Just a few months ago, the World Health Organisation warned the UK is at risk of losing its measles elimination status. It is astounding to think we have reached this state given that it was only eight years ago that the UK first eliminated the disease.
Declining vaccine uptake in the UK has contributed to worsening health inequalities and localised outbreaks of entirely preventable diseases, such as measles and whooping cough. Yet local authorities – who know their populations better than anyone else – are not empowered to feed into vaccine strategy and commissioning.
During the COVID-19 outbreak, local directors of public health, local governments and community organisations worked together to promote the vaccines and encourage uptake. The results were impressive. The initial rollout and uptake were among the fastest and highest worldwide.
The Vaccine Champions programme, for example, enlisted volunteers to promote uptake in underserved and hard-to-reach communities.
In Hammersmith and Fulham, community champions disseminated translated, culturally appropriate materials to the population. This helped people to better understand the importance and possible risks of vaccination, leading to an increased uptake of vaccination. And in the borough of Newham, community champions encouraged high risk groups – homeless people, sex workers, undocumented residents – to get the vaccine by engaging in in casual conversations, working on vaccine busses and in one-stop wellbeing shops.
Engaging vulnerable people where they are and working with community leaders and local organisations to overcome low levels of trust is only possible when you have detailed knowledge of and engagement with your local population. Indeed, developing such locally sensitive strategies is only possible when you're part of that locality – you can't replicate that from Whitehall.
Yet now, vaccine strategy is predominately back in the hands of NHS England, and the knowledge and relationships held in local government is once again not being capitalised on. At the same time, health inequalities are increasing, vaccine uptake is falling, and potentially deadly yet totally preventable diseases are making a comeback.
At the beginning of the year 2,793 cases of whooping cough were confirmed, with five infant deaths tragically occurring. The West Midlands is suffering a measles outbreak, with new data noting that the region reported three quarters of all measles cases.
The evidence shows we are not getting one of the most basic elements of prevention – adequate levels of vaccination – right. Not only is this concerning in terms of immediate outcomes, but it will also increase the pressure on an already strained NHS.
The pandemic could not have demonstrated more clearly the vital role of local government – it was their unique insights and ability to collaborate that enabled the successful roll out of the vaccine to communities than even the NHS can find hard to reach.
As one interviewee for a new Reform Think Tank paper,The power of prevention: boosting vaccine uptake for better outcomes, put it, the key question is not ‘how should we build confidence in vaccines nationally?', but rather, ‘how do we get to the final 15%?' Directors of public health must be at the heart of this, and the new report identifies practical steps to achieving this.
Local directors of public health and regional NHS screening and immunisation teams should be working hand in glove to develop place sensitive approaches to rebuild trust and confidence in the power of vaccines, and crucially remind people of the invaluable benefits. This should involve physically co-locating relevant NHS staff in local government offices with directors of public health.
The report also calls for local directors of public health to be involved in creating an offer of workplace vaccination. Time can be a barrier to some people getting vaccinated, whether due to caring responsibilities, working more than than one job or regularly working night shifts. Working with employers, this approach should be targeted to areas of lowest uptakes and could be done by delivering vaccinations through mobile units on pre-arranged dates.
Government should also invest in existing Community Health Champions networks to develop their capacity and capability to deliver vaccine champions programmes, backed by funding from the Ministry of Housing, Communities and Local Government. This would enable tailored outreach to meet the specific needs of local communities. Volunteer networks should be invested in, working in collaboration with local authorities, to make the positive case for vaccinations and encourage uptake in communities most affected low confidence and falling uptake.
The knowledge local authorities have about their populations is unrivalled. And their track record of delivery on key matters of public health is strong.
If we are serious about reversing the worrying trends in vaccination uptake and boosting health outcomes, then policy must change to give those with the unique ability to deliver the power and funding to do so.
Kate Ardern is former director of public health for Wigan MBC and Florence Conway is a researcher for Reform
