In the 18th Century, the English doctor and scientist Edward Jenner made a discovery that would go on to save millions of lives. He produced a vaccine that would prevent people from developing the deadly disease of smallpox, which then killed more children each year than any other disease.
Since that time, the UK has been a global leader in the development and deployment of vaccines against a multitude of life-limiting and life-threatening diseases. Despite this, public confidence in vaccination is worryingly low, especially for children, and the Covid pandemic has significantly strengthened the ‘anti-vax’ movement. The UK Government’s approach to how vaccination decisions are made, and why we differ from most other developed countries, need to be much more open and made clearer to the public if confidence is to grow.
Different countries have different vaccination programmes
It is perhaps surprising that western countries don’t all vaccinate their citizens the same way. The University of Oxford’s Vaccine Knowledge Project explains that this could be because of differences in the patterns and frequency of a disease in each country, the way that countries make decisions about which vaccines to offer to everyone, capacity of health systems to deliver new vaccines, cost and, somewhat unscientifically, ‘history and tradition’.
This results in some interesting and generally unknown, to the public at least, inconsistencies. For example, in the US and Canada, the flu vaccine is recommended for everyone over six months of age. In the UK, on the other hand, the programme is targeted to children over the age of two years (with relatively high take up), adults over 65 years, pregnant women and those with serious medical conditions. Some vaccines are not included in the UK’s routine programme but are routinely administered in other countries: for example, the chickenpox (varicella) vaccine.
The UK’s approach to covid vaccination of children is illogical
Of 28 countries in mainland Europe, all but two offer the vaccine to everyone over five, and three (Ireland, Germany and Greece) offer it to everyone over six months of age. In the USA, the vaccination is offered to those over six months via insurance and, in Australia, everyone from five years upwards is eligible.
In the UK, however, the picture for children is very confused. In the UK in 2022, all children aged five and over were offered two doses of the vaccine. Uptake was extremely low – less than 10% – and now universal eligibility has been revoked; currently in the UK only those children categorised as having certain ‘high risk’ conditions are entitled to vaccination. The question raised is: Why does nearly every Western country other than the UK offer a Covid vaccine to children?
The situation is inconsistent when compared to the strategy for flu vaccination in the UK. For the 2023/24 season, the nasal vaccine for flu is offered to all children aged 2-16. The primary rationale given by the Vaccine Knowledge Project is that there is “good evidence to show that vaccinating children against flu is a good way to reduce flu-related illness, GP visits, hospital admissions and deaths for the whole community”. So, we vaccinate against flu to protect children and the wider community, but we don’t do that for Covid, even though there are frequent reports of schools acting as ‘super-spreader’ sites for illness in children – why?
Does the UK’s approach make sense? And does it affect uptake?
Even if Covid and other vaccines were available for children in the UK, would parents choose to have their child vaccinated? The anti-vax movement is generally blamed for the lower than needed uptake of measles jabs, which is now resulting in fears of a measles epidemic, particularly in parts of London.
A survey of parents’ attitudes reported to the Joint Committee on Vaccination and Immunisation (JCVI) in February 2023’s minutes showed that 74% of parents considered that it was generally important for their children to be vaccinated. In the previous 2020 survey, 92% of parents indicated that they would automatically allow their children to receive vaccination, but in the 2022 survey this had decreased to 86%.
Maybe if parents were given more information on hospital admissions or deaths from particular diseases in an accessible form, they would feel better informed to make key decisions. While extensive data is published by the Office for National Statistics (ONS) you have to know where to look and to be able to penetrate the somewhat inaccessible content.
So, what do the data show?
Total under five years of age admissions per 100K population in 2023 – up to week ending 25 August.
Average hospital admission rates over the calendar year to date for each condition:
- RSV: 67.58
- Flu: 54.84
- Covid: 79.38
This is the latest available data from NOMIS (census service provided by the ONS). It is important to note that the cause of death relies on in-hospital testing and there is a view that these numbers, particularly flu, may be under-counted.
To the end of August 2023, more children have been admitted to hospital for Covid than for flu or RSV (respiratory syncytial virus), and the data available on the number of child deaths in the first two pandemic years shows much higher numbers from Covid than flu or RSV.
Very recently, the President of the Royal College of Paediatric and Child Health (RCPCH) has publicly shown her frustration at the slow progress in rolling out a programme for administering a vaccine for RSV, a condition that hospitalises thousands of children every winter. Dr Camilla Kingdon told The Independent, “We’re frustrated that if we had acted sooner, we might have at least reduced the extent of the impact this winter and we’ve missed an opportunity”.
So, we vaccinate children for flu and the RCPCH are urging the rollout of a vaccine for RSV, but the UK chooses not to vaccinate children for Covid, even though this might benefit the whole community– why? Why not make the data on the disease more transparent to parents? And why not offer parents a vaccine?
Decision – whose decision?
The UK Joint Committee on Vaccination and Immunisation (JCVI) advises our government on which vaccines are offered UK citizens, the population groups they will be offered to, and how they will be administered. While the JCVI publishes details of their meetings, the debate is certainly very opaque to the layperson and, more importantly, there is no accountability to parents and others as to why they recommend approaches different from our peer countries.
And what about the choice of vaccines? With new Covid variants emerging regularly, it is reasonable for the public to the latest, updated Covid vaccine, but that is not what those in the UK, unlike the USA, will be getting.
The JCVI statement on the Covid-19 vaccination programme for Autumn 2023 shows that the choice of vaccine products for Autumn 2023 has been determined based on factors including, as the public would expect, vaccine safety, effectiveness, logistical factors etc, but also on a bespoke cost-effectiveness assessment. This bespoke assessment included the fact that “there will be sufficient COVID-19 vaccine doses… pre-procured and available at no additional cost to complete the Autumn 2023 campaign”. So, in other words, it would appear that those eligible in the UK will be getting vaccines that are already in stock – last year’s vaccines.
Newer vaccines which were expected by the JCVI to offer similar protection (though not known at this time), would incur additional costs, so fared less favourably in the bespoke cost-effectiveness assessment and were not recommended. Did anyone tell people this?
Surely, it’s important for the public to know that an unexplained new cost benefit analysis has determined that, unlike other countries such as the USA – where manufacturers have rushed to produce an updated vaccine based on the latest variants for their Autum booster programme – we won’t get that here, as we’re going to use up old stock.
The Chair of the Health and Social Committee, Steve Brine MP, recently said “vaccination is the one of the greatest success stories when it comes to preventing infection. However, unless the Government addresses challenges around declining rates among childhood immunisations … the UK’s position as a global leader on vaccination risks being lost”.
The way to address this is surely to be clearer with people about the role of vaccines in protecting their health, to communicate more effectively about the incidence of disease and its impact on them and their children and be more open about how, why and what decisions are made on their behalf.