Vaccination and Public Health

– in Westminster Hall at 11:00 am on 12th June 2019.

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Photo of Chris Green Chris Green Conservative, Bolton West 11:00 am, 12th June 2019

I beg to move,

That this House
has considered vaccination and public health.

It is a pleasure to serve under your chairmanship, Mr Davies, and a particular pleasure to participate in a debate on health with my near neighbour and hon. Friend Seema Kennedy for the first time in her new position as Minister.

Vaccination and public health is an immensely important area not only for the UK, but across the world, and vaccination has contributed so much to our public health. It is a pleasure to open this debate, following on from a Westminster Hall debate that I recently secured on clinical trials. It highlights the UK’s strength in the life sciences sector, not only in the companies and corporations involved, but in the importance of our medical research charities and the academics who work in the sector. In this area, we truly are a world leader.

Some of the concerns that I highlighted about clinical trials also feed into this debate. Fundamentally, it is about saving millions of lives every year, and with immunisation we can also eradicate diseases. The World Health Organisation declared in 1980 that it had eliminated smallpox, a terrible disease that killed a great many people and left survivors with terrible afflictions throughout their lives. I suppose the most famous example of a smallpox sufferer was Queen Elizabeth I.

In 1796—we were a little bit behind the Chinese; I think the first example of Chinese inoculation was about 1,000 years ago—Edward Jenner in Gloucestershire and others noticed that milkmaids caught cowpox, but milkmaids who caught cowpox did not catch smallpox. When that was identified, Edward Jenner inoculated James Phipps, the eight-year-old son of his gardener, and that inoculation protected James Phipps from smallpox. Since then, the World Health Organisation and health organisations around the world have targeted smallpox with such amazing success that the terrible disease has been defeated and eradicated.

Immunisation speaks to something that is increasingly important and increasingly recognised in the national health service: maintaining one’s health rather than having something go wrong and then repairing the damage. It is about asking, “What can we do to keep fit, keep active, avoid excesses in one regard or another and maintain our health?” It is so much cheaper, more effective and better for our standard of living to maintain our health than it is to lose our health and try to regain it. It is also immensely cost-effective; like all organisations, the national health service is under resource pressure, and, in terms of both direct and indirect costs, immunisation is reckoned to provide a saving of £13 for every £1 spent.

In the United Kingdom, we do well on immunisation. The population of the UK is well informed and well educated on immunisation, which leads to a high take-up of those vaccinations; but we cannot rest on our laurels. In 2017-18, there was a 91% take-up of the measles, mumps and rubella vaccination in England, the lowest since 2011-12.

It is reckoned that, in order to have herd immunity, an immunisation take-up rate of 95% is needed. A 95% uptake protects the remaining 5% of people who, for whatever reason, fall through the gaps, do not take the immunisation or perhaps move to the UK after missing the opportunity. England is falling behind the rest of the United Kingdom; in the rest of the UK, the take-up rate is 3% higher than it is in England, and it is important that we close that gap.

Media, and particularly social media, present a problem. When we look at the information that is available, we can see that it is easy for scare stories to develop in the media or to be perpetuated on social media. When stories or misleading ideas not backed by any evidence get out of hand and people buy into them, it is very important that they are challenged.

A sense of solidarity is also important. It is very difficult if a number of people think, “I am concerned about the risk of this immunisation, so I will rely on the 95% of other people to have their children immunised and I will be part of the 5% who are otherwise protected.” We cannot rely on everyone else to do the right thing, because the proportion of people who do not take up the immunisation may increase to more than 5%.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I congratulate my hon. Friend on securing this debate and calling out the frankly irresponsible behaviour of some in the anti-vaccination movement. Does he agree that it is particularly important that mothers get their children inoculated with the MMR vaccine, because otherwise they are potentially putting at risk not just their own children, but other mothers whom those children may come into contact with, who may develop measles, mumps or rubella—all of which can be very harmful to a developing foetus and to mothers in pregnancy?

Photo of Chris Green Chris Green Conservative, Bolton West

I wholeheartedly agree with my hon. Friend. When I was young, I had both chickenpox and measles. At that time, it was part of growing up, and many people who have had those diseases think, “It’s not a big thing; it’s not a big problem.” However, serious health outcomes or problems can develop from diseases that people may dismiss as not being terribly important. In that sense, solidarity is vital; we must all take responsibility not only for ourselves and our own families, but for the wider community.

Media and social media concerns are just one factor. There are a number of other barriers to achieving comprehensive vaccination. The World Health Organisation highlights vaccine hesitancy, and identifies three Cs: confidence, complacency and convenience. Is it convenient to have the vaccination? Are people confident or complacent about take-up, with a sense of, “I’ll be one of the 5%,” or, “It’s not really a problem in our society; the treatment isn’t actually dealing with a significant problem”? Or do people think that the disease has gone the way of smallpox and been effectively eradicated? That is not the case, especially given the ease with which people can travel across the world.

The UK is a leader in what we do here, but our support for countries around the world is also incredibly important. Support for funding the Department for International Development is often challenging, but I think there will be pretty much universal support for the announcement earlier this year of the £10 million to develop vaccines against global infectious diseases. That came on the back of the Ebola crisis in west Africa, where 11,000 people were killed, and it goes into a wider fund of £120 million committed to infectious diseases. The UK is the single largest contributor to GAVI, contributing a quarter of its funding and saving hundreds of thousands of lives around the world.

The UK also has an important role to play in co-ordinating and helping other countries. If another country does not have the health infrastructure that we have, they will need that support—that was the case in the Ebola example in west Africa—and we can lend our expertise. I reiterate that with flights from west Africa to the UK, Europe and the rest of the world, the transition of easily communicable diseases is a significant risk.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

It is great that the hon. Gentleman has secured the debate.

Photo of Geraint Davies Geraint Davies Labour/Co-operative, Swansea West

Order. According to the rules, Front-Bench spokespeople are not supposed to intervene in half-hour debates, but if Chris Green is happy to take that intervention, I will allow it. I just thought that I needed to put that on the record.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

As chair of the all-party parliamentary group on vaccinations for all, I was very disappointed that our debate in the Chamber sadly clashed with the local government elections and was therefore poorly supported. I welcome the hon. Gentleman’s comment on health systems. A huge amount of work has been done on eradication, but less than 10% of children have had their full World Health Organisation vaccinations. Thankfully, the big global players are beginning to see that it is about universal health coverage and routine vaccination.

Photo of Chris Green Chris Green Conservative, Bolton West

Absolutely; those comments are so important. I recognise the hon. Lady’s chairmanship of the all-party parliamentary group on vaccinations for all, which is a really important group.

There has been a slight decline in the UK in the take-up of vaccinations. Is the Minister concerned that recent healthcare reforms have inadvertently contributed to the decline in vaccination rates, as highlighted by the British Medical Association? The loss of care roles—such as primary care trust immunisation co-ordinators, who provide training as well as co-ordination—occurred as responsibility was moved away from primary care trusts.

Turning around the gradual decline in vaccination coverage is likely to involve the provision of more accessible services and more active outreach by health professionals into individual under-vaccinated communities; the wider provision of vaccination services, through things such as school visits by community nurses and mobile vaccination services; better training of health professionals on what vaccines are, what they do, how they work and what is in them, so that those professionals are ably equipped to answer parents’ questions; increasing public awareness of the benefits that vaccines confer and the danger that the return of vaccine-preventable diseases poses; provision of the right public health funding to enable vaccination services to function effectively, including by reaching under-vaccinated groups, which costs more than standard provision; and communicating with parents to improve their access to evidence-based information. By implementing some, if not all, of those ideas, we will help to address the difficulties that are leading to a fall in vaccination rates, and make a positive case for why immunisation is good for public health.

This debate is timely, given that NHS England is currently undertaking a review into GP-led vaccinations and immunisations. The review was first announced in January as part of the NHS long-term plan, but it began properly only in the last six weeks. The purpose of the review is to consider how screening and vaccination programmes could be designed to support the narrowing of health inequalities, as well as to reduce complexity, improve value and increase the impact of the current vaccination programmes delivered by general practices. That includes reducing the administrative burden on GPs by simplifying the system, addressing the anomalies in the system that directly incentivise some vaccines but not others, and looking at how we deal with outbreaks and catch-up programmes.

The review is a perfect opportunity to assess how each vaccine programme is performing and to address and improve underperforming programmes. There are also opportunities to streamline the system and introduce a consistent approach. For example, some programmes, such as flu and pneumococcal programmes, include call and recall measures to boost uptake, but that is not the case for other programmes, such as shingles.

Community pharmacies have a really important role, and they could make an important contribution to vaccination. They are a convenient way for people to address their healthcare and receive vaccination services, perhaps without the need for an appointment. Many community pharmacies in England already deliver the NHS flu vaccination service, which has proved popular among patients. Following that success, would it not be possible to provide a wider range of vaccines in that way? That would help people to remain healthy, and it would reduce GP’s workload and the wider pressure on the health service.

Community pharmacies are uniquely positioned to help the NHS to meet its immunisation targets in England, and to help to ensure that people in more deprived communities receive the vaccinations they need. In contrast to other healthcare settings, there is a greater density of pharmacies in the most deprived areas per head of the population, making pharmacies ideal for bridging the gap in areas where people face greater health inequalities.

I reiterate that the UK has a strong history of vaccinations, from being the country that invented the first ever vaccine to becoming a truly global player in creating a healthier world for everyone to live in. However, we must take stock of vaccination levels here at home, and we must not allow complacency or misinformation to reduce the level of immunisation. We must continue to strive for the highest levels of immunisation, so that our children continue to enjoy living in a healthy society free from disease. I thank the British Society for Immunology, Save the Children and the Pharmaceutical Services Negotiating Committee for their help. I am glad that we are having this important debate, and I look forward to hearing from the Minister.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care 11:17 am, 12th June 2019

It is a great pleasure to serve under your chairmanship, Mr Davies. I am pleased to stand before the House in recognition of one of our greatest achievements in health. I thank my hon. Friend Chris Green, my Lancashire neighbour, for tabling the debate. He is a great champion for his constituents and for raising science and health issues on to the parliamentary agenda.

Immunisation offers every child the chance of a healthy life, from their earliest beginnings and into old age. It saves millions of lives every year, and after clean water is the world’s most successful and cost-effective public health intervention. Our vaccination programmes are a cornerstone of the UK’s public health offer, and I know that all hon. Members here will join me in commending those involved in the delivery of our world-class vaccination programmes, which protect both individuals and all our communities. Our routine vaccination programme protects against 16 different diseases that, even today in developed countries, can cause serious long-term ill health, and even death, if not prevented.

The Government are committed to keeping vaccination uptake rates as high as possible. We constantly review ways to do that, and we are committed to ensuring that everyone eligible for vaccination takes up the offer. We should be proud that our routine vaccinations in England continue to have a high uptake, with more than 90% coverage for almost all childhood vaccines. That reflects the high levels of confidence that the vast majority of parents rightly have in our vaccination programmes.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

The levels are above 90% for the majority, but does the Minister accept that the WHO advice is that the figure should be 95%, for community safety? We have to tackle this drop of even a few per cent.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

I wholeheartedly agree with the hon. Lady, who brings to this place her great expertise from a career as a doctor. The Government have a commitment to reach the WHO target of 95%.

My hon. Friend Dr Poulter is no longer in his place, but he made an intervention. He referred to mothers, but I think that all parents—mothers and fathers—have a responsibility to ensure that their children are immunised. I urge parents who are thinking of getting the last rounds of MMR vaccines for their children to do so. In every classroom, there will be children who are immunosuppressed and unable to have those vaccinations, so it falls to all the rest of us, as parents, to ensure that our children have their vaccinations.

Evidence from Public Health England’s annual attitudinal surveys, which have been run since the early 1990s, shows that more than 90% of parents trust our vaccination programmes and most people automatically get their children vaccinated. Regrettably, there has been a small, steady decline in coverage since 2013. That is of concern. There are likely to be many factors contributing to it, not just a single one. We are not complacent and we know that we need to take action now to halt the decline. That is why I am so glad that my hon. Friend the Member for Bolton West sought this debate: it enables me to outline some of the measures that my Department is taking.

The Department of Health and Social Care leads on policy for immunisation in England, and officials are working very closely with Public Health England and NHS England to take steps to improve vaccination coverage and reverse the downward trend. That includes better national co-ordination of our vaccination programmes; making it easier for people to access vaccinations; making information readily available to parents and those needing vaccines; and better training for staff to enable them to answer questions that parents may have.

In addition, we have data systems to ensure accurate information on the immunisation status of children and young people, so that health professionals can provide a “catch-up” on any missed vaccinations. We will continue to improve those systems. For example, the Digital Child Health programme, which includes the development of a digital personal child health record, will create a system that allows parents and healthcare practitioners to access a child’s immunisation history, improving the ability to give immunisations at every opportunity.

NHS England is reviewing vaccinations in the context of the GP contract, to ensure that GPs are properly reimbursed for vaccinating their populations and that the right incentives for increased uptake rates are in place. That is set out in “The NHS Long Term Plan”, published in January of this year.

My hon. Friend the Member for Bolton West asked about community pharmacies and the very important role that they have to play in our primary care. I thank him for his suggestion. The Government recognise the value and importance of the services that community pharmacies provide. We want to see them working with primary care networks to encourage more people to use their local pharmacy to keep them healthy.

With regard to vaccinations, I am aware of the success, which my hon. Friend highlighted, of seasonal flu vaccines. Indeed, the number of seasonal flu vaccinations provided by pharmacies between September 2018 and March 2019 was more than 1.4 million. I had my seasonal flu vaccine in my local pharmacy in Penwortham. I am sure that my hon. Friend, as a very responsible parliamentarian, had one as well. His facial expression suggests otherwise; perhaps he will have one this September. I will write to him regarding his suggestion. NHS England is currently leading a review of GP vaccinations, and I would not want to pre-empt its findings.

It is very important that our vaccination programmes continue to evolve. They are constantly reviewed and updated to reflect the changing nature of infectious diseases, based on expert advice. The Government receive expert advice on vaccination programmes based on decisions from the independent Joint Committee on Vaccination and Immunisation. That includes advice on new and existing programmes and on which vaccines should be used. Recent examples of JCVI advice leading to improvements to our vaccination programmes include the extension of the seasonal flu immunisation programme to children and the extension of human papillomavirus vaccination to adolescent boys.

It is important to remember—the House will be aware of this—that if we do not continue to vaccinate, diseases that we rarely see in the UK at the moment will return. Examples of such diseases are diphtheria, measles, tetanus and polio. Vaccines are responsible for a substantial reduction in the number of those infections.

Let us cast our minds back to the early 1950s, when there were epidemics of polio infections, with symptoms ranging in severity from fever, to meningitis, to paralysis. At the time, there were as many as 8,000 annual notifications of infantile paralysis caused by polio in this country. Following the introduction of polio immunisation, the numbers of cases fell rapidly to very low levels. The last outbreak that started in the UK was in the late 1970s. Today, protection against that disease is included in our 6-in-1 vaccine, and owing to the success of the vaccination programmes, that disease and its effects are now rarely seen in the UK.

We should be very proud of our successes in the UK and of the public health benefits afforded by our immunisation programmes. However, as I hope I have made clear to hon. Members today, we are not complacent. We will continually seek to improve those services, seeking advice from experts and taking proactive action, to ensure that we have the best vaccination offer in order to protect the health of our nation.

Question put and agreed to.

Sitting suspended.