Sonia Saxena, Helen Skirrow

Child and adolescent public health (CAPH) section, EUPHA

Introduction

Initial declines in routine vaccination uptake¹ during the first few weeks of the COVID-19 pandemic led to timely action from public health and primary care in the United Kingdom (UK) and other countries in Europe. The response may have averted major outbreaks of infectious illness such as measles and diphtheria seen in some countries worldwide.² Following successful vaccination of adult populations during 2021, COVID-19 vaccines have also been offered to children aged 12-18 years in the UK. The focus of this article is on the coordinated action from public health and primary care agencies in the UK that contributed to continued delivery of routine vaccinations and the additional recent rollout of COVID-19 vaccines to children aged 12-18 years.

 How did the UK National Health Service maintain routine vaccination uptake in children?

Routine vaccinations in the UK declined during the first COVID-19 lockdown¹ even though the National Health Service (NHS) prioritised vaccinations as essential services.³ The UK government advised everyone to stay at home, physically distance themselves, and to protect the NHS so that providers and hospital beds would be available to treat patients with acute needs. Hence, many parents felt confused about the availability and safety of routine care for themselves and their children, including vaccinations.^4-6 For example, the number of measles, mumps and rubella vaccinations in England fell by nearly 20% in the initial weeks of lockdown.¹ However, the UK has population-based universal health coverage, and over 98% of infants living in the UK are entitled to access ‘cradle to grave’ health care, free at the point of delivery. This is supported by high-quality real-time digital public health surveillance using general practice electronic health records that enabled early detection of the initial falls in vaccination uptake due to the pandemic.⁷

 A communication campaign was therefore launched by key stakeholders involved in delivering and supporting the routine childhood vaccine programme, including the NHS, Public Health England, the Royal College of General Practitioners (GPs) and the Joint Committee on Vaccination and Immunisation who worked together to give clear guidance that routine childhood vaccinations must be prioritised.^{3 8}

 General practices in the UK continued to provide routine childhood vaccines while also introducing adaptations to reassure parents that it was safe to visit.⁹ One survey of 830 general practices found 97% were continuing to deliver childhood vaccines during the pandemic and that some had made service changes such as delivering vaccines outside.⁹ Routine childhood vaccine uptake in 2020 and 2021 remained lower than in 2019 but further decreases were prevented through rapid action in primary care to catch-up infants who had missed vaccinations,^{10 11} protecting children across their life course.¹² As long-standing trusted vaccine providers, general practices were able to reassure parents that they should continue to bring children in for vaccinations. Recommendations from trusted health care professionals such as GPs are a key driver in maintaining vaccine uptake.

 Trust in health care professionals and public health systems becomes even more important during a global pandemic when vaccines are the cornerstone of the response. Existing primary care infrastructures have facilitated the UK’s rapid COVID-19 vaccine roll-out.¹³ A new immunisation register (the National Immunisation Management System- NIMS) was also developed based on each person who is registered with a GP having a unique NHS number.¹⁴ This gave public health bodies access to real-time individual-level vaccine data and the capacity to rapidly estimate vaccine coverage.¹⁴ It also enabled individual GPs to check the COVID-19 vaccine status when seeing patients and to book COVID-19 vaccine appointments if needed.

 Three core pillars of the UK’s public health system worked together to deliver routine vaccinations and COVID-19 vaccines during the pandemic response (Table 1). Firstly, existing surveillance systems were able to rapidly detect declines in routine vaccine uptake. Secondly, effective communication to prioritise routine vaccines was provided by expert advisory bodies and by individual GPs to their patients that they should continue to come in and get vaccinated.  Finally, the UK’s strong, universal primary care system with longstanding expertise in vaccinations enabled a coordinated response between GPs and local public health teams to continue vaccine programmes. Children’s health in the UK has undoubtedly suffered due to COVID-19¹⁵ but the UK example highlights how all countries must now invest in strengthening universal primary care to promote child health in the next stage of the pandemic.

Table 1. Pillars connecting public health, primary care and the population during the pandemic response

References

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2. Rana MS, Alam MM, Ikram A, et al. Emergence of measles during the COVID-19 pandemic threatens Pakistan’s children and the wider region. Nature Medicine 2021;27(7):1127-28. doi: 10.1038/s41591-021-01430-6

3. RCGP. Royal College of General Practitioners Guidance on workload prioritisation during COVID-19. Version 8. 10 April 20. 2020

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8. JCVI. Independent report. Statement from JCVI on immunisation prioritisation Published 17 April 2020 [Available from: https://www.gov.uk/government/publications/jcvi-statement-on-immunisation-prioritisation/statement-from-jcvi-on-immunisation-prioritisation.

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