ITL #42 A shot in the arm against flu: using communications to boost participation in new vaccination programmes9 years, 5 months ago
Confidence in vaccination programmes is a fragile thing. What can be learnt from the UK’s plans to give the flu jab to healthy children? By Judith Moore.
As a chill returns to the air, the nights draw in and we begin the ever-lengthier countdown to the season of goodwill, the season of coughs and sneezes also kicks in across the northern hemisphere.
Each year, the first week of October marks the start of theseasonal flu campaign in England. The country’s 10,500 GP practices begin to reach out to almost 16 million people at higher risk of complications of flu to offer the vaccine for free. But this year they have an even bigger challenge on their hands as the vaccine programme is extended to include a new group – healthy children. Once fully up and running, the programme with be offered annually to an additional nine million children aged two until around their 17th birthday. It is also the first programme of its kind in the world.
Even moderate uptake could lead to a 40 per cent drop in flu cases – which would mean at least 11,000 fewer hospitalisations and around 2,000 fewer deaths a year. But the important question remains, will parents back the programme? And will other countries follow suit?
Collapse in confidence
Most countries recognise the challenge of introducing a new vaccination programme. And what happens if it derails. Following the MMR controversy, confidence in the UK programme collapsed. Vaccination levels plunged far below the levels needed to guard against outbreaks, and in some areas still haven’t recovered. Just last year, an outbreak of measles in Wales infected 1,200 people, hospitalised 80 and killed one.
In France, controversy around a Hepatitis B vaccine led the Government to stop mass inoculation of French 11- and 12-year olds in schools because of concern the shot might trigger neurological disorders. And when Sweden suspended vaccination against whooping cough from 1979 to 1996, 60 per cent of the country´s children contracted the potentially fatal disease before the age of ten.
The fickle world of confidence in a vaccines programme is illustrated by the difference in uptake rates of the cervical cancer jab. In the UK it remains at over 70 per cent, while in the States it lingers at around a third following concerns that it might encourage teenage promiscuity.
So what is the key to introducing a new vaccination programme? What can other countries learn from the UK’s plans to extend the flu vaccination to all children? And what can the UK do to guard against a collapse in confidence in the programme?
Vaccination programmes are always altruistic at some level. On an individual level, most people’s motivation to be vaccinated is to protect against a disease that may maim or kill. All vaccinations carry a miniscule risk of an adverse reaction. But the benefits of protection from disease far outweigh this. If enough of us accept this, then we reach herd immunity. It creates a firebreak or firewall so unvaccinated individuals – often the very young or those with compromised immune systems – are indirectly protected by vaccinated individuals.
For diseases like measles, which are very infectious, 95 per cent vaccine uptake is needed to prevent outbreaks. Achieving population-wide protection against seasonal flu is more complex. The virus is constantly evolving so yearly immunisation is needed and offered free to those most at risk. Targets on uptake are set by the World Health Organization and sit at 75 per cent. The UK, the Netherlands and a handful of other countries almost reach this target in those aged 65 and over but for most countries figures fall far short.
Children are particularly good at catching coughs and sneezes – and spreading them – but few healthy children die from flu. Extending the programme prevents deaths in their young siblings and grandparents. The biggest benefit by far is preventing illness in those at higher risk of complications in wider society such as those with asthma, those with heart disease or neurological conditions. But this doesn’t sit well with parents.
The benefit for the children themselves – and parents too ¬– is preventing large numbers of cases of less severe disease. Children are not only good at sharing their germs but they stay infectious for longer. Each year around 27.5 million working days are lost due to colds and flu and it is the common reason given for sickness absence. If other countries are to follow suit in extending their flu vaccine campaign, this is the kind of evidence that must be brought to the fore if parents are to be won over.
Playing it safe
Parents aren’t fond of unnecessarily sticking needles in the arms of their child. And if they do, safety is paramount. Current suggestions of a link between the swine flu vaccine in children and narcolepsy could seed worries in the minds of parents, damaging the credibility of the seasonal flu programme by association. The mere sniff of safety concerns and vaccine rates plunge.
Being guilty by association is never fun. Here the UK has been smart. It may be the first country to provide a free national programme but the vaccine of choice, Fluenz has been used in the States for a decade and has a strong safety profile. Fluenz also circumvents the needle issue by offering a nifty inhaled vaccine delivery mechanism. And by piloting the vaccines in a few areas and across restricted age groups, officials should be able to anticipate some of the teething problems ahead of a national roll out.
But what still needs to be addressed is the prevalent view in some circles – in every country – that flu is a mild illness. Flu can be a killer. Pandemics aside, in the winter of 1999 seasonal flu deaths in the UK reached 21,000 and even during average winters there are normally anywhere between 6,000 to 8,000 deaths. Globally the figure sits at between 250,000 and 500,000 deaths every year around the world.
Yet even those charged with taking the message to patients of the importance of immunisation aren’t protecting themselves. Last year less than half of frontline healthcare workers were vaccinated, and despite repeated attempts there has been little change in this figure. Neither have fellow countries cracked this group.
So, what makes people sit up and take notice? The answer is simple – perceived risk.
And this is where media can unwittingly take centre stage. In England over winter months, national weekly flu figures are published. A hike in numbers ¬– which often coincides with a lull in news over Christmas ¬– sends journalists hungry to fill airtime scurrying to write stories forecasting a national crisis and vaccine shortages. The news coverage sends the public to their GP in droves keen to get the vaccine. The challenge is how you create the demand, before the media creates the crisis. And once you create demand, how you maintain it? Sadly, successful vaccine campaigns are often a victim of their own success. The less people that experience a disease, the less they fear it and over time the more fearful they become of the vaccine.
The reality is, introducing a vaccine programme is never easy. The number of confounding factors or otherwise that determine success are boggling.
The UK vaccination programme is recognised as one of the most comprehensive in the world. The centralised vaccine programme and procurement plays a big factor in this. Taking it slowly and having a solid evidence base are critical. And have an independent expert committee that decides which vaccine programmes should be recommended is crucial – it builds trust with parents who don’t always fully trust Government and creates enough distance with ministers so that media generally avoid the temptation of miring a campaign in political mud.
But underpinning all of them is good communication with families, healthcare professionals and media. Lose the confidence of one of these groups and any programme will find itself in tricky water.
And, at the very least, if other countries follow suit and extend their flu programme to all children they can learn from the UK’s mistakes.
Thought Leader Profile
Judith Moore is a Director in the Healthcare practice of Burson-Marsteller, London. She joined from the Department of Health press office where she was the spokesperson for the Public Health Minister and Chief Medical Officer. There she led a team to deliver proactive and reactive communications across a portfolio of over 30 policies that top the news agenda on a daily basis including cancer, obesity, alcohol, smoking and immunisation.
Her achievements include playing a pivotal role in the UK’s response to the swine flu pandemic and delivering major national media campaigns including Change4Life and the quit smoking campaign Stoptober.
In previous roles in the university sector, Judith devised and delivered global media strategies to raise the research profile of world leading institutions including University College London and Imperial College London. She has a degree in Molecular Biology, BSc (Hon), from the University of Glasgow and a Masters in Science Communication from Imperial College London.
Judith Moore is a Director in the Healthcare practice of Burson-Marsteller, London. She joined from the Department of Health press office where she was the spokesperson for the Public Health Minister and Chief Medical Officer.mail the author
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