6. Statement by the Cabinet Secretary for Health and Social Care: National Immunisation Framework for Wales

– in the Senedd at 4:48 pm on 21 May 2024.

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Photo of David Rees David Rees Labour 4:48, 21 May 2024

(Translated)

Item 6 is next, therefore, a statement by the Cabinet Secretary for Health and Social Care on the national immunisation framework for Wales. I call on the Cabinet Secretary, Eluned Morgan.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr, Dirprwy Lywydd. It's just over 18 months since I launched the national immunisation framework for Wales, and I'm pleased to be able to provide an update about the progress we've made and to share some of the plans we have for the rest of this year.

I want to start by saying that vaccination is one of the safest and most effective ways of preventing the spread of, and protecting people from contracting, potentially life-threatening diseases. Vaccines are part of the arsenal we have at our fingertips to fight illnesses and diseases—illnesses that have previously killed tens of thousands of people every year in the UK, let alone worldwide. We have successfully eradicated smallpox globally, thanks to the heroic efforts of teams around the world to vaccinate whole populations, and we are well on our way to wiping out other deadly diseases.

We all saw how effective vaccination was during the pandemic. The COVID vaccine has saved thousands of lives and prevented even more cases of serious illness. Our experience delivering the COVID vaccine led to the development of the national immunisation framework for Wales. Just over a year ago, we created a national vaccination team in the new NHS Wales Executive. The team is providing national support and performance management, while also ensuring health boards have flexibility to deliver vaccination programmes in the way that works most effectively for their local population.

Our commitment to ensuring equitable access to vaccination for every citizen in Wales remains a core priority. The pandemic brought into sharp focus the serious health implications vaccine inequity can cause. It was inspiring to see the advances made in tackling inequities by removing barriers and reaching into and working with communities. Maintaining that momentum has been challenging post pandemic, and we have seen a reduction in uptake in some vaccines, with some very worrying consequences. But I am absolutely clear that we must maintain momentum to reduce inequities where they exist and to improve uptake where it has dipped.

The national immunisation framework set a requirement for health boards to develop vaccination equity strategies to clearly set out ways inequities are being actively reduced.  This work is being prioritised and I look forward to seeing the real-world impacts. Closely aligned to our commitment to equity is the commitment in the framework to improved vaccine literacy. Public Health Wales will publish a vaccine literacy strategy, which will help to improve public understanding and awareness of vaccines and support informed decision making. Ultimately, this will help to maximise vaccination uptake.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:51, 21 May 2024

(Translated)

And at its heart, that is what the national immunisation framework is all about: maximising uptake across all our vaccination programmes. It’s sometimes easy to forget just how many dangerous and potentially life-limiting and life-threatening diseases we vaccinate against in Wales. Even before a baby is born, the mother will have been offered a number of vaccines to protect their baby in the first days and weeks of life. One of those is a vaccination against whooping cough. I am very concerned about the increase in the number of cases this year. Last week, it was reported that five babies in England had died from whooping cough this year. Fortunately, there have been no deaths in Wales to date, but this tragic news should act as a warning to all of us. I appeal to pregnant women in Wales to please come forward to have this very safe and effective vaccination.  

Over the past year, we’ve also seen a significant resurgence in cases of measles around the world. Last autumn, there was an outbreak in Cardiff and the Vale of Glamorgan. We are currently dealing with another case in the Aneurin Bevan University Health Board area. It is hugely disappointing to see the return of measles outbreaks in Wales. With several sustained outbreaks over the border, the risk here remains high. It is therefore vital that we take action to improve protection against this serious illness. In February, the Chief Medical Officer for Wales wrote to health boards asking them to ensure 90 per cent of learners in schools were fully vaccinated by the end of July. I realise the amount of work this involves for our immunisation teams and school nurses, and I would like to offer my sincere thanks to everyone engaged in this catch-up effort.

Dirprwy Lywydd, I now want to turn to the next steps in the framework. Members will be aware that the development of digital solutions to support vaccination in Wales has been an important milestone. I asked Digital Health and Care Wales to undertake digital discovery work to considedr the way forward. I’m pleased to say that work has been completed and next steps to move to the implementation phase are now being considered. I want to thank everyone involved in this important piece of work. Our seasonal vaccination programmes continue to offer important protection to vulnerable people, and to the health and care services. The COVID-19 spring booster programme is currently in full swing, and the winter respiratory programme delivered more than 1.7 million COVID and flu vaccines. 

The national immunisation framework sets out our ambition to move to a centralised model for the procurement of flu vaccine. This would remove the burden of procurement from general practitioners and pharmacists, and create a more flexible system to support the wider ambitions of the framework. Significant progress has been made, and I hope to be in a position to give more details about this in the coming months. Finally, I just want to say what a privilege it was to address the Welsh immunisation conference last month. It was fantastic to witness the energy, passion and commitment to developing a world-leading vaccination service. My sincere thanks go to everyone involved in delivering this valuable service to the people of Wales.

Photo of Sam Rowlands Sam Rowlands Conservative 4:56, 21 May 2024

Thank you, Cabinet Secretary, for today's statement on the national immunisation framework for Wales. Let me also join you, Cabinet Secretary, in saying that the importance of that effective immunisation programme is an absolute must for any nation. Of course, it serves to protect everyone in our society, but particularly those who are at vulnerable points in life, such as children, infants and pregnant women. As such, it's so important that people get the vaccines that are relevant to them at the time that they can, because, of course, it protects them and it protects others as well. 

You mentioned in your statement, Cabinet Secretary, the good news we know of the global eradication of smallpox. Other examples of diseases that have been tackled spring to mind as well, such as diphtheria and tetanus, both having been reduced dramatically due to vaccination programmes rolled out across the UK in the 1940s and 1960s respectively. It's so important that those cases are understood and tracked, and the important work of the framework in doing that as well. 

We also have to recognise that this isn't the case in every country around the world, and it shows the importance of both the effective vaccinations, and also having a population that trusts the process to take the vaccine to protect them as well. I think we all have a role to play as politicians in encouraging take-up of vaccines to our constituents when they are available. 

On the national immunisation framework that you referenced, of course, a statement relating to that was published in 2022, and I've got a few questions. The first is in relation to the role of the framework as it assigns responsibility for implementation to the NHS Wales delivery unit, and the oversight of that, of course, is with the Welsh Government and the Cabinet Secretary. I'm just interested to understand how satisfied you are that the delivery unit is working and that, as the Welsh Government, you have sufficient grip of the situation and governance in place to take a lead if things aren't working as they should. I understand you are interested in governance structures at the moment; I'd be interested in that area, in particular. 

You rightly referenced the COVID-19 response in your statement, and I certainly join you in commending the efforts of all those involved in the roll-out of that important vaccine. We also know that these bacterial infections and illnesses don't stop at borders or administrative boundaries, so I'd like to understand a bit more about how you're working with other bodies, such as colleagues at UK Government level and local authority level, to ensure we maximise that immunisation take-up, and also have a response in place if and when we have further outbreaks or global pandemic levels as well. 

Thank you today for referencing whooping cough and the work that's been undertaken to look to reduce those numbers. I'm really concerned about the rise in those cases, and I certainly concur with your message that pregnant women should come forward for that vaccination if they haven't had it already, to try and stop and reduce any potential harm. So, I join you in that.

I also want to reference your highlighting of the importance of vaccination for measles as well, which, as you've shown, is unfortunately on the increase both here in the UK and around the world. That, of course, can be prevented with the MMR vaccine. You mentioned in your statement, Cabinet Secretary, the 90 per cent figure of schoolchildren looking to be vaccinated by the end of July; that's certainly welcome. But I'd like to know how likely you think that figure is to be met, and what work you're doing to make sure children who aren't in traditional school settings, such as those who are perhaps in home education, are able to access these vaccines as well.

So, I just want to close by certainly welcoming also the digital work being undertaken to support the improvement in vaccine take-up. I think it's a really important area of work, making sure that systems and programmes are talking to each other between primary care and into our hospitals as well. I also want to join you in recognising the role that, again, we all play, in ensuring that our constituents are aware of the importance of taking those vaccines, when they're available, to reduce the risks to themselves and to others as well. Diolch yn fawr iawn.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 5:00, 21 May 2024

Thanks very much, and I think it's good to recognise—and thank you for recognising—the fact that, actually, this is probably the most cost-effective public health tool we have. This is what saves us money, so it's definitely an investment—not just here, obviously, but across the world. And it's good to see that that is increasing across the world, and even things like malaria now, there are examples of where that's moving on.

I think one of your questions was about the delivery unit and how that's working and, obviously, this is now sitting in the NHS Wales Executive. This is an area and a group that I have real confidence in. I think they are delivering really well, developing a real cross-nation approach, just making sure that they've got that focus, making sure that the kind of postcode lottery situation is not something that arises. So, having that overall structure within the NHS executive is actually really useful. I think this particular group—you know, they learnt their trade during the pandemic. These are people who've been tested, they know what they're doing, they're absolutely on top of it. There are other parts I'm not quite so confident in, but this is a group that I'm absolutely sure are doing very well. And, obviously, I'll be looking forward to publishing the governance and accountability group's report very soon.

In terms of working with the UK Government, one of the things we do is to work very closely and take recommendations from the Joint Committee on Vaccination and Immunisation, and where possible, because of some of the misinformation that's around, we try and do that on a four-nations basis, and I think that, I hope, will give more confidence to people to take up the opportunity. And, yes, we are confident that we have the ability to build up the capacity very quickly in future, if we have another kind of pandemic. So, we've tried to make sure that that capacity is in place.

I'm very worried about whooping cough, as you say, but it is also part of a cycle, so it does come around every, I think, four of five years. So, it does happen, but, obviously, that's more of a reason to get people, to make sure that they are covered and they're having their vaccinations. That target for MMR reaching 90 per cent by the end of July, Public Health Wales has said, by about December, it was up to 89 per cent. But the problem is we're worried about equity. So, what you might have is in some areas, it'll be up to 95 per cent, and in other areas it'll be a lot lower. So, equity for us is really, really key, and making sure that we do that outreach work into perhaps those schools that may have seen a lower uptake. So, it's not just about hitting the 90 per cent, it's about making sure there's a minimum of 90 per cent everywhere, if possible—that's got to be our goal, if we can. So, I hope that's given you some answers to those questions. Diolch.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:04, 21 May 2024

We know that, since the Cabinet Secretary's previous statement on the national immunisation framework last year, issues around misinformation have contributed to ongoing vaccine hesitancy, which in turn have contributed to dangerous and entirely preventable outbreaks of measles. In England and Wales, there were 1,603 suspected cases of measles in 2023, an increase from 735 in 2022, and just 360 the year before. Last year we asked how use of an app would help to combat the spread of misinformation about vaccinations. The Minister—the now Cabinet Secretary—responded:

'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, my questions are, given the role that the spread of misinformation is continuing to have in promoting vaccine hesitancy, does the Cabinet Secretary agree that more needs to be done than providing information via an NHS website alone? Does the Cabinet Secretary agree that there is an urgent need for a cross-departmental approach to combating disinformation and misinformation, including about vaccines, and what conversations is she having or will she be having with her ministerial colleagues about this? And does the Cabinet Secretary agree that without the devolution of powers over broadcasting in particular it will be harder to counter the spread of misinformation?

Moving on to digital infrastructure, I'm concerned that developing the digital infrastructure is a painfully slow process and we need to see greater impetus on this front. Last year we also asked how the digital infrastructure would underpin and help to deliver the framework, and how this would interact with the multiple computer systems already being used in the NHS in Wales. The Minister responded, and I quote again:

'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.'

So, can the Cabinet Secretary provide an update on, and/or more specific information about the development of relevant IT systems? What progress has been made on integrating these with existing systems, and what work has been undertaken to streamline and simplify these systems? Diolch yn fawr iawn.

(Translated)

The Llywydd took the Chair.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 5:07, 21 May 2024

Diolch yn fawr, Mabon. You're quite right, I think misinformation is something we should all be very worried about and having people being able to have access to secure advice where they can have assurance is important. That's why I think Public Health Wales has a really key role to play here, and obviously the JCVI as well. You're quite right that vaccine hesitancy, in particular in relation to MMR—what happened is that we know there was a blip when there was all that misinformation a few years ago, so there's a cohort of children that we're particularly worried about, and we would ask them to come forward, or at least to check their records just to make sure that they are covered, because it's not something that you want to get, and we are seeing these increasing cases. We've got cases—. We've seen cases in Aneurin Bevan, in Cardiff, and also now we've had a single case in north Wales.

You asked about cross-departmental work. Well, obviously, the vaccination is a school programme, so obviously there is a lot of work happening with education already.

In relation to broadcasting and whether a centralised and a Welsh controlled broadcasting authority, in some way, would be able to manage this, I mean, I think that's quite difficult because young people, for example, a lot of them, get their information from TikTok. Well, good luck if you think you're going to control TikTok. So, I just think we've got to be realistic about where we're able to influence.

Just in relation to your question on digital infrastructure, the national immunisation framework, it did set out an ambition to develop the digital infrastructure that's needed, and the whole point was that that was supposed to be a system that works for practitioners and patients. So, Digital Health and Care Wales was commissioned to review all the vaccination systems, to conduct a technical, digital discovery, and to provide options that would enable us to realise these ambitions. Now, what I can tell you is that that work has been concluded by DHCW and they've provided options for implementation of a programme of digital vaccination transformation. So, we're considering these options, and I am currently waiting for the advice on that. So, I think the digital changes do offer that opportunity that you were talking about—a single source of truth, that's what we'd like to see—and a complete and accurate vaccination record. I don't know about you, but if you ever try and go abroad, you have to try and find your vaccination record. It's always a trouble. We need to get modern. We need to get a digital system. So, I think no more paper vaccination records—that's where we need to get to. We're on course to move on towards that, and I'm just about to receive some advice on that. Diolch yn fawr.

Photo of Elin Jones Elin Jones Plaid Cymru 5:11, 21 May 2024

(Translated)

I thank the Cabinet Secretary for that statement.