teams do is incredible and ensures that the people of Wales can access the best possible protection from disease. I'm grateful to the NHS for embracing the changes introduced by the national immunisation framework and for helping to create sustainable vaccination services, benefitting individuals and our communities and supporting the resilience of our NHS. Thank you. 

Photo of Russell George Russell George Conservative 4:40, 27 June 2023

Can I thank the Minister for her statement this afternoon? I don't think there's an awful lot to disagree with. I'm very supportive of much of what the Minister has said this afternoon. I remember—. The Minister talked about the joy when the vaccination was developed, and, of course, we were particularly good in the UK and Wales in rolling out the vaccination at pace as well, which had so much of an impact on getting us back to normality again. 

Minister, you talked about the spring booster programme coming to a close this week and that you delivered 0.25 million vaccinations, but I suppose the question there is to assess how successful the programme was over the spring period. Can you tell us how many people were eligible for the vaccination or give us a percentage in terms of uptake? 

Of course, I understand there was a step down of funding for vaccination centres. I understand why that was the case—that was the correct approach, to redirect funding elsewhere—but what that has meant is that people, often, in rural areas are travelling a lot further, those who are eligible, for their COVID vaccinations than previously— people perhaps travelling over an hour. So, can you help us to understand a little bit about—? GP surgeries, yes, they're offering what we refer to as the flu jab, but, yes, people are travelling over an hour away for their vaccination for COVID, so perhaps tell us a little bit about how you feel that you can incentivise or encourage GP practices to take up offering the COVID vaccination as well.

Minister, you talk about the centralised waiting list—sorry, centralised procurement model—so, I'm listening to that with interest as well. I think you talked about that last year, and at the time you were talking about it possibly being ready for 2023-24, but it now looks like 2025. You talk about a piece of work that's complex, so perhaps it would be worth just expanding on what is complex about that work. I can imagine it is, but perhaps you can outline that to us. And also what are the benefits of a centralised procurement model? I can accept that there will be benefits, but perhaps you can outline what they are over the current system, and are there any disbenefits that you foresee in terms of a centralised procurement model? I know that the British Medical Association in Wales have previously raised some concerns about a move to a centralised procurement system, because they're concerned that GP practices could be less well funded and that could have implications for reinvesting in other services. So, can you just confirm that you are having discussions with BMA Wales about this?

You also, Minister, talk about misinformation about the vaccine. Misinformation, I agree with you, is very dangerous, when we see a lot of this information that's posted, and perhaps you could just outline—. You talk about, in your statement, how you're going to work with NHS organisations to ensure that there is clear and accurate and trustworthy information about, but how are you going to do that, or how are the NHS organisations that you talked about going to achieve that?

You've also talked about the vaccination programmes that were under way before COVID in terms of the general vaccination programmes, delivered particularly in schools as well. So, you talked about the catch-up programmes. To what extent has Wales caught up, and to what extent are vaccinations, compared to pre COVID, now taking place? Have we seen an uptake? What's the analysis? Is there a feeling that there's more uptake in general vaccinations, or a decrease? Perhaps it would be good to get some sense around some of those issues as well. I think that covers my questions. Thank you, Minister.  

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:44, 27 June 2023

Thanks very much. So, I can give you some details on the situation in relation to the spring booster in terms of figures. So, what we've had is the delivery of 277,000 booster vaccinations—that was up til 22 June—and that includes about 76 per cent of care home residents, and 71 per cent of people over the age of 75. What’s really good is that we have achieved that offer of a vaccine to 100 per cent of those eligible people, so it was there for them if they wanted it. They’re not bad figures. What we have found is that, every time we offer this, it goes down slightly. That seems to be the case across the rest of the United Kingdom. So, we’ve got to get the balance right, and we can’t do this without the public. There’s a danger of vaccination fatigue, so we’ve still got to keep this going, because it is the best protection for the individual and the NHS, so that’s why I think this new approach is so critical.

You asked about the one size fits all. Well, what’s clear is what’s right, perhaps, in a built-up urban area may be very different from a rural area, and that’s why there’s a recognition that it’s not right to have a one size fits all. Local health boards may want to respond differently, local communities may want to respond differently, and what we have, for example, with GPs, is that it’s up to GPs to what extent they want to get involved, and certainly what we do in relation to flu vaccinations is there’s an incentive for GPs to administer the flu vaccination. As far as possible, I think there are real opportunities here to co-deliver flu and COVID, but some of this will depend on timing and how we maximise the timing of the administration of the vaccine, so that we protect people at the time when the protection is most needed. There’s quite a lot of detail to work out here, and the logistics are not easy. That’s why we’ve got a really crack team on this who've really understood—they learned such a lot during the pandemic, and they’re now driving that through the whole vaccination system. So, that’s good.

Then the centralised procurement model: I think, again, what we learned from the COVID pandemic was that, actually, procuring that centrally meant that we knew exactly what was going on, who had the vaccinations, who didn’t have them, and we could work the system around that. The issue with flu vaccinations is quite often they’re procured by the GPs themselves, and sometimes they under-procure, and they have to come and ask us centrally to make up for it. So, we know we can do it now centrally. We’ve got a lot of faith and confidence in that system, and the point is that all of this is being done in partnership. It’s not being done to people; it’s being done with people, at all levels of government.

On misinformation, a key part of this is the digital shift that is going to happen. We’ve now got the NHS app, there’ll be an opportunity for people to see what vaccinations they had on the app, and there are real opportunities around that. I think having the safety of an NHS app that can be relied on, which has taken—. People keep asking me, ‘Why has it taken so long, this app?’ and I’ve been asking that, I can tell you—I’ve been asking that question as well. And some of it is because people need to be absolutely sure that they can rely on this, and that whatever they see on that app is reliable. So, that is a source of information for the future where people can go where they won’t be misinformed.

And just in terms of catch-up programmes, well, we’re doing much better on the catch-up programmes there are. I think if you look at the routine immunisations, we’ve got the six-in-one vaccine that children have when they’re very young, protecting against diphtheria, tetanus, whooping cough, polio, flu type B, hepatitis B—there’s a whole list here. What I’ll do, if you don’t mind, is I’ll get some information sent to you, so you get a sense of where we’re at on that catch-up programme.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:49, 27 June 2023


Thank you to the Minister for her statement, and for giving us sight of it beforehand. This announcement is to be welcomed, and of course it is important to ensure that as many people as possible are vaccinated here in Wales. It is an undeniable fact that vaccination and immunisation have saved and do save millions of lives across decades.

Now, the statement refers to misinformation that is being shared about COVID vaccinations, whilst we also know about misinformation about MMR vaccines too, and it's surprising how many people continue to be doubtful of flu jabs, even. You mentioned one way that you hoped to roll out a broader understanding, and that was by use of an app. Of course, with Rhun ap Iorwerth and Mabon ap Gwynfor, you could turn to Plaid Cymru for information on apps. [Laughter.] But I wonder how you will ensure that people download the app. And how will you tackle things like The Light paper that provides disgusting misinformation across the country, and how do you ensure that mainstream news learns of these important things and the importance of vaccination, as well as encouraging people to use the apps? How are we going to get that information to permeate through to the public?

The Minister will be aware of GPs' concerns about the proposal to centralise procurement. Russ mentioned the concerns of the BMA about this too. Their concerns, of course, are their inability to negotiate their own prices for vaccinations. When similar plans were introduced in Scotland, the Government there provided £5 million in order to support GP practices so that they could convert to the centralised system. So, whilst the Minister's statement mentions funding the NHS to establish a team to oversee the delivery of vaccination programmes, there's no talk about how much money or what kind of support and what kind of budget will be available for GPs to help them in the process of transitioning to the new system. So, I wonder if the Minister could expand on how GPs will be supported to cope with the transition to this new central procurement system and follow the example of Scotland.

Last year, when Plaid Cymru asked the Minister about financial support for GPs if this Government were to adopt a central vaccination procurement system, the Minister mentioned at that time that there were examples of GPs not ordering enough vaccines, and the Government having to step in. The Minister mentioned that in her response to Russell George a little while ago. But the BMA's Welsh council isn't aware of any significant shortages in the procurement of vaccinations by GPs. I do note, however, the recent advice of the Minister to GPs not to procure flu vaccinations for people aged between 50 and 64 this winter. We have to bear in mind that if there were to be a change in the Minister's thinking on this issue now, then there would be a shortage of flu jabs this year as a result of that advice. So, can the Minister provide some detail as to how many GPs she's aware of that have under-procured vaccinations in the past, and also acknowledge that if there is a shortage in flu vaccinations this winter, that that will be as a result of her own advice rather than anything else?

The Minister also referred to digital infrastructure, and it's good to see this at the heart of the framework that is being introduced today. This will be an important development, not only that modern technology can enable better order, but it's also extremely important in ensuring that patients get the right vaccinations. But I've mentioned in this Chamber previously about the different computer systems being used within the NHS in Wales. So, will the Minister expand on this new digital system and give us an assurance that this new system won't be held up amidst the complexity of all the different digital systems currently being used in the NHS, and that it will work seamlessly, as they say, with other digital systems in the NHS? Thank you.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:54, 27 June 2023


Thank you very much. I want to thank you not only for the joke, that was quite good, fair play to you, but also for the fact that you know what shingles is in Welsh. That was fairly impressive, I have to say.

In terms of misinformation, I do think that this is a serious subject. It does affect people, some people listen to the nonsense they see online in particular. That's why it's important that people can go to websites and other places where they can have confidence that the information that they are getting is factual, scientific information that they can rely on. That's why I think there is a prominent role, not only for the app, but also for the NHS locally in ensuring that people have that confidence. People still have a lot of confidence in the NHS and the people who lead the NHS.

So, in terms of the centralisation of procurement, it's clear to me that if you are going to negotiate a price, you're going to have a better price if you're negotiating for 3.1 million people compared with 30,000 people. So, it makes sense for many reasons. But this isn't just about money. What we've learned from the pandemic is that we had someone in the Welsh Government who knew exactly how many vials were available in every part of Wales, and having that overview meant that we could move things around the system when we needed to do that. So, I do see that that does mean that you take some power away from the local GPs, but I think that the provision on the whole for Wales, well, it does make sense for us to follow that path.

In terms of the flu and what's happening next year, what we know is that people, for example, who are over 50 years of age and under 65, that the risk of contracting flu is less, or that the impact of the flu on them will be lower. Evidently, money is tight at the present, and we have to consider these things, and we have to ensure that we do get value for money. If there was more funding, then we would come to a different decision, but what we do know is that we have to focus the support that we provide on those who are most vulnerable.

Regarding the digital infrastructure, we are doing a lot to transform our digital systems in the NHS. I'd like to do a lot more if I had more funding. I think it's an area where we would get great value for money, but there are problems, evidently, in financial terms at present, so what we're trying to do is ensure that the computer systems are in place, and our digital team is spending a lot of time ensuring that that is in the right place.

Photo of Joyce Watson Joyce Watson Labour

Diolch, Dirprwy Lywydd. I want to thank you, Minister, for your statement today, and I'm going to focus my contribution, my whole minute, on the human papillomavirus, the HPV vaccine. We know that it protects against cancers caused by HPV, including nearly all cervical cancers. HPV is an extremely common viral infection, and it's been estimated that 80 per cent of people will be infected by this virus at some point in their lifetime. For most people, that won't have a major impact on their health, but for some, it can have devastating consequences, and results in HPV-related cancers, like cervical cancer, show us that this vaccine will prevent—and probably has prevented—many deaths, going forward. I'm pleased to see that you're going down to one dose, because it might help facilitate uptake, which you've mentioned has dropped since the COVID pandemic.

I want to focus also on the equality of access to this vaccine, because it's offered in all schools in all areas of Wales, and there is again evidence that demonstrates quite clearly that people from areas where there are significant levels of deprivation are also found to have higher levels of cervical cancer within those areas. So, that equality of access to the vaccine is absolutely critical.

And finally from me, I'm going to ask what you're doing as a Government to inform people, young people and their parents, about the advantage of the uptake in the offer of the vaccine, because again, there's been an awful lot of stigma surrounding this particular vaccine, and some parents perhaps aren't aware of the advantages and, therefore, are not passing that on to the young people.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 5:00, 27 June 2023

Diolch yn fawr, Joyce Watson. You're absolutely right—I think it makes sense also for us just to focus a little while on the situation in relation to HPV. As you've suggested, at the moment we give it in two doses, but expert advice from both the WHO and from the JCVI has suggested that you get the same level of protection if you give it to a young person as you do if you give two doses, so we're following that expert advice. That means all girls aged 12 to 13 are offered that, and boys, obviously. What we've found is that the uptake of the first offer is about 82 per cent, but the second one is around about 70 per cent. So, we'll hit the target, and we've just got to bear that in mind, but that still leaves—and I think this addresses your equality issue—quite a few people. It's almost 20 per cent who are not protected. What we've learnt during the pandemic is that you really have to chase these people down, really make sure that they feel like they've got access, that they get the information they need, and we've developed a degree of expertise around that, about how to reach out to those communities that are traditionally more difficult to get to. What we know is that if it is given to girls and boys who are 12 and 13, you are less likely—. There's 87 per cent less of a chance that you're going to get cervical cancer in your 20s compared to people who are unvaccinated. That's the thing to sell, that actually the evidence supports it; if you want to protect yourself, this is what you do. But, again, we've got to make sure we get that evidence out there and get that communication right.